di S.Lenti, L. Polenzani, S.Giovannoni, E. Messina
26 AGO –
Dear Director,
we believe that the SARS-CoV2 pandemic has dramatically highlighted the fragility and inhomogeneity of the NHS as a whole. The experience of the pandemic has shown how useful the acquisition of new skills in the technological field by General Practitioners (GPs) can be.
This has helped to strengthen the hypothesis of the implementation of the figure of the “expert doctor”, understood as a doctor with particular skills within Primary Care in a future organization of territorial assistance. However, it is in our opinion questionable that the need for a transfer to the teaching of General Medicine at the University derives from this.
The objective of the Specific Training Course in General Medina (CFSMG) cannot be to create “expert doctors”. We are more than sure that the training objectives of the CFSMG are to better prepare a general practitioner in all his complex identity.
The COVID phenomenon also tells us another story, not so much linked to the lack of expert doctors, but to the continuous and slow weakening of investments in the territory and at the same time the failure to create a territorial network capable of responding to the health needs of the population and last but not least, the lack of planning of the real needs of medical personnel.
Today the need for a General Medicine is strengthened which ensures, in addition to the treatment of diseases (CURE), the taking care of people (CARE), in a context characterized by continuity of care and relational centrality; a General Medicine that promotes health and guarantees the taking charge of chronicity and frailty, which represent the challenge to be faced if we want to continue to guarantee the universality of the right to treatment.
A Medicine centered on the person and his microcosm (family, social, work) can guarantee all this, through an appropriate use of resources, in a phase in which “defensive” medicine is manifested by the use of laboratory and instrumental tests considered vicariate and not supportive of the actions of the doctor any discipline exercised. The collaboration of the patient and the family can allow the GP to plan and share personalized interventions especially in chronic and frail conditions.
If this is the identikit of the GP who will have to face the challenge of the third millennium, the CFSMG will have to respond to these expectations. The objectives to be achieved are exhaustively represented in the WONCA tree that GPs from all over Europe and beyond share; some skills can be summarized briefly in the following points:
- Build specific and personalized prevention paths in a proactive action of health promotion
- diagnose and treat diseases
- promote coping skills (especially in chronic conditions)
- take care of the person in his complexity, in his psycho-somatic unity also made up of emotions and existentiality
- share with the patient paths and goals of care
- orient oneself according to “global diagnoses”, also evaluate everything that belongs to the context in which the patient and his family live and in which one operates
- prepare GPs who know how to take care of themselves, in a program of contrast and above all prevention of burn-out
To achieve these objectives, future GPs will have to acquire:
- the awareness of operating in a setting with a low prevalence of disease
- understanding the importance of communication in relation to specific skills such as:
- care centered on the person, oriented to the individual, the family, the community
- effective communication
- listening
- narrative medicine
- the construction and maintenance of a long-lasting relationship
- continuous care according to the patient’s needs
- the semeiotics that finds expression and consistency in the interview and in the visit
- skill in new technologies
- knowledge of organizational methods in general medicine in all their forms
What has been described is an essential condition for the training of professionals with a specific identity in which they recognize themselves, sharing methods, tasks and functions: this represents the objective of the CFSMG and not trivially that of preparing “expert doctors”. We therefore ask ourselves how those who do not practice it and have no knowledge or experience can teach a profession. We would like to underline how the basic aspect of any training course is the transmission of knowledge, declined in its various forms.
We recognize that General Medicine certainly needs a reorganization in the context of primary care to improve “management” within its organizational components (Department, AFT, health houses, shared protocols in a multi-team perspective) . In this process, it is possible to foresee the professional figure of a “GP with particular skills”, some of which may even go beyond the know-how of the discipline of General Medicine, but certainly functional in the management of particular phases of chronicity / frailty and of the first rescue.
This raises the problem of defining the tasks and functions of these new professional figures and organizing an ad hoc training course in the realization of which an effective collaboration between University-Hospital and General Medicine could be fruitful. However, we believe that this collaboration must go further, participating in the construction of a less fragmented NHS, recognizing its different roles and skills.
Dr Stefano Lenti
CFSMG Director of the Tuscany Region
Dr. Loretta Polenzani
former CFSMG Coordinator of the Tuscany Region
Dr Stefano Giovannoni
former CFSMG Coordinator of the Tuscany Region
Dr Emanuele Messina
former Director of the CFSMG Region of Tuscany
August 26, 2022
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