by Enzo Bozza
09 GEN – Dear Director,
there is and, I hope it will continue, a service strongly linked to the dramatic need for health care in the area, and it is the programmed and integrated home care service. It is the resource that best responds to the chronicity of pathologies related to aging and all those clinical situations where it is necessary for patients to be followed up at home.
This aspect is so important that it is inherent in local medicine and the institutional value of the general practitioner. A role that can only be filled by a doctor who is present throughout the territory and who knows the reality of his patients globally and who must be followed up at home, because any other hospital-type solution is not feasible. Obviously, it must be a team effort, with synergy between the health district, the general practitioner who coordinates the interventions, the nurses in the area and the specialists called for consultancy.
Following the patient in his home environment has countless advantages, from getting used to his own spaces, to the proximity of the family network to tailor-made therapies with little expense and waste of resources compared to hospital costs.
Chronicity itself, almost always, does not require amazing and heroic interventions but periodic monitoring of the parameters and an adjustment of the therapy, reducing the use of hospitalizations to the bare minimum. Everyone is happy: from the patient who can be followed up at home, to hospital doctors who see improper visits reduced, to the general practitioner who finds a full-thickness enhancing and motivational meaning in his work as a clinician and less and less overburdened, hopefully, in all that bureaucratic hodgepodge that makes him closer to a land registry employee than a care professional.
In terms of costs, for those who love figures and health economics, it is the least expensive resource possible, because hospitalization of chronicity is the least appropriate at all levels of performance: from costs, to ineffectiveness, up to clogging of spaces for acute cases and, indirectly, on the waiting lists of a hospital that cannot deal with chronic pathologies without collapsing in an inappropriate setting, also due to lack of personnel.
Let’s move on to the pars destruens of the matter: since the governmental consideration of local medicine is equal to the useful and pleasant manicure for hippos or Barbie’s styling and, in fact, the resources used for local medicine are equal to zero, it is very It is probable that planned and integrated home care will become another missed opportunity to give strength and value to local medicine.
It usually works like this: is public spending in trouble? No problem, costs are cut on personnel and departments, peripheral branches are cut, which is great for pruning fruit trees, a little less so for healthcare. Outlying hospitals and services are progressively impoverished and when they collapse due to lack of funds, they are declared useless, expensive and dangerous. Gentlemen, it closes. It is thus that in Cadore, as in many other marginal areas, it has come to no longer have services.
Content to silence the usual ignoble: it is privatized, giving a concession to some cooperatives the indispensable services which, managed by private entrepreneurs with this strange passion for profit, I don’t know what quality can arise from it. Completely personal doubt. Price to pay? The usual, at the expense of the most fragile patients. In Naples it is said that the dog bites the ragamuffin. A more explicit metaphor is that of the donkey whose load was increased every day and was seen dropped to the ground with the last kilo out of the two hundred already borne.
Incapable and pretentious donkey. This is the national health service: a donkey collapsed to the ground.
General practitioner for the municipalities of Vodo and Borca di Cadore
09 January 2023
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