The strike of family doctors explained to patients. This is what Ivo Vulpi, a doctor from Bari with a long experience, does, through an open letter that with examples and direct references rattles off the reasons for the protest of the members of the SMI, Simet and CGIL trade unions which will lead to the closure of about 300 clinics throughout Puglia. 1 and 2 March, about forty between Bari and the province. Among the reasons there is what happened in the two years of the Covid pandemic and the denial of the Senate vote for the recognition of an indemnity to the families of the 400 doctors who died from Covid indemnity. For them during the demonstration on the 2nd a minute of silence will be observed under the headquarters of the Ministry of Health in Rome. The dispute also concerns workers’ rights, with rests that would have vanished during these two years of health crisis. Recognition of accidents at work, more time for oneself and for patients, because they are burdened by bureaucratic practices that take away time from clinical diagnostic and preventive tasks for basic administrative ones, to make up for the lack of other professionals of the ASL, subtracting time to devote to patients with chronic frailty. And again the shortage of medical personnel, which in the next five years could become dramatic, to guarantee primary care, continuity of assistance, medical services, 118, penitentiary medicine, hospital medical management and nursing and administrative study staff.
The first point addressed by Vulpi is that of the excessive bureaucratization of the role, as also denounced by the union, which takes away time from clinical activity to cope with the formalities to be fulfilled. “I saw the transformation of basic medicine, already under agreement, at the turn of my father’s retirement – explains the doctor -, and experienced the transition from the famous vertical yellow recipe book in which everything was prescribed, to the horizontal red one full of codes and ministerial notes, that if you get a code wrong, the patient goes back and forth. Many examples can be given and the patients themselves live them. Starting with the notes from the Aifa drug agency. The Ministry of Health began introducing them to regulate the overprescription of high-cost drugs under the pretext of dictating guidelines. In the beginning there were 48: now they are 100. Before you just had to observe them in the prescription phase, now for many of them you have to fill in monitoring cards to keep, full of boxes to be crossed and patient data. It is not clear whether only the specialist or the general practitioner should do them. We often call the Pharmaceutical Service for explanations or help with doctors on WhatsApp chats. The patient pays the costs of this bureaucracy, the doctor puts the paper and toner “.
A further bureaucratic step is added to the complexity of the requirements. “The distribution and prescription of blood glucose strips and machines for diabetics: seven A4 pages to print and fill and it is not yet clear who supplies the machines and how. It is always the patient who goes back and forth “. And again “the supplies of incontinent aids, such as diapers and sleepers, for example: every now and then a relative shows up who must obtain a leaflet from us on which it is declared that the relative who has been bedridden for 10 years is still incontinent, as if he could recover , because if not, the supply is interrupted, more back and forth “. Then there is the problem of priority lists, continues Vulpi. “Thousands of trees are cut and transformed into paper for this wickedness invented by some councilor and absolutely disregarded by the system. They force us to reprint the same requests with the different wordings: urgent, short, deferred, programmable, depending on the availability that the employee of the Cup at that moment decides. In these cases the doctor’s point of view is of no importance. More back and forth for patients. By now we have thrown in the towel: impossible to replicate. You argue with the patient, you harm him and it is not the fault of the employee who otherwise fails to find the service “. But the denunciation of the paradoxes that afflict the profession does not end here.
“We can talk about insertions in the Rsa of disabled patients. Or Svama, Svamdi, Pai cards to print, fill in, sign, scan and send via conventional email, without a minimum of legal value. And do we also want to talk about all the certifications required by the school, the Municipality, private companies, Inail and the INPS? And all the ballet of requests for swabs for school with angry mothers and school leaders who do not know how to unravel the tangle that the family doctor has to solve? Patients must understand that all this time, and I have cited only a few examples, dedicated to bureaucratic tasks imposed by a system which has obviously failed in the organization, is all time taken away from listening to them, treating them, making important decisions for their health. Our patients – he continues – know well that when they have a serious need we are the ones who call directly the colleague expert in the sector and ask for courtesy, not the call centers they turn to and that, after hours of waiting on the phone with exhausting music, they find a thousand pitfalls for not booking, ending with the classic phrase ‘Ask the family doctor’. Our patients know very well who answers the phone and who pretends to answer, if he answers, referring to the famous family doctor ‘do everything’ and solve everything ”.
This is why, Vulpi concludes, the two days of discomfort for them due to the strike actually constitute part of a battle in their favor, and not in favor of the doctors’ pockets. “It is painful to note that not all trade unions, under various pretexts, do not adhere to this strike – he adds – which aims to sensitize the Government that issues decrees born in the upper echelons but without consulting the suffering base, penalizing, in return, the harassed patient and forced to feel mistreated by the ASL and Cup counters “.