by Ornella Mancin
21 SET – Dear Director,
there is a great ferment around family medicine from what we have read in the press (the Sisac proposal for the renewal of the convention, the hypotheses being examined by the regions on the future legal-contractual status, the placement of territorial medicine in mission 6 of PNRR, etc.) and after years of inaction, of reforms announced and never actually implemented, of a slow and inexorable “getting by” today it seems that we really want to change the structure of general medicine.
After all, the family doctor as we have known and lived up to this moment has suffered such wear and tear, especially in these years of pandemic, as to be like a patient in agony whose death is expected soon. We have now come to the famous “redde rationem” that is to say the showdown on both our past and our future.
It is surprising that those who govern the profession are not realizing it and imagine that it is enough to continue to say a few no and a few yes to make family medicine remain unchanged over time.
If we take for example the three hypotheses of legal status under discussion (full transition to dependency, partial transition to dependency, accreditation therefore also cooperatives, etc.) we realize that these hypotheses represent in one way or another the questioning of this that we have always been historically.
Whatever happens, the family doctor in one way or another from tomorrow will not be the same as before.
But how was it possible to get here? What brought us to a point of no return? It would be too simple to say that if we are at this point it is because the trade union proposals have been rejected, nor can it be said that if these proposals have been rejected then they are wrong. But one thing is evident to me and it is that our representatives have often proved inadequate to stand up to the challenges of our time, who have not been able to grasp the super complexity of the moment and have continued to act as if the world remained unchanged. over the years, accepting over time only corrective measures often pejorative for our profession but never accepting the challenge for a true re-foundation of family medicine.
I remember a 2007 Fimmg document (unanimously approved by the FIMMG national council on 9 June 2007) and which is significantly entitled “The re-foundation of General Medicine”.
Reading it today makes you cry because you fully understand what kind of self-deception our category and our representatives have fallen into in recent years: on the one hand, there was open talk of reform of the professional role on the other hand it was specified that refound medicine general did not mean rethinking it but simply strengthening it legally as a role and function…. everything in the series has to change so that everything remains as it was before.
After all, the prof. Cavicchi had written it well in 2013 when he wrote about the convention for general medicine that “the risk is that Fimmg proposes, as it has done in recent years, to change everything in order not to change anything, that is by giving some sop, but being careful to keep close all the advantages of the contracted relationship “(QS 11 December 2013) and prophesied” that its historical untouchability sooner or later for many intuitive reasons {was} destined to end “.
8 years have passed since then but the trade union strategy appears unchanged: however, the external conditions that no longer seem favorable have changed.
For years, the Fimmg has supported the conventional relationship based on the excessive spending that would be burdened on the state coffers to implement the addiction, now that money is there, one of its warhorses is missing and the only fiduciary relationship remains in defense of the convention. which I am sure the citizen would give up in favor of greater efficiency of services (assuming that only the relationship of dependence can offer it); not to mention that more and more doctors who are tired of a job that does not allow for breaks are lining up in favor of addiction.
Why do our representatives prefer to ignore the data of reality and continue to propose anachronistic strategies?
Today we do not have clear what we will become (theoretically we could even end up in a cooperative managed by the union) the bewilderment that I cannot avoid is that both about the death of the family doctor and about his future, no one today feels the need to promote an extraordinary discussion as if dying were, after all, a matter of ordinary administration and being reborn was an automatism.
What a sadness and what a disappointment. And how much anger.
Ornella Mancin
Doctor of general medicine
September 21, 2021
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