The future of general medicine between difficulties and complex solutions

by Sarah Albertini

July 08

Dear Director,
In the current difficult and complex scenario, with the epidemic showing no signs of giving up its control in terms of energy, time and labor resources declining, and the health problems of the elderly and increasingly sick, as well as the disgruntled population, 3 macro themes are essential, all of which are necessary to deal with the lack of human resources (This is a wonderful historical moment in which funds, treatments, and innovative ideas are available, but there is a shortage of doctors and nurses who can make them usable!).

The time when every Italian had a doctor at his disposal for every slightest doubt or offer is over, and yet it is unthinkable to “abandon” the people who for decades have been dependent on the advice of a professional even on the most trivial matter, and also to urge them to aspire to Absolute luxury without getting tired.

It is necessary to start with effective and widespread campaigns (schools, workplaces, social networks, newspapers, television) to make adults independent (maybe they started as children and adolescents) in every issue of first self-medication, and to gradually eliminate the prevailing notion that every disease needs medicine, and therefore the doctor (antibiotics) Vital for sore throat or fever, proton pump inhibitors at the first stomach ache, etc., drugs whose abuse already causes serious damage over time), when resting often, drinking water and proper nutrition is the healthiest and most effective way to accompany the path Natural for many acute diseases. If this all sounds so obvious and cliched, then you’ve never been to a GP clinic!

In this macro area we must mention, albeit superficially, the need to ask ourselves as a medical class and as a society as a whole how to manage the burden of health and social care for the elderly in a sustainable and equitable way (often in isolation without a family network), and to understand how much can be done In acute care facilities, and how much intermediate solutions really work for their purpose. It will be done in a serious manner, free from prejudice and guilt, without losing the piety towards the elderly that characterizes the Italian people, without falling into the quagmire of inertia that prevents us, for fear of medical and legal controversies. Than to find radical but dignified solutions.

The age pyramid has not been pyramid for some time, and the elderly population will grow exponentially: therefore, a critical initial preventive intervention targeting adults and young adults is necessary and cannot be postponed.

The misconception that performing annual complete blood tests safely from all harm wastes resources and time for clinicians and operators, but above all distracts patients from essential actions to be taken from an early age: abstaining from smoking, following a low-calorie diet, physical exercise, and adherence to With oncology and general health checks like the latest hepatitis C virus check, workplace safety (not forgetting the psychological component of health) are the foundations for a healthier life, and good old age has been shown to protect against most chronic diseases. At a later stage, targeted and adequate pharmacological interventions must be prescribed with decision and freedom (today it seems paradoxical to aim to contain pharmacological spending on those medicines that have shown reduced hospitalization and mortality, and the benefits of treatments will be seen too late!)

Today the general practitioner must organize himself with study collaborators and nurses responsible for part of the clinic’s work, and in groups of colleagues in order to ensure adequate daytime coverage to more effectively intercept patients’ needs.

In this field, attention should also be paid to the subject of all the doctor’s actions that are not beneficial to the patient’s health and are not clinical. Not using the word

‘Removing bureaucracy’, which seems to open up a world too vast to be resolved, we can begin to eliminate the ‘dual’ procedures which are all that two specialists (often two doctors) need:

General Practitioner and Specialist) each in turn uses the time that can be directed to other patients. The examples may be endless and so obvious to those who live the daily lives of our clinics, but the most recent and astonishing are the INPS disease certificates issued to patients who already have an isolation procedure sealed by the local DSP chief.

My professional experience is short and I don’t claim to have solutions to such complex problems, but it seems that PNRR solutions and projects mostly deal with physical and organizational structures and cathedrals in the desert that will not solve the problem if they are not filled with content and if not dealt with the necessary cultural change that can alter Really the type and quantity of citizens’ requests for their doctors in the area, the first bastions of access to the NHS.

It will be necessary for all of us to realize that our health and the health of the national health system is in everyone’s hands: doctors, politicians and citizens.

Sarah Albertini

Ravenna General Practitioner

July 08, 2022
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