2023-06-11 06:00:00
This week a thread came to my heart in Twitter Dr. José Luis Domínguez Tristancho (@Dr. Tristancho), colorectal surgeon from the Fundación Jiménez Díaz in Madrid. It reads like this: “1. When Berta finished her degree, I asked myself, will she be able to practice medicine? She gave me the answer: yes. 2. Later she had the great courage to prepare for the MIR and enter the quota. Now the real things begin barriers and they deny her a place due to disability. 3. Now I wonder, could she practice medicine with her disability? I give myself the answer: Absolutely yes, knowing my daughter I have no doubt that she will contribute a lot to this fascinating profession 4. As long as she is considered for the things she can do and not for what she cannot do, as she has been done up to now, Berta will be another example that allows us to be better people“.
The world He collected in detail the history of his daughter, Dr. Berta Domínguez (Badajoz, 1994), quadriplegic due to an accident she suffered at the age of 23: “She had approved the MIR on January 21 with position 8,171. Once the specialty was ruled out of his father, Surgery – “I lowered my feet to the ground because you reach the point where you are assuming your limitations, although the evolution of robotics gave me hope for a long time” -, he wanted to opt for Psychiatry, but the grade (had to be to be among the first 1,000) prevented him from doing so. He was also unable to take advantage of this specialty through the existing quotas due to disability. Finally, chose Family and Community Medicine, convinced that it suited her situation, and they awarded her a position in this service at Hospital 12 de Octubre in Madrid. However, and by surprise, five days before her incorporation, on May 17, she received a cold email. “Not fit”. No feelings, no soul. In two brief lines of e-mail they denied him the position. Her excuse was that she couldn’t scan the patients. She has never been asked nor has she held any personal meeting where someone in charge explained to her dear to dear the decision or seek a solution. “I don’t understand so much dehumanization or so much discrimination,” he denounces.
First of all, if you have been able to successfully pass the degree and the MIR exam, what insurmountable impediment can there be so that Dr. Domínguez continues training, has the degree of physical disability that she has, in the specialty of Family Medicine and then, when it is finished, she can practice it according to her abilities?
I’m reviewing the Spanish Strategy on Disability, approved by the Council of Ministers in May 2022, and does not seem to endorse discrimination in the training of people, whether in a medical specialty or in any other subject. In it Deontological Code of the Collegiate Medical Organization (OMC), of 2022, article 19.1 states that “the doctor must refrain from actions that exceed his competence and capacity. In this case, he must propose to the patient that he resort to another competent colleague in the matter”; 19.2, that “if a doctor observes that, due to age, illness or other causes, his ability to judge or his technical ability deteriorates, he should ask a colleague for advice to help him make a decision about his future “, and 19.3, that “if the doctor is not aware of his deficiencies and these were noticed by another colleague, the latter is obliged to notify him and, if necessary, to inform the College, objectively and with the due discretion.” Which also does not seem to support the discrimination in specialized training of Dr. Domínguez.
Your case (physical disability), which is neither the first nor will it be the last, poses a dilemma which well deserves an in-depth analysis by professional corporations, guarantors of good medical practice, and by health institutions and centers that train and hire specialist doctors.
But, naked eyeIt does not seem fair that after the sacrifice made by Dr. Domínguez to get to where she is, she cannot access the specialized training she wants. That the MIR stage is very hard, of course; and that the units and teaching centers, with the lack of professionals and the excess demand for care, cannot personalize and adapt the training conditions to each resident, is unquestionable.
Nevertheless, why not explore the possibility to accommodate Berta Domínguez as best as possible in a MIR position of Family Medicine? Who knows if primary care, and the rest of the health system, will be missing out on a specialist who, from her perspective, will be key to improving the quality of care in primary care.
Albert Jovell (1962-2013)a doctor specializing in Preventive Medicine and Public Health and sociologist and founder and president of the Spanish Patients’ Forum, said that the sector has to count on sick doctors (add here “or with different degrees of physical disability”) because “we are in the two sides of the barrier and we are misused capital”.
I usually remember that phrase when I read or write about the patient participation in decisions related to the government and management of health because I do not believe that all of them have all the training and information necessary to do it hand in hand with health professionals and other agents of the system.
That’s why you can’t waste capital They have doctors, nurses, pharmacists and other health workers with magnificent training, also specialized, and with personal conditions (disability, health problem, etc…) that make them especially valuable to the system. They can contribute to filling gaps in knowledge about the patient experience and about the quality of care that only they, due to their training and their characteristics and personal experiences, can perfectly fill.
For all this, I hope that Dr. Domínguez fulfill your desire to specialize and that the health system be generous with her and with all those young doctors who, whether it costs them more or less, do not give up on their dreams.
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