Primary Care is dead… Long live Primary Care! Family Medicine is dead… Long live Family Medicine!
Allow me to start this reflection emulating the words that used to be said before the death of a King and the consequent proclamation of a new one, who could be better or worse than the previous one but never the same.
That Family Medicine, as it had been considered, has died is a fact, or at least it is that it is dying, in a terminal state. Neither the patients, nor surely the administration and certainly not the professionals were happy with her.
As a first bad symptom of the degenerative disease of Family Medicine, the idea had spread that health centers were a place to go whenever you want and for whatever you want, without any restrictions, since “ for that they pay”, and without any of the health administrations, until now, having set any type of criteria (limits), since “the client” was always right and could use public health at will, obviously causing an unaffordable overload for the professionals of these centers at all levels.
In response, the different administrations had done nothing more than go patching things up at the drop of a hat and as the problems worsened, without “really” undertaking an authentic reform of Primary Care, which, on the one hand, would satisfy the real healthcare needs of the population and, on the other hand, allow health professionals to carry out their work to full satisfaction, with enthusiasm, dedication and with maximum efficiency.
Primary Care professionals (doctors and paediatricians) gradually lost that illusion with which they began their professional practice, that vocation and dedication. Most of them were ‘burned out’, and this made it very difficult for them to provide day-to-day adequate care for their patients as they would like and consuming an enormous amount of time and resources in tasks that really did not correspond to them and that of course they had not contemplated when they were trained in specialties as beautiful as Family and “Community” Medicine or out-of-hospital Pediatrics.
Although we could talk for hours and write hundreds of pages, the reality is stubborn and clear and, as they say, they all killed her and she died alone. Neither patients, nor administration nor professionals were happy with this agony that lasted too long and for which there was no way out.
In case we had any doubts, the last sample button has been the election (the non-election) of MIR places in this specialty in the last call. If we add to this the flight of professionals, the retirements, those who already with their place give it up to apply again to the MIR and do another specialty… the future thus acquired a color… let’s say dark, if there was any future and if this could have a different color.
But as I said at the beginning, Long live Primary Care! Long live Family Medicine! We all have to compose a new concept of what Primary Care is, what it should be.
The population (essential) must be trained and made aware of what a health center is, they must be informed of how, when and why they should or can go to it, what their rights are, what their obligations are, and how health co-responsible, what the limitations. This is very difficult, I know, but it is essential.
In order for the new Primary Health Care, successor to the one that has already ceased to exist, to be proclaimed, the health authorities must undertake once and for all a complete and profound reform of this first level of care, beginning with an adequate budget to what is intended to be achieved, with a rethinking of the true needs of according to what type of professionals, of a correct distribution of competences, starting with the administrative, auxiliary, nursing, medical levels… without this leading to an assumption of competences by some of them outside those legally (and logically) assigned by law.
On the part of professionals, and from my position I refer above all to family doctors and primary care paediatricians, they must change their current ‘chip’ and fully enter a new Primary Care, a new Family Medicine and “ Community”, the one they studied, the one with which they dreamed with hope, of full attention to its citizens without other types of pressure, especially bureaucratic, focusing on the clinical problems of their patients, guaranteeing their continuous training, intervening in research programs, prevention and health training for citizens, completing and updating their professional career, etc.; and obviously with a remuneration in accordance with their high degree of competence and the social importance of their professional work and that is comparable between the autonomous communities and with the rest of the European Union.
Now, I know that this is very difficult and that is why, from the Official College of Physicians, “the only representatives of the profession”, we offer ourselves once again and with more insistence than ever to actively collaborate in the birth of this new Primary Care , with everything that is needed, because we believe that good Primary Care is indeed absolutely essential for the health of the population in general and also for that of the doctors who practice it.
So I end as I began. Let us consider the current Primary Care to have died with dignity and let us all fight for a new Primary Care, for a new Family Medicine, as we doctors dream of and as society demands of us.