According to Nathaniel Branden, “The first step towards change is awareness. The second step is acceptance”. This phrase from a psychotherapist can be perfectly applied to understand the moment that a National health System is experiencing that needs a profound change, an adaptation to the new reality we live in, moving from the 20th century to the current 21st century. It seems evident that we are already aware of this need for change, although many do not admit it, but now is the time for its acceptance.
I cannot go without mentioning the several articles that I have dedicated in this same opinion forum about the need to change the National Health System. There have been several and, in all of them, I refer to the unavoidable need to change a model that has already become obsolete, outdated, and that no longer responds to the needs of patients and professionals.
I believe that this need for change has already permeated those responsible for carrying it out; not only patients and professionals are aware of it, but also managers and many politicians make this need public. What is evident is that I hardly see serious and rigorous proposals for change, what is proposed as the future and how we can achieve the change, what advantages and disadvantages it may have, what this change is based on, who and how it will be piloted, with whom. What is needed to carry it out, what role will the different professionals play in the new model, who will lead it, etc. I think There is a lot of fear of telling the truth, possibly because the changes that will occur will not be to the liking of many..
Going back to the beginning, we are clear that there is awareness of change, the change has already begun and it is doing so without having informed us, without debate, it is simply changing and the facts demonstrate it. Already No one can doubt that the model that was based on strong Primary Care has already changed, this level of care is no longer dying, it is definitely dead. It is evident that it is a reality that Primary Care is left to do bureaucratic procedures that no one else wants to do, it is there to direct patient traffic to the corresponding hospital specialist, to “get it done.”
There are many truths that are already known and, sadly, accepted. Waiting list to see your family doctor or pediatrician, loss of “longitudinality”, health centers without doctors or with minimal minimums, hundreds of thousands of patients without an assigned doctor, out-of-hospital emergencies without doctors, difficulty in filling all the training places of family doctors, a certain normalization and assumption of the “lesser evil” which is seeing doctors without a specialty filling positions of specialists in family medicine or many of these doing the same with those in pediatrics. The last thing I have seen is that they are considering a reduction of the 4 years of specialty to 3, and we will see if it is not the beginning of a return to the model of a graduate, now a graduate, equal to a general practitioner with a license to practice as a general practitioner. family, something that is already being done and that we run the risk of extending.
But We are also seeing and accepting that things are changing in hospitals.. They seek “excellence”, they seek to dazzle, what is wanted and encouraged is to have the latest in technology, to provide hospitals with dazzling techniques and equipment, those that the manager/politician likes so much and that allows for news and electoralism. with grand openings. The towel has been thrown in with the management of waiting listsit does not matter that millions of patients wait indecent times to access a consultation, a complementary test or a surgical intervention, If when the time comes they will be delighted because they operate on you with a Da Vinci robot, they apply the most recent treatment with monoclonal antibody or therapy with CAR-T cells. Everything is constantly changing, we are already aware of it and we have accepted it.
| “Awareness has been created and a change of model is accepted without having openly debated, everything is changed little by little, through the back door, by force of facts” |
And finally, We are at the beginning of a path to the near future, in some things it is already current, a future/present that involves the introduction of Artificial Intelligence applied to medicine. How many family doctors can be replaced by Artificial Intelligence? It seems impossible for this to be the case, but the conversion of the traditional family doctor, that close doctor who cared for you throughout your life, who dedicated time to you, explored you, diagnosed and treated you, into a mere person in charge of bureaucratic procedures and referral to hospital, makes it possible for powerful machines, more electoral inaugurations, with Artificial Intelligence programs that become more complete every day, of course also “inaugurable” and “competitive” (remember that public contests also have their associated mischief/corruption for the benefit of those we already know), make this possible for this to be a more or less close reality. And let’s not believe that this Artificial Intelligence will make us need fewer family doctors or pediatricians every day, it’s just that no one should be surprised if one day very soon we see that you arrive at the hospital emergency department and emergency triage is no longer done by a nurseit will be a machine that classifies the patient and directs the “triadora” machine to where it deems necessary.
But there is more. I see hospital medical specialties subjected to Artificial Intelligence, some of them based on images, such as radiology, dermatology or pathological anatomy, seriously compromised, not with its complete disappearance, but greatly reduced to specialists who validate the diagnosis that the corresponding machine issues after comparison with an image bank of millions of samples. By the way, specialists who can reside in those parts of the world where their salary costs are much lowerLet’s not forget the speed at which image files travel.
Definitely, Awareness has been created and a change in model is accepted without having openly debated, everything is changed little by little, through the back doorby force of facts. We are facing a new SNS modela model that, sharing the need for change, I do not accept as valid, especially when it is being imposed without dialogue, without debate, without assessment of its pros and cons, it is introduced without having professionals and patients, without any consensus, simply by force of facts.
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