Antonio Fernandez-Pro Ledesma.
The XXVIII National Congress of the Spanish Society of General and Family Medicine (SEMG) has provided a space for reflection on the future of the first level of care. A future where professionals claim to be participants in the decisions in order to put an end to a model that they qualify as exhausted.
In an interview with Medical Writingthe president of the SEMG, Antonio Fernandez-Pro Ledesma, reviews the main ideas extracted from the annual event such as decentralization, the application of new care models, priority given to chronic patients or diagnostic tests in the health center.
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Antonio Fernández-Pro: “The main tool we need is time”. |
What assessment do you make of the XXVIII National Congress of SEMG?
It’s very good. It has met the expectations we had and there has been a fairly important level of interaction, with many young people. People really wanted to be in person and that has been noticed in the rooms, everything is practically full and the level of interaction with the speakers has been tremendously important.
The number of streaming connections that have been made when the nine rooms came out live has also been very important, and the truth is that there have been a thousand questions regarding whether the presentations are going to be perpetuated like last year and obviously we will be up to mid-August with the Congress open.
Has the hybrid format come to stay?
Yes, definitely. It is an excellent format, although it still needs to be polished a bit to finish knowing and accrediting the online sessions. Removing these things to refine it a little more, the result is spectacular, I mean, it is a successful format without a doubt.
Have they managed to readapt to Family values?
We seriously believe that a new stage begins. Primary Care in this country really has to take another course. Professional instability and professional malaise is a clamor. The politician and the manager have once and for all to realize that they have to count on the professional to carry out this exercise. And that change will start sooner rather than later, from then on the values will remain the same.
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“The politician and the manager have once and for all to realize that they have to count on the professional” |
What is the roadmap to change Primary?
The roadmap to follow is very easy. Stop doing what we are doing wrong. If we continue doing the same things we will continue to obtain the same results. We have seen that it is not a matter of money, in Catalonia it was encouraged with €9,000 and despite this, 20% of the vacancies have remained empty. Something more is needed.
In the lecture by Rafael Bengoa It was clear, he said it without any hesitation, and I totally agree with him. We must begin a clear and manifest decentralization, leaving the initiative to the professionals. This does not mean chaos or save yourself who can and does not mean that everyone does what seems good, but you really have to have management autonomy. We have to apply other models because we are not going anywhere along this path
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Antonio Fernández-Pro Ledesma, president of the Spanish Society of General and Family Physicians (SEMG). |
How is the gap between the politician and the family doctor?
It is a gap that takes many years, not living the reality of day to day makes you not see things the way you see them. There has been a great distance between the manager and the ordinary doctor. So, there has been a lack of understanding and a lack of communication. Another atavistic evil that our profession has has been the lack of connection or understanding between levels of care. We have to be interconnected, this has to be transversal and it cannot be order and control without professionals.
How can that gap be reduced?
Like everything in life, increasing communication. That is, simply take into account the professionals. When a decision of a certain depth is to be made, to agree with… It is not complicated at all, this is like a big family and what it is regarding is seeking the common good, not seeking prompt and rapid solutions to complex problems, they are not that easy. The paper supports everything, but really later it goes to the reality of the trenches and it is not so easy to couple those protocols.
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“Other models must be applied because we are not going anywhere along this path” |
How do you rate that Health leave Primary out of technological renewal?
It is reckless, thinking like this I think is due to ignorance and not really knowing what reality is. When the technological systems that we have are absolutely obsolete, when there has been no renovation in years, saying that a technological renovation is going to be carried out and that Primary does not need it because if we do it in the hospital we reduce the waiting lists for Primary … Really, the only thing I think is that whoever has done it does not know very well what the system is because the problem is in the difficulty of reaching the second level.
“We must start a clear and manifest decentralization, leaving the professionals to take the initiative” |
Should diagnostic devices be given to health centers?
Yes, Family Medicine has been saying it for a long time. One of the intentions of this society has always been to remove as much technology as possible from the hospital and bring all technology closer to the general practitioner. Not because we have a desire for protagonism, but because what we do is bring the diagnosis closer to the patient. In this way we reduce waiting times and uncertainty, thus increasing patient safety by being more accurate in the diagnosis.
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“The main tool we need is time” |
The attention to chronic patients has been another of the main topics of the congress. Can you make up for lost time?
I believe that there is a time that is irretrievable. Cancers are appearing in later situations that we diagnosed before. You have to put your batteries and mark some priority criteria from the query. We have to have time to be able to talk and look for that patient who has not had a control in two years. The main tool that we need is time.
How do you get more time?
The last great crisis that we suffered in Primary Care in the sixth wave was due to bureaucratic issues, due to sick leave, something that might have been resolved in another way. We need time for patients, if up to 35% or 40% of my time is spent on bureaucratic issues, then it makes no sense. We also dedicate a lot of time from medical transport to solving second-level interconsultations or requests for complementary second-level tests. It is a situation that we have to put an end to and, in addition, we have to improve the flow of the patient within the system, with single consultations, decisive consultations and little else.
What hopeful message for the future can you convey to a family doctor?
There’s a lot. I always say the same thing, we are in a difficult profession and the situation is complicated, but we are also in the most beautiful profession in the world. It is the only specialty that has an ideology, not politics, but of contact, of fraternity, it has an accompanying ideology. And that intimate moment of being with the patient face to face, just the two of them, is so intense and so passionate that I personally would not change it for anything.
Antonio Fernández-Pro Ledesma during the interview at the XXVIII National Congress of General and Family Medicine. |
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