2023-08-24 13:48:02
“It seems that we are training our medical students to replace the protagonists of Grey’s Anatomy or ER Emergency Room in their positions, as if we were living in a series script. Our doctors are trained with false expectations and then crash with the reality of the very poor job market. Doctors who know the ICU criteria for pancreatitis by heart but can’t formulate tonsillitis, much less perform an onychoectomy (operate on an ingrown toenail); and it is not that it is bad to know the first, but it does leave a lot to be said if you do not know the second”.
I already told you in another column the incidents in which fate would make it possible, although I already thought it unlikely, to provide my Mandatory Social Service in some municipality of my beloved Huila. The love of a concerned father, the indecipherable chance that never gives explanations and the violence that has crossed at will, like a Homeric curse, our geography and our lives would put me in a truck headed for Iquira to start my rural service. It was the year 2006.
At that time, despite the fact that Law 50 of 1981, which created the Compulsory Social Service, that is, the law that forced professionals in medicine, nursing, bacteriology and dentistry to provide a rural social service, that is, in In remote areas of the capitals of the departments where access to health is complex, the violence in which the country was forced the authorities to decree that in those municipalities where the public order situation was “difficult” the rural one, which lasted by law one year, it was only done for six months. This was precisely the time that mine lasted because, although there was an apparent calm in the municipality where I lent, it was a place declared a red zone.
There I met the other rurales: a head nurse who came from a university on the coast and a dentist who came from a university in Bogotá (the bacteriologist was on staff, so there were no rural professionals in this profession).
I must say that we suffered what it is to attend to a rural population with the deficiencies of our health system, but I must also say that we enjoyed the experience of attending to the population in their most basic needs in the territories. An enriching bath of reality, of Colombianness. It was undoubtedly a hard experience, but also a valuable one that I consider helped me to form character and judgment.
But that “school” is being lost today.
Not only are there no longer rural places in the different municipal hospitals, but the newly trained doctors are no longer interested in doing their rural. We are facing a complex situation with multifactorial origins that are difficult to treat.
On the one hand, abusive contracts in which doctors do not have labor guarantees. Many staff positions (not to say most, if any remain) have been replaced by service contracts that have reduced medical practice to something akin to blatant pandering, and this with the consent of colleagues who have dedicated to the administration of these hospitals.
The large number of recently graduated doctors versus the small number of rural places have led to a “draw” being used to decide who is “rewarded” with a rural place. (This is not how chance operates. Although it may not seem like it, it is more poetic).
The tendency of many teachers who insist on training doctors to work in highly complex centers and not to contribute to primary health. This represents a complete disintegration with the duty of the general practitioner. It seems that we are training our medical students to replace the protagonists of Grey’s Anatomy or ER Emergency Room in their positions, as if we were living in a series script. Our doctors are trained with false expectations and then crash with the reality of the very poor job market. Doctors who know the ICU criteria for pancreatitis by heart but can’t formulate tonsillitis, much less perform an onychoectomy (operate on an ingrown toenail); and it is not that it is bad to know the first, but it does leave a lot to be said if you do not know the second, especially in the context of primary health care. And these are only small examples, since the deficiencies in terms of the basic skills that a doctor must have are seen daily.
The negligence of the students themselves and some recently graduated doctors to practice rural practice, with excuses that come and go to stay and work in the cities, to avoid going to do their rural practice at all costs. In public health it is said that the primary level should take care of 80% of health needs and it seems that we are only training them to take care of the remaining 20%.
Rural medicine is in crisis and that is why from the National Government at the head of the Ministry of Health, the universities and the Health System itself, we must bet on strengthening primary medicine and give the general practitioner the place it deserves. We cannot pretend to run when we still do not know how to walk.
To all those medical students who have the opportunity to read this column, to medical teachers, to those in charge of curricular designs at universities, to the academy, to the authorities, to the government, and to all the doctors… let’s go back to primary medicine.
All the columns of the author in this link: Sanders Lozano Solano
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