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“We do not need an official state bulletin to define ourselves as emergency physicians. We need it to organize ourselves, to claim our rights and specify our field of work. Our struggle is not to be, it is to be allowed to be” |
No political institution, medical society or specific person can deny us the right to be for the simple reason that we are already emergency physicians. From the resident who comes out of a shift full of energy and knows that the Emergency is his thing, to the assistant who has spent ten years directing emergency situations and saving lives. This identity is conferred by hard work, sacrifice, untimely shifts and care pressure 24 hours a day, seven days a week throughout the year. We don’t need an official state bulletin to define us. We need it to organize ourselves, to claim our rights and define our field of work. Our fight is not to be, it is to be allowed to be.
The beginnings of Familia e Interna
Early sixties. Winds of change from the United States and Great Britain. These revolutions led, in 1978, to the creation of the specialty of Family Medicine in our country and culminated in its subsequent golden age as the central axis of the health system. I think of the frustration that family doctors must have felt until the specialty was created and in the subsequent years until it was consolidated; obsolete structures, government abandonment, atomization of professional practice, lack of resources, poor training and discredit and undervaluation of the rest of the medical profession. Family doctors understood the creation of a specialty was something necessary. They got it by fighting people, governments, and other disciplines that didn’t want or understand that family medicine should be a specialty.
On the other hand, since the first half of the 20th century, specialized training progressively eclipsed general medicine. From the womb of what is today the Internal Medicineemerged the Cardiologythe Pneumology o la nephrology. I can understand the frustration of general practitioners to see how little by little they were losing field of work and influence. Internal Medicine has never fit into a current system that tends towards specialization and this discomfort is manifested in a constant drive to return to a more general medicine. They are usually the hospital services with the highest volume of patients but they do not have the weight of yesteryear and in hospitals with strong and powerful specialties they end up being a mixed bag of patients with less interesting pathologies.
When I think of all the difficulties these two specialties have had to go through and all the identity problems they have dragged on for years, I cannot understand your determination to prevent the creation of the specialty of MUE. They should understand and support us better than anyone, and yet the three main family medicine societies and the internal medicine society have turned the creation of our specialty into a dangerous popularity contest where hatred and lies prevail more than truthful arguments and brotherhood; pamphlets such as “Almost 30 reasons to say NO to the emergency specialty”, the famous and embarrassing “official statement together with other scientific societies in relation to the proposal to create an Emergency specialty” and the dozens of opinions of senior officials and relevant personalities of these four medical societies, following a destructive line, censoring and delegitimizing our aspirations. The main political parties in this country have been showing support for years and promising on numerous occasions the creation of the EM specialty. Ministers and ministers as Jose Manuel Soria, Trinidad Jiménez, Leire Pajín, Carmen Montón and Salvador Illa. The current minister has not yet spoken, but a deputy from her same party, Carmen Andrés, in March 2021, in her speech at the Health Commission, explained that her political party has always “showed support for the creation of the specialty, we reaffirm ourselves in this commitment and express our appreciation to its professionals”. In this scenario, only one party across the political spectrum is opposed (the fourth party in seats in the last general election). It seems clear to me that something has to happen at the highest levels of power, because despite receiving the majority support of the political class in recent years, several non-law propositions (PNL) have been knocked down in the Health Commission of the Congress of the deputies. Powerful and influential personalities block the situation. People with names and surnames that are diluted in the network of acronyms and bureaucracy.
Arguments against the emergency specialty
One of his arguments against it is that the creation of the specialty does not meet the “real needs of citizens and the health system”. If we talk about the real needs of our society, Internal Medicine services should cede part of their hospitalization plants to services such as Geriatrics, really bet on home hospitalization or give prominence to palliative care. Primary Care management should focus on becoming the gateway to the health system again, resume health prevention strategies and promote the monitoring of chronic patients (who have been so helpless over the years) instead of wasting time money on ultrasound scanners and minor surgery material.
In his opinion, “professionals via MIR (family and intern) have acquired training in quality knowledge and skills, relevant to solving urgent problems, during the course of their specialty.” This is not only false, it is a dangerous delusion because it creates a false sense of security and also shows a deep ignorance of the state in which the specialized training in family and internal medicine, as far as urgent pathology is concerned. They are the kind of phrases that look good as slogans and are pronounced by people who hold important positions within the health organization chart or medical societies but who have lost touch with reality. Specialized training in family and internal medicine does not provide the knowledge or skills to deal with an emergency situation in the hospital or out-of-hospital setting with guarantees, and those who are able to do so do so because they have invested personal time and money out of their pocket to complete the training. parallel and unofficial.
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“Patients are happy because they go to the Emergency Room for non-urgent abdominal pain and come out with tests, imaging tests and a referral to Digestive. All in four hours. The inappropriate use of resources is never good care, no matter how satisfied they are.” citizens are; this way of approaching the process is harmful to our hypochondriac society and that it badly copes with uncertainty” |
For them, 60-70% of the consultations attended in the emergency services of the country are non-urgent pathology and the doctors who work there are perfectly trained to treat them. For this reason “citizens are satisfied” and also “social perception is biased” because work in the ER is not “mostly vital emergencies of apparent complexity.” It is the same type of argument that has led the Emergency services to prostitute their function by collecting the work of a Primary Care that has been dead for years. The patients are happy because they go to the Emergency Department for non-urgent abdominal pain and come out with blood tests, imaging tests and a referral to the Digestive Unit. All in four hours. The inappropriate use of resources is never a good service, no matter how satisfied the citizens are; This way of approaching the process is harmful to our hypochondriacal society, which badly copes with uncertainty. We work in this way because Primary Care is no longer the gateway to the health system; this creates an asymmetric situation that is addressed in the Emergency Department. Primary Care needs to become the basis of the system again. We need to assume that it is dead to create something new. The Urgency that we want, the one that we seek and demand, would be supported by quality Primary Care that manages that 60-70% of non-urgent pathologies. An Emergency without full waiting rooms and intended for that 30%-40% of urgent pathology.
Solutions for emergencies
His solution to our demands is the creation of a Specific Training Area (ACE) for the EUTM. This solution is at the same time a test that reveals the real reason for his opposition to the creation of the MUE specialty: to avoid by all means losing influence and power. It’s the foregone conclusion when the argument is so visceral and illogical. The ACEs are smoke, but they would allow them not to lose areas of contracting and influence, a carrot on the end of a stick: a power strategy that represents everything we want to change.
The specialty of MUE, our specialty, is necessary to ensure quality care and guarantee the safety of patients who come with urgent or emerging problems. It is necessary to alleviate the massive and annual flight of family residents to the Emergency Department that contributes to the lack of medical personnel in Primary Care throughout the country. Primary Care must be strong again and our specialty demand is not only compatible with this mission; would help to get it. It is necessary to define ourselves at an administrative, legal and labor level; without an established legal framework, we are unprotected against labor abuses who take advantage of many occasions of this administrative limbo. It is necessary to delimit and unify our field of study and work and thus put an end to unequal relations with other specialties.
It is necessary to provide us with quality training, consensual and balanced, and that can alleviate the deficits and deficiencies of a deficit specialized training. It is necessary to recognize the work of hundreds of colleagues who have been carrying out their work professionally for years. These are our reasons, the real reasons, those of ordinary people, far from the circles of power and influence, who work daily in Urgencies and Emergencies, the reasons derived from an intimate need and an identity problem. The reasons for our commitment and respect for our patients and their needs.
A few weeks ago I attended a training course at the hospital where I trained as a specialist doctor during my residency. I met again many colleagues and colleagues that I had not seen for a long time. During a break, I met one of my assistants in the ER. We talk about the state of the specialty and the latest news. I noticed that he lacked that verve and spirit that was so characteristic of him when he talked about this whole problem. Pessimism and weariness invaded him. More than twenty years working in the Emergency Department, training residents and saving the lives of patients. I remember one of his phrases: “I hope to see the MUE specialty before I retire”. I hope you see it too.