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What should a patient who is ill with suspected Covid do? Call your doctor, who treats you, checks your positivity, then collects symptoms over the phone, offers advice, eventually sends you to the hospital for an evaluation or urgent hospitalization, otherwise monitors the situation and if necessary makes a home visit ( or send special Continuity Care Units, notes the Usca). Instead, in recent weeks, one in three infected, scared and left at home, will clog emergency rooms, where only Covid patients who require complex clinical evaluation should arrive.. Furthermore, one in three patients occupy hospital beds, even if they could be treated at home. However, in Italy there are 44,000 family doctors. Where does the mechanism get stuck?
Duties of the doctor
Law 833 of 1978 in art. 25 says: General medical assistance provided by employees or contracted personnel of the national health service that operates in local health units or in the municipality of residence of the citizen. Between the two alternatives, the choice fell on free profession in the agreement (Law 502 of 1992, art. 8), that is to say that the work of family doctors will be governed by three-year collective agreements signed by their union representatives and by the State-Regions Conference. Therefore, each additional service must go through union bargaining.
Who should care for the patient at home
For the Italian Medicines Agency, the family doctor must wait carefully in the home phase of the patient and effectively treat only feverish symptoms. The decree of April 8, 2020 says that frail and chronically severe patients must be supervised at home. In Milan, the Ats was informed of 127,735 sick doctors to contact by phone to verify the need for social support, the therapy taken and the general clinical conditions.. The planned incentive of 3 euros per patient. Well, only 48,624 have been attended. The other 79,110 were left uncovered. We are talking about patients whose risk of death, in the absence of surveillance, is eight times higher. The same decree urges local doctors to attend to their patients in quarantine, or discharged from hospitals but not yet cured, through telephone monitoring or home visits. In fact, each one decides for himself: who wants does it (we have seen doctors work beyond human limits without waiting for the decree), who does not want does not. It should be said that the distribution of personal protective equipment came with the dropper, as well as the availability of pulse oximeters (and worse for minimal diagnostic tools like chest ultrasound, which is currently not received).
Quick tests at the beginning
Meanwhile, the virus is running. For a quick identification of the outbreaks and the isolation of cases, on October 28 the current national collective agreement was integrated at the proposal of the ministers Roberto Speranza and Francesco Boccia: GPs are asked to perform rapid antigen testing on their suspected patients and their asymptomatic close contacts. The additional salary of 12 to 18 euros per pad. On November 4, Special Commissioner Domenico Arcuri began the distribution of 50,000 daily kits and more than 3 million weekly pieces of masks, visors, gloves and overalls. To this is added the endowment of the Regions. Doctors who fail to do so may be subject to disciplinary proceedings. But the agreement signed only by the Fimmg that represents 63% of family doctors, and even among these there are opponents and willing to return the union card. The most recurrent problem: studios are inside buildings and condominiums are opposed because they fear the coming and going of the infected. It is possible to carry them out in outdoor areas made available by the Municipalities. The fact is that the category is in crisis: in Lazio, for now, 341 have given availability (of 4,600). In Veneto, Governor Luca Zaia signed an ordinance: the 3,198 general practitioners are obliged to carry out rapid tests on their patients under pain of losing the agreement. The number of accessions in Emilia-Romagna on the high seas, in Lombardy, will only be known in the coming days.
The Hippocratic Oath
The fears are understandable (most are between 50 and 60 years old), and the fears about the burden of responsibility that no one has defined can be shared, but every doctor on graduation day swears to help in emergencies and make me available of the competent authority in case of public disaster. In hospitals, as we have seen, no one talked about it that much. What we do know is that even for the simple request to run the traditional buffer, From March to October in Milan, 39% of suspected Covid cases had to fend for themselves, while those reported by GPs were 61%. These include those who pulled their necks (8% reported more than 200 cases) and those who did as little as possible (20% stopped in 50 cases).
In any case, in the agreement with the unions, nothing was foreseen in home visits that would allow hospitals to send some patients home. There are only initiatives in no particular order: On October 30, the Lazio Region made a call to find general practitioners available to make home visits within the first two days of the onset of symptoms. There will also be financial compensation, but what is not specified in the advertisement.
Paradoxes
For months, the order: strengthen local medicine. In fact, for general practitioners they are considered a second-class category from the start, for at least three reasons. 1) The scholarship for new graduates who enroll in the three-year training course to become family doctors of 11 thousand euros per year, subject to Irpef and paid contributions; while for those who choose the 26 thousand specialization course, contributions included and without Irpef. It is clear that the young graduate will aim for the specialty, even if he has to pay an average of 2,400 euros per year for university fees. 2) Training is less and less than necessary: 2,864 general practitioners retired last year, but only 1,765 scholarships are awarded; in 2020 they drop to 1,032 to replace 3,493 that stop their activity this year. 3) Funding for three-year training courses of 38 million a year, the same figure as in 1989.
Finally, the total lack of planning– The 2019 scholarship contest was held at the end of October 2019, the training courses were supposed to start in March 2020, but have unfortunately been postponed to the end of September. The 2020 competition will take place in January 2021.
November 8, 2020 | 22:28
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