user – Good morning, my father is 100 years old and needs to see a doctor urgently. I fear he has pneumonia. He has had a persistent cough and yellow phlegm for four days and has a headache and muscle pain. He does not have a high fever, but he usually does not have a fever.
Health Center – Then bring him to the health center for a checkup this afternoon in the emergency room.
Ut – My father is bedridden. What I ask is that the doctor comes home.
CS -No urgent home consultations.
Ut – I don’t understand….
CS – Health centers do not provide urgent home consultations. The doctor may come there when he is available, but I do not know when that will happen. If it is urgent, call an ambulance and go to the hospital.
I couldn’t believe what I had just heard. It was the same health system that sent me to the hospital emergency room, without first being seen by a doctor who could resolve the situation without overloading the hospital emergency room or putting the patient at risk of contracting bacteria and having to wait on a stretcher for hours to be seen.
I still couldn’t believe it and thought I had misunderstood the situation, so I asked a friend who also works in medicine at a health center for clarification, and she confirmed that this was indeed the case:
Our schedule does not include urgent home visits. It depends on the goodwill, availability and common sense of the doctor to carry out these consultations: in his free time, when he leaves work, or fit them into scheduled appointments, or carry out these consultations at lunchtime or arrange with a colleague who sees some of your scheduled appointments so that you can be temporarily absent.
Here’s the thing: There is no room in family doctors’ schedules to respond to urgent, daily home requests. There is no clinical response, in primary health care, to the needs of the most vulnerable patients, in a state of dependency and with the worsening of their condition, nor to users at the end of their life or independent people who suddenly become ill and are unable to travel.
In order to improve the performance of the SNS (National Health Service), it is urgent to expand the entry points to primary care. A comprehensive reorganization is needed that does not exclude an increasingly ageing population, who are being abandoned to volunteer doctors who are more available or conscientious.
In the above incident, I had no choice but to seek private medical services. Pneumonia was confirmed and the doctor prescribed antibiotics.
My parents had been without a family doctor for several years. In January, this gap was filled by the appointment of a very friendly young doctor. One day when I asked him for a home consultation, he replied that he would come during the lunch hour. Ten minutes after the first phone call, he called me back and asked if the house was far away. If I could go on foot. I found the question strange and replied that it would take an hour to walk… Then he told me that he would not be able to go that day. “Maybe tomorrow.” I asked her what had happened and she replied that she had a car from the health center at her disposal, but since she did not know how to drive, the only option was to travel with the driver, but he had already left. I asked, so you could not come by taxi? He replied: No, “this situation is not covered by the regulations.” So the visit was postponed due to the inflexible strictness.
With a fragile 100-year-old, events repeat themselves, and shortly after we had to go to the (public) hospital as everything pointed to a relapse of pneumonia. The doctor who attended us told us that my father needed to take antibiotics in the hospital and prescribed hospital treatment. I had read some information about home treatment – which was actually successful – so I asked for it. It didn’t happen, and I don’t even know why, as it mentioned the constant support of two caregivers (who alternate) and a private nurse who came home to see my father every week, and every day if necessary.
In the last months of his life, my father had a lot of aspiration pneumonia (he choked and food got into his lungs) despite the nurse suctioning him whenever necessary. I checked and then realized what the doctors meant when they said “you need antibiotics in the hospital, let’s admit you”. Most of the time this meant that I needed to receive the antibiotic intravenously. Later, when this happened (another pneumonia confirmed by the private doctor who came to the house) there were one or two cases where I got the prescribed antibiotics from the pharmacy and asked the nurse to give them that way. On a third occasion, the antibiotic in question was not available in the pharmacy, but I got it by other means. And all went well. He was treated at home, in his environment, with his family, avoiding the risk of contracting hospital bacteria and leaving a bed available for those who needed it most. I have a vague feeling that I did something secret this time, but I still don’t understand why the doctors don’t check whether the patient is able to take these medications at home instead of admitting him straight away to the hospital.
As for the nurses in the health centers, I noticed that they were punctual in the pre-scheduled treatment appointments, but we cannot rely on them to respond to emergencies. This is what happened when I had to arrive to see my father unexpectedly. I had to resort again to the private system, because in this sector (nursing) too, primary care is not organized to respond to the urgent needs of users.
There is an urgent need to reorganize health centers so that emergency cases are not pushed to hospitals as is happening.. If these emerging conditions, as well as the vulnerabilities of a population increasingly weakened by longevity, are not taken into account, no emergency plan will be able to address health problems.
