Illness was difficult in Portugal about 50 years ago, when the phrase “medicine is the first of sciences while health is the first of the goods” was common in the corridors of medical school, uttered with much rudeness and arrogance. Holy water, to annoy friends who are not medical students more than the contentment they were said to want to pretend.
In fact, we can even accept the idea that medicine may not be a science per se, but a body of science that enhances knowledge and which, if put together correctly, becomes medicine.
Chemistry, physics, biology, physiology, mathematics, pharmacology, mathematics, all the so-called exact sciences enhance knowledge through trial, trial and error, and more experience over and over, until a safe end result, while medicine, perhaps, is a philosophy It unites the knowledge generated by the so-called exact sciences on a philosophical basis, with the service of others, to those who suffer, being a lump and a catalyst of this union of knowledge.
Medicine in itself is not synonymous with health, but it does contribute to health. The World Health Organization defines this as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Health is not an individual benefit. It is a collective value, good for all, and must be enjoyed by each individual, without prejudice to others, and in solidarity with all, just as medicine, nursing and all specialized fields that share the same purposes are a union of knowledge from many different areas.
For this reason, talking about health as just another essay in a political game will lead to knowledge bias, since political approaches are usually not based on scientific knowledge, but also usually on personal convictions that have not passed through the sieve of experience, a hypothesis that leads to the thesis being tested. And retested until a safe and reliable result is obtained.
Health transcends physical spaces where the different aspects of care leading up to it converge, from first administrative action to medical advice and follow-up, in order to achieve shared well-being.
Thus, all interrelated work, administrative, nursing, ancillary diagnostic exams, and medical advice, needs physical space in order to be effective. The office, health center or hospital embodies this physical space, without which the care necessary for the development of health would not be able to respond effectively.
But, since it is also a philosophical approach to the convergence of knowledge, this must be, for this very reason, the starting point for a global approach.
We can have a hospital, a health center, a fully finished and very well equipped office. If the concept does not live there, it is worthless. In other words, consultations and exams will take place, but the end result will not get good health care.
In order for the end result to be effective and satisfactory, it is necessary to combine the efforts of all concerned, including respecting everyone’s space, without mishap, in cooperation. Peer-to-peer relationship is fundamental to the ultimate satisfaction of the patient (used in the newest and most politically correct terminology), as well as of all those called upon to cooperate for this purpose.
Motivation brings satisfaction, and inhibition brings dissatisfaction.
The dissatisfaction of professionals working together to ensure effective health inevitably leads to patient (user) dissatisfaction.
And just because it’s new doesn’t make it better.
We can go in the top of the Mercedes range with 120,000 km or in a new FIAT 500 (advertisement pass) from Lisbon to Bragança which we will take, complying with good driving rules, about the same time, but we will. It might be more comfortable at first. That is, the best is not because it is new. It’s only better if the content is better.
It was difficult to get sick in Portugal fifty years ago.
There were no hospitals in terms of quantity or quality, doctors were devoted to their offices and clinics where they cared who could pay and people were entitled to welfare funds where they were treated like sardines in a can. With the emergence of the state’s social role as a result of the April 25 revolution, the National Health Service was established, similar to similar services found in the United Kingdom and the Nordic countries, where the state provided needs in terms of health care • The health of the population, regardless of their social and economic status. A strong sense of public duty has also been enforced in medical schools, leading some thousands of young doctors to commit unreservedly to the NHS. Jobs were identified, and although the salary was not very attractive, it guaranteed future employment. In the early days of SNS, there was not much concern about unaccounted hours or overtime, because what mattered most was the service provided.
But the SNS was born biased, with a strong base of hospital hacking, that is, it based its structure on hospitals, which were an essential part of the system, secondary to the importance of primary care, forgetting that the relationship between primary care / hospital care should be the base of the hierarchy, since it must The patient (later called users) moves from the first to the second and not from the first to the second, as is often the case. And this peer relationship must be personal, from doctor to doctor and not impersonal from hospital service to health center or vice versa, thus losing the direct trust relationship that must exist between peers of the same profession who treat the same patient.
Meanwhile, as a counterpoint to public structures, private hospitals began to appear, gaining space due to the ineffective (and non-existent) change of mindset, which is necessary for the feeling of public “duty” to become attractive, i.e. to work for those who need it most. The allure of better rewards in private activity has led many young people to choose the second option over the first, and so we are where we are now.
And we are, once again, trying to captivate young doctors with salary increases, without any increase in incentive. Young doctors lack motivation at the time of their training as ex-specialists, and this motivation cannot be based solely on the salary they will take home at the end of the month. They need more, much more, and they need to feel nurtured by a system that only seems to want them to fill in the gaps in public services.
Motivation should be based on the quality of training, on peer communication, which is central to the development of scientific knowledge, and on links with universities and research.
There is a lot to do and a lot to explore to attract young doctors before they are offered exorbitant salaries, which is undoubtedly an important factor, but one that should not be of paramount importance.
Oftentimes, the above “first goods” also serve to gain attention, precisely because they are a commodity essential to physical, mental and social well-being. A new structure can be a form of palliative care for an old mindset.
It is necessary to look at the pyramid, as Maslow described it, from bottom to top, starting from the base, and not from top to bottom, only for self-satisfaction, accidental to all those who want to make their “first of the sciences” (which we have already seen. Not be) Just because they need to ‘satisfy’ the first good as much as casting votes from time to time.
We can, and we must, know how to do better.
But for this it is necessary to change the paradigms and mindsets of political leaders, who seem to be doing everything they can to make the disease difficult in Portugal in 2022.
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