For months or even years – since the Covid pandemic at least – there has not been a news program that does not talk about flaws, shortcomings, staff strikes, lack of updates and so on. For our social network – the greatest achievement after freedom, April 25, which brought us out of dictatorial oppression.
Having been a doctor for 70 years, I witnessed the long evolution of medical care in our country until the birth of the NHS, and had a modest involvement in it.
After the revolution there was a large influx of students into colleges and we saw the emergence of a large number of doctors who accumulated in Lisbon. It is clear that at the international level, after the famous ALMA meeting, the benefit of having primary care (primary, not primary) before hospital care, which we call secondary care, has become well established.
Even before April 25, the problem had already begun to arise among us at the initiative of Miller Guerra, who encouraged public meetings to discuss such a possibility (at which I was always present).
But what to do with the large number of doctors who accumulated in colleges after April 25? Five years later, someone had the idea of organizing a “suburban medical service,” spreading these doctors throughout the interior of the country without the support of more experienced colleagues. It was an opportunity for young doctors to realize the poverty and state of our population and their complete abandonment from the point of view of disease care.
It was an excellent idea to create appetite for potential SNS. Two other veteran doctors of the famous British SNS came from England to learn about the Portuguese reality and offer advice. The Minister of Social Affairs, António Arnault, created our social networks.
A group of these young doctors created an association (APMCG), invited me to lead it (I already had a lot of experience and a white beard), and began the struggle to provide specific training for these newly graduated doctors, to persuade them to colleges to create a general practice specialty. And to persuade the authorities to adopt these new structures.
General practice soon became family medicine, on a much larger scale and with much greater prospects for better serving the population – and later health centers and family health units were born.
We have reached a critical point: universal service funds have improved their effectiveness and organization. And we come to the present, the SNS crisis and the efforts to provide every Portuguese person with a family doctor. The problem is widespread. The news talks about a shortage of doctors, emergency rooms and closed services, which has created a state of panic among the population, especially in the so-called emergency rooms.
Meetings and more meetings, strikes, declarations setting emergency hours, etc.
Having arrived here, I would say that there is a lot of talk about fees, there is a lot of talk with unions, ideas are being put forward, and it is even said that there is money. I don’t hear anyone putting their finger on the wound. Family doctors must have specific training, must have time to listen to the patient, and must live in a team with nurses (and, if possible, with psychologists, physical therapists, etc.).
Some statistics say that out of 800 complaints, only one requires hospitalization! And here’s the problem – I don’t hear anyone talking easily about training family doctors and also about jobs that lead to continuous training and effort to advance. Everyone claims that the problems are serious, there is a lot of talk about salaries and very little about training – and this, in our opinion, is the “secret” in appeasing the “healthy people”.
And in the background, we have the problem of large private health companies and medical business companies, which, for me, it is necessary to put “in the forefront.” For a real response to the health crisis, more than unions are needed, contributions from unions and professional associations are needed!
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