The “expert” doctor – Health Newspaper

Di S.Lenti, L. Polenzani, S.Giovannoni, E. Messina

August 26 –

Dear Director,
We believe that the SARS-CoV2 pandemic has significantly highlighted the fragility and heterogeneity of the NHS as a whole. The experience of the pandemic has shown how beneficial it is for general practitioners to acquire new skills in the technological field.

This helped reinforce the hypothesis of implementing an ‘expert physician’ figure, understood as a physician with special skills within primary care in a future regional assistance organization. However, it is doubtful in our opinion that the need to convert to the teaching of general medicine at the university stems from this.

The objective of the CFSMG course cannot be to create “expert physicians”. We are more than sure that the training objectives of CFSMG are to better prepare a general practitioner with all his complex identity.

The COVID phenomenon also tells another story, related not so much to a shortage of expert physicians, but to the continued and slow decline of investments in the region and at the same time the failure to create a regional network capable of responding to health. Population needs and last but not least, the lack of planning for the real needs of medical personnel.

Today, the need for a general medicine that guarantees, in addition to the treatment of diseases (Cure), the care of people (CARE), in a context characterized by the continuity of care and the centralization of relationships, is being strengthened; General medicine promotes health and ensures chronic responsibility and vulnerability, which is the challenge that must be met if we are to continue to ensure the universality of the right to treatment.

Medicine focused on the person and his microcosm (family, social, work) can ensure all this, through the appropriate use of resources, at a stage when “defensive” medicine is manifested through the use of laboratory tests and instruments. The physician’s actions do not support any disciplinary practice. Patient and family collaboration can allow the GP to plan and share personal interventions especially in chronic and debilitating cases.

If this is the identity of the GP who will have to meet the Millennium Challenge, the CFSMG will have to respond to these expectations. The goals to be achieved are comprehensively represented in the WONCA tree shared by general practitioners from all over Europe and beyond; Some of the skills can be briefly summarized in the following points:

• Building specific and customized preventive pathways in proactive action to promote health
• Diagnostics and treatment of diseases
• Enhance coping skills (particularly in chronic cases)
• Take care of the person in his complexity, in his psychosomatic unit also composed of emotions and existentialism
• Share with the patient the pathways and goals of care
• Orienting yourself according to “universal diagnoses”, as well as evaluating everything that belongs to the context in which the patient and his family live and in which one works
• Preparing doctors who know how to take care of themselves, in contrast program and above all prevention of burnout

To achieve these goals, future general practitioners will have to obtain:

• Awareness of working in an environment with low spread of disease
• Understand the importance of communication in relation to specific skills such as:
• Person-centered care, directed to the individual, family and community
• effective communication
• listening
• Narrative medicine
• Building and maintaining a long-term relationship
• Continuous care according to the patient’s need
• Semiotics that find expression and consistency in the interview and in the visit
• Skill in new technologies
• Knowledge of organizational methods in general medicine in all its forms

What has been described is a prerequisite for the training of professionals with a specific identity in which they recognize themselves, share methods, tasks and functions: this represents the goal of the CFSMG and not trivially to prepare “expert physicians”. So we ask ourselves how can those who do not practice it and have no knowledge or experience teach a profession. We would like to emphasize how the essential aspect of any training course is the transfer of knowledge, rejected in its various forms.

We recognize that general medicine definitely needs to be reorganized in the context of primary care to improve ‘management’ within its organizational components (Department, AFT, Role of Health, Shared Protocols in a multi-team perspective). In the process it is possible to anticipate the professional character of a ‘general practitioner with certain skills’, some of which may go beyond knowledge of the general medicine specialty, but is certainly functional in managing certain stages of chronicity/impairment and first rescue.

This raises the problem of defining the tasks and functions of these new professional figures and organizing a training course dedicated to achieving effective cooperation between the university hospital and general medicine. However, we believe this collaboration should go further, engaging in building a less fragmented NHS, and recognizing its different roles and skills.

Dr. Stefano Lenti

CFSMG Tuscany District Manager

Dr.. Loretta Bolzani
Former CFSMG Coordinator for Tuscany

Dr. Stefano Giovannini
Former CFSMG Coordinator for Tuscany

Dr. Emmanuel Messina
Former Director of CFSMG Tuscany

August 26, 2022
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