Dear Director,
someone might ask: why such a counter-current choice, or why now? Why do you choose General Medicine, you who have always said you want to leave with Doctors Without Borders or want to do “great things”? Well, it’s not that easy to explain: at times I struggle even to tell it to myself, let alone what can happen when others ask me.
But this very special and intimate Christmas has inspired in me a series of reflections that made me want to write, black and white.
And so, here I am to tell you what I dream.
I dream of a territorial medicine equal to the complexity of the real world, between inequalities and absurdities. Who knows how to respond promptly to the patient’s needs: a non-fragmented, visionary, present medicine.
I dream of a family medicine equal to everything I have learned in recent years, from the SISM to the Community of Sant’Egidio, to the world of international cooperation: a medicine that knows that poverty is a determinant of health as is cigarette smoking or substance abuse. Who knows the neighbourhoods, the people who live there, and who knows how to get his hands dirty when it comes to doing so.
I dream of general medicine that knows how to revolutionize and renew its foundations, focusing its work on health promotion and proximity medicine. In which the generational change in progress becomes an opportunity to overcome old logic and build new ones, through a continuous dialogue between health professionals and institutions, on a level that is culturally and deontologically higher than the banal trade union bargaining.
Without adequate clinical training, future general practitioners will never have the opportunity to overturn a system based on guarantee and bargaining. So, I dream of a high quality, independent, interactive training; who knows how to draw from the practice in a hospital, Case Della Salute and GP of the three-year period all that is possible, and even beyond.
I dream of becoming the General Practitioner I needed last month, when Covid-positive, I was scared in bed, and I wanted to rely on someone to visit me in my home (lucky USCAR came).
And again, I dream of a territorial medicine that is not closed in on itself, that knows how to delegate bureaucracy to bureaucrats and recover high-level clinical skills. Because analysis, synthesis and research skills are essential for a doctor who will one day work in the hospital, but even more so – probably – for a doctor who will one day work in contact with the extreme variety of the territory.
It is now clear to everyone how efficient the hospital-centre system is in the treatment of patients in acute but not chronic, or efficient in the case of acute myocardial infarction, but not in the course of an epochal pandemic. Just as it is now clear to everyone how urgent the need for unity in disease, rather than fragmentation, is.
So how can we think of still believing in a public health system, universalistic and accessible to all, if not starting from territorial medicine? Societies are changing: the number of elderly people suffering from chronic diseases is increasing, families are becoming thinner, elderly people often live alone and find themselves having to face the most fragile phase of their life in three places to choose from: at home alone, in the nursing home or in the hospital.
The traditional acute-care approach has proved unsuccessful. So, what are we waiting for?
Finally, I dream of family medicine at the height of my dreams, because giving up the Specialization School in Infectious and Tropical Diseases at Gemelli, certainly does not cost me little, after the endless series of jokes of Mr Minister Manfredi, all the effort experienced and six years of university, in which after graduation the path traced is one, and certainly not that of general medicine.
And so, I dream that “little things” become Big things. “Every choice is also a renunciation.”
Dr Manuela Petino
1st-year student in General Medicine in the Lazio Region
