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Everywhere they boil beans, the primary care crisis is national heritage, and is that even the mighty U.S. in the same thing happens to us every day there are fewer medical students who want be family doctors, or at least that is what is concluded in the article: Changes in Medical Students' Views of Internal Medicine Careers From 1990 to 2007 , published in Archives of Internal Medicine . The causes of this decline is the fact that family doctors see many more patients than other specialties and instead charge less pasta. The students surveyed felt that general practice workload was more and more stress than other specialties. Thus, during a career spanning forty years, the total difference between a cardiologist and a generalist is close to $ 3.5 million (the technology-focused specialties pay much better attention to the management of diagnosis). Over the years, the attractiveness of primary care medicine, as a reason to study medicine, has fallen from 57 to 33 percent. Given these data, the thing is clear, it is necessary to change the image of the Primary Health Care compared to other specialties, so that students not only respect and admire the family medicine but want to do it.
seems to have opened Pandora's box of worms, depending how you look, with the announcement of the creation of the specialty of emergency medicine. I sincerely believe that most current residents are adequately trained and qualified for emergency medicine, but is this the philosophy of your training? We are family doctors to work in health centers or doctors we are potentially useful in all areas?. Possibly a surgeon is able to pass a primary care clinic, but is this role? Has this been the target your training?. I am one of those who still believe that that family medicine had its specific place of work: the health center, also believe it that the family physician performs and organizes its work within a team primary care sharing goals and working for the same and given population. I also believe in the integral and integrated, or those of its main pillars: Global and longitudinal, that of serving the whole person as a whole, and serve in their context and in their environment throughout his life. I am among those who believe that after the various attentions must establish a monitoring plan in order to assess adherence and evaluation of results achieved. I also believe in the need to meet the family as a system, how the disease affects them some of their members and how to use it as a health resource. It is true that we have forgotten his last name, as of COMMUNITY, that of identifying risk groups in our society, to make an active recruitment of vulnerable subjects, that of cooperating actively involved with community organizations in our environment. This is what I have learned over the years that is family medicine, and my limited understanding of emergency medicine is something else, possibly more exciting, more resolute, but for me it's like the difference between seeing a photograph and a movie.
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In this day, the Forum for Primary Care Physicians, which represents professional organizations of primary care medical nationwide, has called the National Day of Primary Care, (here in Murcia should be the day of the "Area of \u200b\u200bcontinuity of care" and that is how we are represented in the flowchart of Management and Single as you see we have lost by losing to the name). In this blog we subscribe to the publication of the text:
Call the door! We will no longer regularly called
Written by Robert Sanchez. Medical fourth-year resident of Family and Community Medicine. Prosperity Health Center. Madrid
few days ago, our resident Vanessa Ayala, published an entry about a clinic session on adolescent care which he expressed that "Physically, the adolescent may be considered a healthy individual, they sick on rare occasions" , a few lines below we read "... because of the sense of invulnerability and omnipotence of the adolescent, it must be remembered that this can lead to maintain risk behaviors (snuff, alcohol, drugs, etc). " This hypothesis seems to have come true, because for the first time kills more teenagers than children in the world. I was struck by the study, published in The Lancet , analyzing mortality data in the last five decades in 50 countries with high, medium and low income. The study finds that although overall mortality rates have declined, the numbers of premature deaths are far higher in people aged between 15 and 24. The causes are mainly violence, suicide and traffic accidents.
When a teen comes first to my query from the query of Pediatrics, I have the habit of scheduling a visit with him, which he titled " Welcome to the world of adults" , I know that this consultation should continue minimum technical standards of the service portfolio to weigh, height, power sockets, vision inspection, exploration mouth ... but sincerely I miss. In this consultation, which usually lasts about 20 minutes talking about adolescent sexuality ("awakening") , snuff, alcohol and other drugs ("forbidden") and traffic accidents ("the pleasure of risk ") . I know it's little time for such broad topics, but it's not a lecture, and strokes are just a way to open the door of my office in case I need. For me, frankly, is one of the most rewarding queries I do, and in view of the public believes that I have not changed my clinical practice, time will have to weigh, sizes ....
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New Reflections of our R4, Dr. Yanira de la Torre
As we all know time does not exist in our country specialized in emergency medicine and emergency, so that, in most cases, emergencies are handled by specialists in Family and Community Medicine.
Given this situation, one would expect in this specialty are properly train residents to perform efficiently and certain ease his work in the field of Family Medicine and in the ER. I am a resident family of "near seniors" and begin to consider the employment potential in the future I will have next. I am interested in the work that my colleagues are doing now, "adjuntillos." Many make substitutions in a health center, but many others working in the EMU or a PCES, like it or not, is the work that has been offered.
Given this reality, I wonder, am I really ready for proper care in the field of outpatient emergency? What do I know intubation, stops, mobilization of multiple trauma, non-invasive ventilation, intraosseous medication ....? NOTHING. And training is provided in the last year of residency the acquisition of these skills? NO.
spent many hours in the hospital emergency room, but as cheap labor, since most of the guards performed the pits watching the interesting cases, but also a lot of trash and, of course, many situations of risk vital imminent. I think I can count on the fingers of "hemodynamic" I've seen in years and never was alone, of which I have to say I'm glad. Also in the Morales Meseguer Hospital is giving priority to training in "beds" where they are more severely ill patients, residents, hospital specialty, so The family partners have now been completed in the best case, about 50 guards in beds, 5 guards for a month for 10 months (while "scholars" are from Year 2 made). 10 months to 4 years. Why so few? For the rest of the time is spent taking work forward in the pits. But our contract is a contract of training in addition to care? SI.
This text attempts to reflect on the functioning of the system. If you expect to be ready to deal with emergencies in any context, why not me is my management? To this question I have no answer ...
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OPEN FORUM: The cohesion of the National Health System
Marciano Sanchez Bayle, president of the International Association of Health Policy and FADSP spokesman
Since the transfers were completed, there has been a drift in the National Health System which has primacy over-particularism of the autonomous regions, facilitated by the absence of effective systems of coordination and inability to articulate a common policy line in health between the Ministry of Health and the Health Departments of the Autonomous
Madrid (02/01/1911) .- The lack of cohesion in the National Health System a fairly clear that highlights some abracadabra situations such as the absence of a routine immunization schedule despite the evidence that the epidemiological reality and knowledge Scientists do not respect the boundary lines of the CCAA, but also in other less known facts, but no less important for the implications this has for the design of health policies, such as lack of updated information and approved at the NHS . There
course differences in health indicators of the CCAA, differences that appear to be mediated primarily by socioeconomic status. So the maximum difference in life expectancy at birth is 2.4 years between Navarre and the Canary Islands (mean 79.6 years) in the percentage of population with poor health expectancy at birth is 5.5 per cent between Galicia and La Rioja (mean 24.8 percent), and on the rate of potential years of life lost per 1,000 inhabitants, the maximum difference of 9.61 between the Canary Islands and Castilla y León (average 39.68).
is known that the influence of the health system on population health is limited (explains about 14-20 percent of it) and also their impact will occur in the medium to long term, it is likely differences are detected now only produce identifiable differences of 15-20 years (one study shows that an increase in health spending $ 100 a decrease in mortality of 0.01 per cent).
The large differences in resources between the ACs have basically two explanations. The first related to the financing model not being a finalist allows health funds to be decided by each autonomous region and end up being very different. If we look at per capita budgets for 2010 we see that there is a difference of € 556.71 (on average € 1443.94) and that this difference between the highest and lowest per capita funding does not have a tendency to decrease.
Congruently, resource differences are striking, both in hospital beds per 1,000 population (1.8 beds with an average maximum difference of 3.6), as well as professional resources in primary care (1,067 inhabitants per doctor maximum difference on an average of 1,410) and technology, and logically active (vaccination coverage for children and over 65 years, offering diagnostic and therapeutic procedures, etc) which also generates large differences in waiting lists (over 130 days in the first consultation of the specialist and more than 15 percent in the percentage having this consultation with a delay exceeding 15 days) and surgery rates and the delay access to them. A major problem is that the expected delays are not public disaggregated by regions, preventing evaluation. Obviously
this is already producing inequalities in access to health care and end up having repercussions on the health of the population.
The second reason has to do with the health care model is advocated from each region. Some ACs are betting so decided by the health privatization funds and consequently reduce the public health system, as well as the PFI model and administrative concessions to private companies that produce inflexible financial commitments in times of cuts further reduce funding of schools public.
What can be done? It seems obvious that the first thing is to ensure coordination the NHS as a whole, it is indispensable to provide the Inter-Territorial Council the ability to make common decisions binding on all, then establish health objectives for the NHS as a whole, or, which is, to adopt the Integrated Plan Health is still pending since 1986 is contained in the General Health Law and the RD 938/1989 and never saw the light, making good that claim Sánchez Albornoz that Spain is characterized by good laws that routinely fail. Should also make sure the final character of health financing and establish minimum standards of health provision (infrastructure, personnel, etc) and of course, two key issues: an approved health information, disaggregated by regions and public (can not steal from the public knowledge of what is done with their taxes) and the intervention of the Ministry of Health where, as in the case of privatization, is called into question the essential characteristics of public health system.
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the morning, after the relevant reception (presentation of the act), is presented in two different classrooms at the same time, clinical cases accepted as a poster, where first-year residents of the health center Vistalegre-Fleet contribute our bit with the case entitled "More than osteoarthritis" at the end, after "a coffee", were given several workshops for residents, when in which all participants we split again, each going to where we were registered. In my case, I was in the one entitled "Update on COPD, where there were some general ideas about this condition, which never come bad considering the frequency with which we are dealing with it. At the end, and after half an hour of "rest", we ate.
Immediately after, he began the exposure of clinical cases as "oral presentation" (according to criteria of the scientific committee), also presented in two different classrooms, in this case, we participate in a clinical case entitled "The dizziness that improves with sugar." At the end, there was another training session in this case, I I went to "The Departed," which was very practical and interesting, approaching a little more to the handling of infiltration techniques, useful in expanding our capabilities, enabling us to solve more problems in our daily activities. In parallel, several workshops were held for students, having to choose between: "CPR", "Introduction to electrocardiography," and "minor surgery."
Finally, came the closing of the conference, with gratitude to all those attending the awards to clinical cases found most interesting, and a projection of Doctors Without Borders, showing at a glance what your task, encouraging us to participate with them in any of several possible ways .
Later, we met a very limited number of participants to go to the "Gala Dinner" which was the true end of these days, but many people forget ... (Although I have to say that did not stop that became a meeting place where we share many experiences, exchange views and laughter and established new ties.).
experience in general was pretty good, tiring but good. I missed a bit more organization, for up to 3-4 days before the appointed day, residents were going to present a clinical case, we had no information on how we had to submit (if such poster or PowerPoint presentation) ; missed many residents do not know if the lack of information or lack of motivation ... and I did not feel they were a conference with students, which was the "novelty" of this event, because if not misunderstood, one of ends this event was to share the family medicine with them, let them know a little more of our specialty, that it is always the talk of the world, but in reality, is the great unknown. Maybe because it was Friday, perhaps because students were not well informed about what it was that day (so I could see as many of them told me), attendance was sparse, and the student-resident interaction quite zero.
Regardless, we must thank the organizers of this "project" which will embark on this adventure, because for the first time that we went to an event of this kind, served us as a touchdown for the multitude of experiences of a similar nature that we hope to enjoy in the near future. Moreover, from here (How easy it is to say it!) I encourage the emergence of the "Eleventh Day of Family Medicine Residents and Community" and "Second Day of Medical Students" in the Region of Murcia, in which I will be happy to participate again.
Greetings to everyone!
I have a friend who called the doctor at the UN and not because he works for the institution, but because it has counted more than 40 different nationalities in its quota. In this reality of our consultations, a few days ago appeared a patient, a Colombian, who after the initial greeting tells me
.- Doctor, look at me! I have sadness.
Given this expression, unusual, I establish the relationship melancholy depression (melancholy . (Del lat. Melancholia ) f. vague sadness, deep, quiet, permanent, born of natural causes or moral, which causes the sufferer can not find pleasure or fun at all.) and the beginning of an interview aimed to assess the extent of it. During the interrogation was a dissonance between my language and expression. After a few minutes of conversation, told him that I find nothing in the interview that made me suspect a depressive background to what he told me that of course which is phenomenal, he's happy and that is certainly not depressed. Before this, I insist:
. - So ... How do you say that it is melancholy?
.- But why, look at me! I have "a melancholy white patch on the back."
Paso to effectively explore and discover a little below the neck an irregular spot, white, slightly larger than a coin of 2 euros, making a rapid diagnosis of these we do based solely on observation.
told him what I know of this dermatological condition and say that this disease la conoce normalmente como vitíligo , a lo que él me contesta que en su país es padecer de la melancolía. La sonrisa brotó en nuestras caras. Al parecer en otros países al vitíligo se le llama también bienteveo . Un caso más de los que vivimos día a día en nuestras consultas y aprendemos de nuestros pacientes.
