2024-02-17 12:02:13
San Diego is a popular neighborhood located southeast of Madrid, in the district of Vallecas Bridge. The multiculturalism of San Diego is not a label for electoral consumption: it is supported by figures (around 35% of its slightly more than 40,000 inhabitants are immigrants) and historically sedimented in the community work that this neighborhood has carried out for decades around various neuralgic points. .
One of those points is the Vicente Soldevilla Health Centerwhich officially has an assigned population of 30.000 personas. Last February 15 was the last day of work for Daniel García Blanco, the only regular doctor left at this health center on the afternoon shift. It goes. She leaves him. He resigns. “I can’t take it anymore. The situation is unsustainable. For a few months now, I have felt that the work I do in the office does not maintain the conditions or the minimum quality standards that patients deserve: It is not serious or professional. This is not Family and Community Medicine, and not because I don’t want to or don’t know how. I simply cannot; We do not have the necessary means. So the most honest thing is to hang up the robe“.
Mute witness of the farewell of his family doctor, the facade of Vicente Soldevilla looks askance down the street. Less than a kilometer away, just a 10-minute walk away, stands proudly the headquarters of the Assembly of the Community of Madrid. Their lordships (from all political parties) often travel through the area of influence of Vicente Soldevilla. For the neighborhood that today is left without a regular afternoon doctor. The de facto dismantling of the evening medical shift also leaves about 10,000 of the 30,000 residents assigned to Vicente Soldevilla no active reference doctor.
Linked in one way or another to the health center for almost two decades, García Blanco is the quintessence of the doctor who boasts the two surnames of his specialty (Family and Community, both…). He attended the MIR at the Vicente Soldevilla, worked at the center on health promotion projects promoted by the Madrid City Council, was at the genesis of the so-called Vallecas Community Health Board and, although he then moved momentarily away from its center, he never completely abandoned it. In 2020, when what broke out broke out, he asked to return “to lend a hand” and he already stayed as a starter. She was coming home.
Of the eight medical positions assigned in the afternoon shift, just a year ago there were seven occupied. A luxury. From there, he tells us, the trickle came: “Of the seven of us, one colleague left and her position was never filled, despite the fact that there were two colleagues who had expressly asked to work here, and do so on the afternoon shift. . In theory, You had to wait for the places to go public, they could apply for them and they were assigned.. “In short, it took them more than a month to leave and the two candidates were already working somewhere else.”
When a family doctor leaves, he takes both hands with him, but his job stays, and the rest of the staff has to share it. At Vicente Soldevilla, the healthcare part of this job is not trivial: each doctor is assigned a health booklet with 1,800 or 2,000 patients. Translated to day to day, “we talk about work schedules with an average of 60 appointments a day, but, this last month, there have been days in which the appointments have exceeded 80 and 90. That is neither attention, nor primary, nor community; that is seeing a string of people without pause or concert“, denounces this family doctor.
The whiting that bites its tail is a classic in every self-respecting Care Saturation Manual in PC: “If to your almost 2,000 patients, you add the quota of a colleague who is not replaced, there is no way around it: saturation , stress, leave, resignations, transfer requests…”. Of the seven initial doctors, In October there were “two and a half” left: him and another colleague (both part-time to care for minors), and a third colleague who came two afternoons to cover part of the day for those who were on leave.
“Since October, on Mondays and Fridays there was only one doctor after 5:30 p.m., the delay in making an appointment shot up to over a month and there were days when we closed the center at 10:30 p.m., to try to meet a demand that overwhelmed us.” Vicente Soldevilla then shouted for help.
“We spoke with the Assistance Directorate and had several meetings with the Management to inform them of the agonizing situation of the center and ask them for concrete solutions. In addition to caring for patients at the center, we had to cover home calls and we had no hands. Literally. “They listened to us, they gave us good words, but there were no concrete solutions.”
According to García Blanco, the lack of official response was made up for – for better or worse – with another classic from the Assistance Saturation Manual: the tighten the rows. “Here, teamwork is much more than a cliché. From Nursing, taking care alone of immobilized or chronically ill patients at home; or the administrative staff, looking for non-existent gaps in the agendas, to the midwives, the physios , the cleaning staff…”.
MARGIN FOR… WORSENING
In October, anyway, Vicente Soldevilla had lost more than 68% of the afternoon medical staff that it had just a year before. From then on, there is only room for improvement, García Blanco must have thought. Well no. There was still room for worse.
On February 1, the pending mobility calls were resolved and two physicians requested (and obtained) the transfer to the morning shift for conciliation reasons. García Blanco remains the only regular doctor…, and with reduced hours. The afternoon shift is a dissolved sugar: “A doctor comes on Tuesdays, for 4 hours, to attend to the overflow agenda [en el Vicente Soldevilla todo es rebosamiento]and the colleague who came two afternoons to cover the absences of the squad continues to help us, but it is evident that we cannot cope“.
At the beginning of February, García Blanco gives the notice: if things do not change by February 15, he too will leave. “If they haven’t changed in years, it seems obvious that they won’t do it in two weeks, but I think the best way for there to be catharsis is to make this decision, no matter how much it cost me. You have to be clear, coherent, and reorganize the situation from scratch. “I am a family doctor, my vocation is healthcare, I want to continue seeing patients and, if possible, do so in the same center, but it does not seem honest to me to continue in these conditions.”
Water leaks, by the way, are not just about doctors: of the 14 nursing professionals who, according to data from the Ministry of Health, practice in Vicente Soldevilla, three have already requested transfer to other centers. Nor exclusive to the center of Vallecano. According to data published by Amyts this same month of February, there are up to 18 health centers in the Community of Madrid with a “serious or very serious” shortage of personnel, “the majority, curiously, focused on neighborhoods where there are more needs and where strong public services are needed,” says García Blanco.
These 18 health centers have, in total, a population of more than 480,000 Madrid residents, and a common denominator: Vacant positions in Family and Pediatrics. According to Amyts’ count, at the Abrantes Health Center (Carabanchel), for example, 9 of the 17 family doctors that it should have on staff are missing; 5 of 14 in the Pinto Health Center and 8 of the 18 that Parque Loranca should have. In the case of Pediatrics, the Panaderas Health Center (Fuenlabrada) has its 6 assigned positions vacant, and 4 of the 5 pediatricians who, on paper, are assigned to the Carabanchel Alto Health Center are missing.
DON’T CALL IT FAMILY MEDICINE…
If History in capital letters is written with dates, battles, treaties and illustrious figures, the history of the primary care crisis is written with improvement plans, meetings, forums, monographic meetings, days of reflection, improvement documents, interterritorial councils. .., a lengthy list that “I have no idea what it is for,” says García Blanco, “if it does not translate into concrete changes and real institutional support.”
In the last Interterritorial Council, held last Friday, the Health Minister of the community where the Vicente Soldevilla Health Center is located asked the ministry to talk about the problem of professionals. García Blanco would be delighted to sit down with Fatima Matute and tell them what the problem is about, or what it is about, at least, in their health center.
“Of course they don’t find doctors, because what they are looking for are professionals with low salaries, who assume the quota of their colleagues if they leave, who see more than 60 patients a day or who work piecework. And that, I insist, is not Family and Community Medicine“, emphasizes García Blanco.
In the last Interterritorial, the communities complained about the primary doctors that they cannot find, but none made reference to those who are leaving. To the next meeting, perhaps they could invite the García Blancos from the SNS.
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