Always making the same decisions in health systems and hoping for better outcomes the next year is a poor strategy, and patients and professionals suffer every winter. Respiratory viruses emerge with greater or lesser force every winter, and except during turbulent times of pandemics, influenza floods health centers and hospitals again and again. “That’s not how it should be. …
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Always making the same decisions in health systems and hoping for better outcomes the next year is a poor strategy, and patients and professionals suffer every winter. Respiratory viruses emerge with greater or lesser force every winter, and except during turbulent times of pandemics, influenza floods health centers and hospitals again and again. “That’s not how it should be. The flu is not something special, it’s something predictable. The most special thing is COVID-19. If flu overwhelms hospitals every year, it’s because of the decisions we insist on making in health systems. Imbalances and problems persist for a long time,” explains Ana García-Altes (Barcelona, 51), President of the Association of Health Economics (AES).. This discipline studies how best to use existing resources to obtain care for diseases and health promotion for optimal results.
ask. Are we not allocating resources well enough to respond to flu waves?
answer. Doesn’t it seem like that? If we have something as predictable as a flu epidemic every year, we’re not doing something right.
ask. It may also be due to lack of money and the need to invest more…
R. That may be part of it, but I don’t think it’s the most important part. If investing more money doesn’t provide value in terms of health, then investing more money isn’t the best solution. Also, what do you do with more money? Hire more doctors? If they tell us they don’t, then they’re missing. This is also incorrect, as Spain has more doctors per million inhabitants than the OECD average.
ask. Well, the health department couldn’t find them…
R. The problem is that the family doctors that we train and that we need to deal with influenza in the health centers are not there. They’re in hospital emergencies, they’re in palliative care… they’re scattered throughout the system because primary care doesn’t appeal to them. We spend a lot of money to train them, we have more doctors than the average of surrounding countries, but when push comes to shove, we lack them where we need them.
ask. Is this the reason hospitals are saturated?
R. For this and other things. Emergency room corridors are crowded with patients, and when this happens repeatedly without anything unusual happening, it indicates that there is a problem at every level: in civic education, in public health policy, in the consulting work of doctors…
ask. Let’s review these errors. In your opinion, the first one is civic education…
R. Our attendance rates are very high, much higher than surrounding countries. People always think that you have to see a doctor for everything, but that’s not the case. For example, with uncomplicated influenza, patients can care for themselves at home without the need for professional visits.
ask. But if I have a fever of 39 degrees for three days in a row, feel terrible, and can’t eat, how do I know if I should see a doctor?
R. If necessary, you can call resources such as 061, or request an electronic consultation via email. Or get better self-care training.
ask. Who provides me with such training?
R. There’s no one right now, and that’s part of the problem. This can be done from school. Nowadays, classes are taught about the benefits of the Mediterranean diet, the importance of eating healthy foods…but, on the other hand, there is barely any knowledge about healthy self-care. There are many other actions that systems and authorities can take. During the epidemic, some actions began to be taken in this regard, but they did not continue.
ask. Isn’t it dangerous to go to extremes? For the elderly and vulnerable groups…
R. No. The system has to protect the most vulnerable, who have to go to the doctor, to the infirmary when they need to… In these situations, being there in person adds a lot of value. But in many other respects it contributes almost nothing, while other resources (061, e-consultations…) are more efficient. The real value is using the appropriate resources to address each behavior. But if we all think about going to the doctor, we will end up overloading medical centers. When they stop giving of themselves, we go straight to the hospital.
ask. Understood. Explain another question to us.
R. We are squandering the potential benefits of the flu vaccine, which can be a great tool in the fight against other illnesses.
ask. Tell the doctor, many people don’t understand.
R. This shows that everything we still need to do at every level: administration, public health services, scientific associations, professionals… We must be guided by evidence-based medicine. What this tells us is that the flu vaccine reduces mortality and hospitalization rates in the recommended population. This is not the perfect vaccine we want. Sometimes its effectiveness is lower, depending on the strain chosen. But it is undeniable that if more were used, the pressure on the health system would be reduced.
ask. What do we do in a health center?
R. First, health care workers must stop doing things that add no value: sick days, bureaucratic tasks, inconsequential visits… it’s a waste. The great contribution of a family physician is to take care of his patients, to whom he can provide the highest quality of care. In a short time, you will be able to discover what is important because you understand it very well. The same goes for nursing. Let professionals do what is necessary and free them from ancillary things that other professionals, such as administrators, can do.
ask. Sorry, but that doesn’t sound very original. We’ve been hearing it for years.
R. But we did very little. It has been repeated many times that the basis of the system is primary care, yet the Government act as if they do not believe this. Necessary resources were not committed, solution capabilities were not provided, and professionals were not attractive…The focus of the system shifted in practice to the hospitals.
ask. because?
R. Because we have weakened primary care and are forced to care for unnecessarily high numbers of patients. When this happens, the response it can provide falls short of patients’ expectations, and they end up looking at the hospital as the place where the real problem can be solved, because that’s where the government is focused. This further increases the flow of patients to the emergency room until the condition becomes chronic.
ask. But shouldn’t hospitals be prepared for an increase in patient numbers?
R. First of all, it’s not that easy to do due to space and personnel constraints…but in reality, most of these patients should not go to the emergency room. They should self-care at home or be cared for by appropriate system resources to manage the clinical course. You should only go to the hospital if necessary, as it is a place that can even be dangerous.
ask. As?
R. Health experts like Andrew Segura joke that hospitals should put up large signs warning of the dangers inside. This has certain practical significance. The hospital is a place where seriously ill patients are treated, a place where the risk of adverse effects cannot be ignored, a place where nosocomial infections occur… It is not a place to go for unimportant things, but a place when care is truly needed. Treatment is not available at other levels of the health system.
ask. Well, I understand that in an ideal world, fewer people would get the flu because of the vaccine. Many people also take care of themselves at home. You can dial 061 at most. Those who need to see a family doctor can get timely treatment. Few people reach hospitals, especially those with severe conditions, who can be treated in undersaturated emergency services. that’s it?
R. Yes.
ask. Why isn’t it done yet?
R. That’s the problem, even though it’s the ideal goal we must strive to achieve. The problem is that we don’t seem to be doing this. Taking a step forward is difficult, and public health remains central to civic life and national politics. Everything around her is heavily influenced by other debates. It would be interesting to come up with an agreement that preserves the protocol space and co-working space so we can move forward. Furthermore, this is a space in which many actors with important interests intervene. We have to be able to find the formula that allows us to manage it all and make it compatible with the common good.