Primary care: the law of reverse healthcare 49 years later

@varelalaf

The current primary care operation system guarantees citizens that they will be able to see their family doctor, or whoever replaces them, whenever they deem it convenient and, in this way, doctors, in their day to day, are faced with an agenda full of unfiltered visits, a source of widespread dissatisfaction, both for the neediest patients who feel under-served, as well as for doctors, who waste too much time in resolving matters that are not their own, not forgetting that, in this scenario, nurses are relegated to a secondary role.

Along these line, I would like to remind you that Julian Tudor Hart, a British family doctor, and one of the inspirers of the most communitary primary care, in 1971 described the law of reverse healthcare, an observation in which Tudor Hart said that there are more and more people who ask to see the family doctors for minor problems, which is a hindrance to properly treating sick people.

Triage as the Way Forward

Not too long ago the emergency services of the hospitals put sorted out the access to adjust the clinical work to the specific requirements of each person. Like any change, it was difficult, but seen in perspective, the matter was quite straightforward. It was necessary to agree what the selection criteria would be and, when they were decided, the professionals who should carry out the task were accordingly trained. Since then, people are treated according to the degree of urgency of their demand and resources are adapted to each level.

In my opinion, to overcome the current issue of unfiltered agendas, primary care leaders should be inspired by the emergency triage to generate their selection model, but first, they should be able to structure bedside equipment, a new collaborative format between doctors and family nurses, which should also incorporate social, administrative and other support professionals. This new model should solve the limitations of the current individualized assignment, and already in a teamwork framework, the next step should be to establish criteria and open differentiated agendas for each professional, considering that there could also be a combination of two or more professionals for specific attention.

Who should do the triage and how should it be done?

The triage unit, to be effective, would require specific training of the administrative staff assigned to it, in addition to having appropriate remote means so that all people can contact, if they wish, through the channels that the technology offers. The new model of primary care selection should allow the change of ready-to-wear one-size-fits-all for attention adjusted to the nature of the request, but if, for example, there was an error in the allocation, the coordination mechanisms themselves of the header equipment should be used for the necessary rectifications and adjustments.

In summary

Citizens have the right to be taken care of whenever they see fit, but that doesn’t exclude the fact that the system, to provide them with the most appropriate care, should be able to foresee the most appropriate resource for each specific need.

If we can deploy an efficient triage model, perhaps we will realize that we don’t need more doctors but we need to prevent them from wasting their time with so much bureaucracy and actions that don’t correspond to them, and nurses, social and administrative workers may assume more competencies.


Jordi Varela
Editor