Defend

Salvador Casado

Everyone defends something, mainly their interest. In the healthcare world in which I work, this also happens and it is very common for these interests to clash between some professional categories against others or those who think in one way against those who think the opposite. In fact, this division has been one of the main reasons for the high levels of institutional mistreatment of health professionals in our environment.

But, beyond the purely statutory, I would like to ask the following question What do I defend as a public family doctor in a rural health centre? What do you defend from your position?

I could start by saying that I defend a series of ethical and deontological values, some basic principles of family and community medicine such as longitudinality, accessibility, integrality, polyvalence, closeness to the patient... and although all this is true I would like to go a little further.

What I basically feel I am defending are people. People who come to consult as patients, sick or healthy, with some fear or health problem. People who belong to a community and a family I know. People who in many cases are in vulnerable situations for various reasons or are facing serious illnesses or life crises that cause them pain, discomfort or suffering.

And that advocacy requires me to be more than just a technician who fulfils his institutional obligations, his portfolio of services and his programme contract with Primary Care management. It requires me to be human, something that paradoxically cannot be measured and therefore is not easy to count. 

But my patients know this. As soon as they enter my clinic they know the degree of humanity their doctor has that day. If I are absent-minded, if I are in a hurry, if I will not be able to spend a minimum of time with them, or maybe I will. They know if I worry about their case or if I overlook it and take it out of my hands, they know if I offer them easy solutions or if I go in deep, they know if I am in tune or not. 

The defence of others therefore has a musical aspect, it needs to sound good, to be in tune. If it is not, we are left with shouts or squeaks, with mere performance, at most with a mise en scène. Personal tuning implies having presence, being present, having the capacity to listen. It implies the recognition of the other as one's own and not as someone else's, to understand deeply that the wound they show you is somehow similar to your own, to know that the personal space that others show you along with their miseries is sacred ground and it is necessary to take off one's shoes so as not to stain it with the mud one may drag. 

When I see how politicians and decision-makers defend their partisan interests and their level of power, I cannot help but look at myself empty-handed. I also get confused and often try to sweep up for my own benefit. I also cheat and sometimes I get away with it. But like first-time violinists I keep tuning my instrument knowing that my clumsiness will inevitably end up ruining the sound. This desire is perhaps the only thing of value that I can truly bring to those who place their trust in me. 

I consider myself a barefoot doctor for the above reasons and because the institution where I work does not make it easy for me to walk safely by forcing me to attend the patient with times and manners that would often be more typical of veterinary care than of adults, sparing me the possibility of an anamnesis, an exploration and a minimum of reflection.  I feel it is fundamental to make it visible but I do not like to get stuck in an attitude of permanent complaint or protest that I consider toxic both for me and for those around me. That is why I make it compatible by sharing my scarce reflection on what I consider to be a narrative path that connects and twins me with many other caregivers. 

Defending is therefore an essential verb for me that joins a long list whose conjugation allows me to find meaning in what I do. And that in these times is very valuable because every society needs people who not only serve and support, but also bring understanding and insight. Perhaps you don't recognize this as you deserve, but I can assure you that when I manage to be faithful to these values my conscience can rest in peace at night, something that few notable or powerful people can afford. 

@doctorCasado

Link to blog "La consulta del Doctor Casado"