Primary Health Care: Working in the Darkness

Working as a family doctor these days is not easy because we're walking blind. First of all we are trying to do as much work as possible over the phone to prevent patients from travelling and coming to a health facility if it can be avoided. On the other hand we do not have reliable data. Every day we receive various protocols, instructions, directives, official emails and so on in what has been a fluctuating data overload in addition to what everyone receives through their personal social networks, Whastapp groups and so on. 

The truth is that the clinical picture of #covid19 is very variable, both in intensity and in manifestations. It produces sudden worsening without warning, which we have no way of foreseeing, and although it can be forceful with older people, we are also seeing severe cases in the fifties or sixties. 

I have been asking for days to be able to do chest X-rays at the regional specialty center to try to decongest the hospitals, I even asked to be able to have access to hydroxychloroquine to be able to treat mild pneumonias in young patients without associated comorbidity... both things are not possible at this time in my health area. Everything has to be sent to the hospital. 

On the other hand, in Primary Health Care we see how the staff is reduced both by sick leave and by the diversion of professionals to the Ifema macro hospital. Who will be in charge of keeping patients with minor pathologies at home if we run out of health centres?

Instead of maintaining a clear leadership, health care runs like a headless chicken without. We are all nervous about doing many things without being clear about which direction the boat is going and this, together with all of the above, makes me feel that I am sailing blindly, without seeing clearly. 

I will not take advantage of this to make eulogies in favour of Primary Health Care or to criticise the "perfidious" politicians and health managers. I will only share several ideas in a constructive spirit. 

1. Let us improve the management of information, both institutional and scientific

a) Health departments should provide a daily report of new developments with hyperlinks to annexes or sources. 

b) Some multi-professional group could systematize scientific information with relevance to clinical practice. If possible, in brief format or on video, with their corresponding references.

2. Let us improve the value of health centres
a) Facilitate the internal organization of work according to the idiosyncrasies and resources of each centre (respiratory circuit, circuit of other patients, triage, call management, community health, coordination with management/hospital/other resources).

b) Let us promote telemedicine and home management of the patient at home.

c) Allow remote access to medical records (for professionals in quarantine or on leave if symptoms allow for telemedicine).

d) Follow up on patients discharged from hospital.

e) Establish criteria for admission and transfer to hospital.

f) Implement community health activities and coordinate with the City Council, civil protection, volunteers.

g) Promotion suport to old people's homes and coordinate with their directors and professionals.

3. Improve the functioning of hospital emergency

a) Reinforce human resources with professionals from other hospital units.

b) Reinforce material, beds and other spaces (external tents, waiting rooms, library...)

c) Reinforce admissions both to hospital beds and to medicalised hotels, other resources or home hospitalisation coordinated with Primary Care. 

And above all, let's take care of the mood and personal rest. These are weeks of great personal, social and, in the case of the health workers, professional tension. In order to continue to be able to do our best, we must be able to disconnect and try to put our heads in other things so that we can return to the task with energy on the next shift. I wish you much encouragement!

Salvador Casado

Family Doctor. Villalba. Servicio Madrileño de Salud


Link to blog "La consulta del Doctor Casado"