There is a strange silence, around us, and it is the one left by the general medicine that is disappearing. It is not a phenomenon that takes place suddenly but with a slow fading. In summer, the physiological deficiency is heard for the legitimate holidays of the professionals and during these periods of absence, often, there are no substitutes. The general practitioner is not a public employee, but a freelancer agreement with the National Health Service. This means that, despite being an integral part of the system, it does not enjoy the organizational structures or the support that employee workers would also have even in the event of a replacement.

The emergency room as a “last beach”

The patient, when he cannot contact his trusted doctor, often turns improperly to the emergency room, open 24 hours a day. The consequence? An improper use of the emergency and urgency service, already in trouble, with the overcrowding of the emergency room and waiting times that stretch for everyone. Also for truly needy patients.

We are talking about 1,500-2,000 family doctors who will retire every year for the next ten years and no number of substitutes that will fill the void because the real problem is that today general medicine is not attractive. We mind well, and I particularly want to underline it, that there is no shortage of doctors in Italy but they simply do not choose to take the path to become general practitioners. A path that, unlike the other specialists, is not university, but managed by the Fimmg, the Italian Family Federation of Family Doctors, is less paid and involves the choice of a freelance work with a “business risk”.

The mirage of health houses

The general practitioner, today, is at the same time secretary, manager, switchboard operator, cyber, accountant. And he must also think about finding a substitute, at his own expense, during periods of vacation. It is not surprising then that more and more doctors choose to associate in polychers, trying to share spaces, costs and workloads, perhaps with the support of administrative and nursing staff.

A necessary solution, in many cases useful, but which should not be confused with the concept of community house. Because a set of studies organized to better manage bureaucracy is not the same as a place conceived to offer the patient concrete and integrated answers, with the presence of specialists, basic diagnostics, shared welfare paths. The community house is – or should be – a territorial public garrison capable of absorbing and solving complex health needs without resorting to the hospital, if not in serious cases. A place where specialists also pass.

But according to the latest Agenas data of the 1,717 community houses provided by the PNRR, only 485 are active. But an even more chilling figure tells us that active with all the services (including doctors and nurses) there are only 46.

The loss of contact medicine

The defeat of territorial medicine inevitably brings that of contact medicine with it. Fragile, elderly, non -self -sufficient patients remain closed in the house, often abandoned, because no one reaches them anymore. The family doctor risks becoming a mythological figure. One of those who remember with nostalgia, but that are no longer seen.

If we see a significant decrease in the number of family doctors, the workload for those remaining with consequent loss of contact medicine increases. The time dedicated to each patient is reduced, compromising the quality of assistance and the possibility of building a relationship of trust. In addition, the unavailability of the doctor or long waiting times make access to difficult care, especially for the elderly and people with reduced mobility. In Italy, it is estimated that between 3 and 4 million people are without a family doctor with serious repercussions on individual health and the efficiency of the health system as a whole.

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