Doctors' strike: the problems of the healthcare system
The healthcare system is one of the most complex and successful achievements of democratic societies. Complex because knowledge, and consequently the capacity to treat illnesses, is constantly evolving for the benefit of us all, and also because those of us who are part of the healthcare system sometimes speak indecipherable jargon. Furthermore, healthcare activity indicators are not easy to interpret in their entirety. We must acknowledge that today we have more information than we are capable of processing to draw the necessary conclusions and adjustments.
The welfare state, when it first came to be called that, sought to deepen citizens' involvement in collective decisions related to how to live longer and better lives. The healthcare system of the second half of the 20th century has been a key element in achieving this second objective, although many other actions in urban spaces, housing, and food have also played a decisive role.
We have not made progress, however, in involving citizens in decisions regarding certain aspects of government action, and healthcare systems are an example. As I mentioned at the beginning, the healthcare system has become more complex and specialized in its actions, and a new system has been created de facto The idea that understanding this complexity is the domain of a small group is flawed. Even non-medical professionals present in some decision-making bodies of the system have failed to engage the public in the way this grand objective was originally envisioned.
But there are many things that should interest both the super-experts and the average user with equal intensity: What is the shared objective of all the operators involved in the public healthcare system? How is operational efficiency evaluated? How is the quality of the service provided monitored? How is user satisfaction improved? Clearly, they should also be interested in how all deviations from the defined objectives, agreed upon with the broadest possible social consensus, are addressed.
I don't understand the fulfillment of public responsibilities without clearly defining the aforementioned elements. Once these elements are defined and communicated in understandable language, it would be possible for the debates to focus on more than just waiting lists and the cost of on-call shifts.
I'm not saying that resolving these points isn't important, because they generate understandable discontent among users and healthcare workers. However, these are secondary considerations, because the main objective of any political leader in healthcare is for citizens to embrace the public system as their own and not want to abandon it, and—above all—to involve workers to the point that the changes needed to achieve operational efficiency become part of a collective commitment and a source of pride. This formulation may seem naive, but it points to dysfunctions that underlie all the problems the healthcare system faces today.
The success of the Catalan system in the 1980s and 90s wasn't just that various actors participated in a fully shared vision, but also that the professionals, all with scientific knowledge and social concerns, felt part of that transformation and were proud that politics was embracing the concepts of May '68.
Opening the debate on a framework statute without having secured the involvement of new generations of scientists could end up—and my colleagues will forgive me—with an even more corporatist organization of the medical profession. We risk forgetting that, since the new Bologna university system, nurses are also university graduates in health sciences, and therefore scientists who can and should assume much more responsibility and skills in treatments previously reserved for physicians.
Thinking that a few tweaks to the overhead budget of a particular primary care center will change systemic problems that originate in the workplace is a mistake. It's working against the involvement of scientists in evaluating the operational efficiency of the teams they belong to, stemming from a lack of trust in the scientific judgment of the very people who, let's not forget, are the guardians of one of the greatest achievements of our evolved society.
It's true that in the last fifteen years the number of users, the age of complex patients, as well as diagnostic capacity and treatment options have increased. But what has grown most is the distance between managers—both technical and political—and the teams that need to be involved to reduce waiting lists and address grievances.