Artificial intelligence is already part of the daily life of primary care in Catalonia. In fact, ChatGPT is the most used tool by family doctors, far ahead of other options, according to a study published in The Lancet Primary Care. The work, promoted by the Societat Catalana de Medicina Familiar i Comunitària (CAMFiC) and led by Antoni Sisó, shows that AI has become a regular support in tasks such as medical literature research, text drafting, or clinical session preparation.

Getting water in your ears isn't serious, this is the first thing Fran Fernández Segura, a family doctor at the CAP la Paz in Barcelona, ​​makes clear, but it can be annoying. "The external ear is like a tube, and when water gets in it at the beach or in the pool, it will come out naturally," he explains. If it takes a while or bothers us, we can use a towel to dry the ear or move our head. However, under no circumstances should the ear be manipulated by inserting objects or cotton swabs "because it can become inflamed and we can introduce bacteria."

"I am AXIA, a personal agent for healthcare professionals. I provide diagnostic guidance according to medical protocols and clinical guidelines." This is how the new generative artificial intelligence (AI) that has been available to all primary care center (CAP) staff in Catalonia for two months is presented. It's a kind of ChatGPT developed by the Department of Health to assist healthcare professionals in decision-making: when a patient comes into the office, the doctor can discuss their case—without providing personal details—and the AI will propose diagnoses and treatments compatible with the described symptoms. According to the ARA (Argentine National Health Association), it will be on trial until the end of the year, and then a decision will be made on whether or not to continue it based on its reception.

The resilience It is a term that derives from Latin resilient, participate in the verb resiliency, which means "to jump back and bounce." It refers to an individual's ability to adapt and recover from an adverse or risky situation. There's no doubt that we've had a few unexpected situations in recent years, and on a global scale. Remember the 2008 financial crisis, the coronavirus pandemic, the rise in armed conflicts, and the subsequent escalation in prices? If we add to the social, economic, and political context the fact that insufficient resources are allocated to our mental health, frankly, getting through this successfully seems more heroic than resilient.

As a legacy of the pandemic, the Catalan health system has a multitude of contingency plans to respond to external phenomena quickly and flexibly. The latest example of an emergency situation shook the Iberian Peninsula on Monday. While the country held its breath for an unprecedented blackout that paralyzed everythingPrimary care centers (CAPs) and hospitals ensured that all urgent activity that could not be postponed could be handled normally. However, to ensure they had sufficient energy and to avoid travel at this most uncertain time, almost 5,000 medical tests and 500 operations were postponed, according to provisional data from the Department of Health. Sources consulted by ARA emphasize that all interventions without serious impacts on care are already being rescheduled.

Absolute rejection by all primary care representatives of the measure proposed by the Catalan Health Institute (ICS) to grant financial incentives to doctors who process discharges for patients referred by mutual insurance companies. Colleges, scientific societies, and unions reacted this Monday against the proposal, which ultimately came to nothing after the ICS backed down. "There will be no objective designed to incentivize doctors to increase the number of discharges," stated sources from the company after the uproar.

The number of sick leaves due to covid (or at least due to symptoms compatible with the virus) has doubled in the last month due to the avalanche of infections during the seventh wave: about 5,000 infections are detected every day despite the fact that the real figure is much higher. Up until now, and since last May, diagnostic efforts were focused exclusively on the vulnerable population; those infected who felt unable to go to work (or work from home) had to go to their health centres in person to request a sick leave from their GP leave, who decided whether the symptoms they described were incapacitating. In short, the Department of Health standardised the evaluation and management of covid as if it were any other pathology. But as of Wednesday, due to the high incidence in the middle of the summer season, with fewer professionals working and with the fear that the health service could collapse for a third consecutive year, the Department has brought back online and automatic processing of sick leave for symptoms compatible with covid. This sick leave is limited (only valid for five days) and will allow the affected population to request sick leave on La Meva Salut app or the Salut website, without the need to provide a positive test and without having to make an appointment to visit their doctor.

Contagions are on the rise and Catalonia is once again experiencing a wave of covid, the seventh in just over two years. Most of the cases are not recorded because, by protocol, tests are only carried out on the over-60 and results from tests carried out at home are no longer counted. This means knowing how the pandemic is evolving is now more difficult than ever, but there is one indisputable way to identify a significant increase in infections: an increase in the number of patients seen by primary care centres and hospitals. And this is precisely what is happening. Catalan Health minister Josep Maria Argimon doubts the impact of this wave will be similar to those experienced in previous waves, but the rise in cases coincides with staff holidays, especially nurses, who are usually the most difficult positions to fill. In addition, according to primary care and hospital workers, there is limited information on the variants now in circulation, which have a greater capacity for transmission. There is no doubt, however, that the more infections there are, the more overloaded the system will be.

The workload generated by covid in primary care is unsustainable: on Monday 97,081 consultations related to the virus were made, the highest figure of the entire pandemic. However, and unlike other waves, most of the patients who arrive suffer mild symptoms and many want to confirm their positive result with a diagnostic test or process their sick leave, which always has to be validated by a doctor. The professionals consulted by ARA warn that they are exhausted and that the trickle of these patients makes the ordinary functioning of the centres impossible, since it prevents access to medical care for people with other urgent illnesses.

It was an innocent question: "How are you?" But enough to tip her over. "I burst into tears and I couldn't stop. I thought I was fine, but I had an anxiety attack. They sent me home and I spent two months with psychological help," explains Marta –fictitious name– an A&E nurse at Bellvitge Hospital. The increased workload, fatigue and uncertainty impact on health workers' mental health after almost two years of the pandemic. Marta works in the emergency surgical block, the only one of the five blocks that attended everything but covid during the pandemic, "and we have found ourselves with a greater workload because operating rooms, outpatient clinics and diagnostic tests have stopped, pathologies have taken longer to diagnose and tumors longer to be operated on, and this means it is more likely for there to be complications," she explains. She assures that they are not back to 100% activity. "At each wave, when beds were needed for covid, we have had to stop our activity. And now, with the sixth wave, patients cannot go up to the ward because they are occupied with covid patients and they accumulate in A&E, it is a collapse". After two months on sick leave she has already returned to her job.

The avalanche of covid cases - more than 7,000 in the last hours - and tests for close contacts have saturated the primary care centres and the Department of Health has decided on Wednesday that hospitals will also enable points to make diagnostic tests. Health minister Josep Maria Argimon has admitted "a lot of concern" for health centres in an interview on Tv3 and has indicated that support from hospital staff will help ease the pressure health centres have been experiencing over the past fortnight, especially in Barcelona and its metropolitan area. The assistant to the direction of primary care of the Institut Català de la Salut (ICS), Ariadna Mas, has explained on Catalunya Ràdio that tents will be set up outside health centres to test positive contacts and thus avoid risk of contagion inside the facilities. "We need many hands for testing and diagnosis," she explained.

The explosion of covid infections among young people is putting primary care centres (PCCs) on the ropes. With a large part of the vulnerable population vaccinated, hospitals and especially ICUs have been decongesting and now it is mainly the burden of unvaccinated patients between 15 and 30 years of age with mild infections that is stifling the outpatient clinics. The data are shocking: in fifteen days the number of positives that are diagnosed in Catalonia with antigen tests - the test that primary healthcare centres perform when they come across a possible case - has increased tenfold and only this week 8,354 infections have been detected. Some of the new cases also correspond to tourists and the forecast is that the incidence continues to rise.