La distancia en Atención Primaria

Nunca la atención médica telefónica podrá sustituir a la atención personal y a la relación médico-paciente, nunca se establecerá el conocimiento y la confianza suficiente como para resolver los problemas de salud a distancia.

M. Victoria Calvo Pérez , Médica de familia jubilada

 

La Atención Primaria de Salud es:

*Asistencia sanitaria esencial.

*Accesible a todos los individuos y familias de la comunidad.

*A través de los medios aceptables para ellos.

*Con su plena participación.

*Con un costo asequible para la comunidad y el país.

He tenido que tirar de viejos conocimientos para ver si pudiera entender algo de lo que se está convirtiendo ya en habitual. Dediqué treinta años de mi vida a trabajar para que la gente recuperara su salud; ahora quien demanda esa atención soy yo. Sin pasar por alto algunos errores y muchas deficiencias con las que tuve que lidiar, la situación actual de la Atención Primaria ha llegado a extremos inauditos. Acuñé en aquellos tiempos una frase coloquial, «siempre podremos estar peor» como fórmula irónica de poder asumir aquella situación. Bien se dice que la realidad supera la imaginación y lo «peor» ha llegado ya.

En estos momentos me voy a referir, parece ser que idónea, a la llamada, «atención telefónica», algo que ha llegado para quedarse. Si bien en unos primeros momentos de la pandemia podría aceptarse como medida de emergencia, hoy, casi diez meses después, nada ni nadie puede justificarla.

Nuestro Sistema Público de Salud andaba ya tocado del ala, pese a las muchas alabanzas políticas diversas. Se había prescindido de inmensos recursos, sobre todo humanos, siempre por razones de crisis económica. Entre tanto aparecían los llamados «conciertos» y otras colaboraciones con entidades privadas, a las cuales sus atenciones sanitarias se les pagaban a toca teja con dinero público, todo ello ya contemplado en la Ley General de Sanidad de 1986 y la posterior Ley 15/97 de Nuevas Formas de Gestión.

Con esta base nos llegó la COVID-19 con su sobrecarga de atención, escasez de recursos, etc… Como se pudo se reorganizó el Sistema (sin tocar la privada pese a las declaraciones) y en esa debacle la Atención Primaria Sanitaria (APS), base fundamental de cualquier Sistema de Salud, sencillamente ha desaparecido. Pese a todos los proclamados anuncios de refuerzos, en la práctica y en lo que percibe el paciente, no se ha hecho absolutamente nada salvo mover peones de lugar. Leo en el periódico local de Málaga que no va a haber sustituciones en estas próximas fechas y ¡¡¡ojo!!! por falta de médicos disponibles. Nuestros dirigentes/gestores de salud nunca hubieran pensado en ello pese a las pésimas condiciones de trabajo que venían ofreciendo. Fui atendida una vez por un neumólogo que llevaba tres años en el hospital encadenando contratos mes a mes. Consecuencia de ello: quien pudo emigró.  Bajando a la vida cotidiana, en mi calidad ahora de paciente, voy a reseñar otras situaciones con las que me topo, tanto yo como mi entorno más cercano. Soy ya una paciente con enfermedades importantes, crónicas, lo que me hace utilizar con relativa frecuencia la Atención Primaria (AP), mi médic@ y enfermer@ de familia. En estos momentos las citas no son posibles antes de 2 o 3 semanas, por supuesto «atención telefónica» y no siempre con la misma persona. Que ningún médico de familia, hospital, gestor o el diablo con bata venga a justificarme esta situación, pura aberración de los principios de la  Atención Primaria.

Si la AP está colapsada no es porque los pacientes sean hiperfrecuentadores, sean reiterativos o demanden cuestiones administrativas, es simplemente una pésima gestión y planificación por parte de los gestores del sistema, donde se han estado priorizando la productividad y el ahorro, jamás la mejora de la atención y el aumento de los niveles de salud.

Nunca la «atención telefónica» podrá sustituir a la atención personal y la relación médico-paciente, nunca se establecerá el conocimiento y la confianza suficiente como para resolver los problemas de salud a distancia.

Hoy se sabe la cantidad de patologías mal atendidas qué se están produciendo, las interminables listas de espera que procuran derivarse a la privada, con el consiguiente aumento del gasto, etc… Y me consta que la privada no da puntada sin hilo y ante cualquier intervención quirúrgica procura repetir todas las pruebas preoperatorias  para mejorar, con dinero público, su cuenta de resultados.

Si el Sistema Público de Salud andaba escaso, al amparo de esta pandemia se van a implantar las medidas más adversas e inútiles para la salud, lo que procurará el desarrollo y expansión de los sistemas de salud privados. Hace falta aumentar la financiación del Sistema Público con el aumento, ante todo, de recursos humanos sin los cuales ya podrá haber tecnología, pero ni la mejor será suficiente para mejorar los niveles de salud, incluida la «atención telefónica». Ahora bien, el incremento de la financiación del sector público de la sanidad debe ir parejo a la derogación de todas aquellas disposiciones de la Ley General de Sanidad de 1986 y de la posterior Ley 15/97 de Nuevas Formas de Gestión que favorecen el traspaso de fondos públicos al sector privado de la sanidad.

Y un consejo. Tras la lectura de este texto váyanse al comienzo y cotejen la definición.

M. Victoria Calvo Pérez , Médica de familia jubilada

La distancia en Atención Primaria

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