We are facing the authentic epidemic of chronicity”

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Juana Carretero has become the second woman in the history of SEMI to preside over the Society. Carretero shows her concern about the general aging of professionals and the complicated generational change that is expected. For this reason, the internist is committed to promoting more attractive working and economic conditions for younger specialists and thus avoiding their exodus to other countries. On the other hand, she has highlighted the importance of promoting research within the specialty and publicizing the important work they do for the National Health System.

Ask. What are the main lines on which your presidency will revolve?

Reply. Research and make our specialty better known. The internal medicine specialty may be the specialists who have the most difficulties when it comes to saying what we are and what we do. Our main line is to defend our specialty as a fundamental trunk of medicine without fragmenting it. Always protecting internal medicine and our values. In short, always defend the patient. Our commitment is to always be close to the patient, we always have to seek his well-being and improve the quality of life of these people. With which, we have to abide by a strict ethical code, always act within that code with our values, our vision and within good practices to provide high-value medicine.

I would like us to be known more, in the general population and towards the rest of the specialties or scientific societies and, towards the people who make the decisions, the health authorities. Decisions are often made that influence our specialty, our way of working or how we can carry out our work influencing the people we serve. In fact, most of the time we are not there where the decisions are made. For this reason, we have to increase our visibility, both internally and with the population, but above all with the health authorities. For this, as internists, we not only have to do clinics, which we do very well, it is what we do and we are very comfortable, but more and more, we have to sell what we do and what we are. For that we have to promote research, clinical research, above all. We have to make good publications that put aside what we do every day and see how that improves the attention we give to people. For example, in the worst part of the pandemic, several internists came up with the idea of ​​keeping a record of those patients who were admitted to the plants with COVID. (SEMI COVID Record) and there are approximately 57 SEMI COVID Registry publications. In fact, we did that at the worst moment of the pandemic. It contributed to improve and provide knowledge about what we do and about the pathologies that these patients had.

Q. Is there any proposal within the Society to promote research?

We are clinicians, we really like the clinic, we really like talking to the patient, doing extensive clinical reasoning. But we are not used to taking it to an investigation or to publishing it. However, there are very powerful groups that do so in the SEMI, but we have to extend it to all internists. Likewise, encourage research at all levels. For this we are going to create a registry, as has already been created in recent times of the previous presidency, a registry of internists, like a LinkedIn of internal medicine researchers so that we can all be informed. Hence, trying to connect internists from many different places, so that they can get in touch and they can access certain resources that may allow you to develop the research.

These are the most important points of the mandate, apart from ensuring that the SEMI works well. Really continue to maintain the course that the SEMI is taking. Because the internists really do it well and we don’t have many problems, but we do have to try these two years, in those fields, to do as much as possible.

Q. The challenges that the specialty has is to face the chronicity of patients. How will chronicity be addressed? What challenges does the specialty have ahead of it?

R. Chronicity was already a problem before the pandemic. People are living longer and diseases are becoming more and more chronic. This undoubtedly requires that these people be cared for by generalists, both in primary and hospital care. Because a person who has kidney failure, heart failure, COPD and diabetes cannot go to four different specialists, being able to go to an internist who will assess him globally, provide comprehensive treatment and if he later needs a more specialized care, some diagnostic test that we cannot do, would be consulted. This attention to chronicity must always revolve around primary care and we on hospital care. That was a challenge before the pandemic, in fact, a lot of work is being done to implement chronicity plans in all health areas and in all communities. Although, there is a lot of dispersion by communities with the implementation of chronic care plans, but when COVID arrived it stopped. However, now we are facing the authentic epidemic of chronicity. People have long been cared for in the wrong way. That challenge must be taken up now and we are fighting and working with the administration so that they really invest in hiring and training more internists, because we believe that it is the most efficient way to approach these people.

Q. The pandemic has totally disrupted internal medicine. Has the pandemic meant a before and after in the specialty?

R. When the pandemic broke out, we left everything, and we took care of COVID patients, practically 85% of the patients we cared for were COVID patients. We had to postpone the rest of the patients in favor of these new hospitalized, who had to be treated no matter what. While the people who are in the consultation could wait several months to be treated. In addition, we were a small team, so many of our patients have lost that continuity of care, those periodic check-ups they had before the pandemic. With which, right now we find ourselves with patients who have not been seen in the consultation for two years, who also have difficulties accessing primary care, like everyone else, due to the problem that PC doctors are experiencing. In short, in our specialty, the pandemic has been very noticeable in our patients, it has caused a lot of havoc and we must always look for equity in the care given to people. So, all patients receive the same care in the most equitable way possible.

Q. What are the main lessons you have learned from the pandemic?

R. The more flexible the specialists who care for people are, the better. That we cannot compartmentalize care for these people. We cannot make watertight compartments, because, for example, when the patients with COVID arrived, whose were they? It was a new disease, which we did not know who should assume it. At first it seemed like a respiratory disease, then an infection, but in the end we saw that it was an infectious inflammatory disease that did not just produce pneumonia. So, the more general the care that we can give, the more easily we will adapt to these new challenges and to these new diseases. When it comes to caring for chronic patients, it is exactly the same. The more generalists we are, with fewer resources, with fewer professionals, we will be able to care for more patients. In this way, we will be able to prevent these people from having to come to the hospital repeatedly to be treated each time by a different specialist. We have learned that the really brave and efficient thing is to bet on generalist professionals. In short, bet on internists

Q. How does the specialty deal with the generalized aging of its health professionals?

R. The generational change is a big problem because it has not been addressed correctly in the past, the necessary provisions have not been made. We have to deal with the retirements of existing professionals and the overburdening of doctors today. COVID has taken a very significant toll, and people who were thinking of extending their working time beyond 65, 67, 68 years of age are not doing so. People are retiring earlier or especially when they can. All these forecasts have not been made in a normal scenario, a scenario without COVID, now in a scenario with COVID everything has changed drastically. We are how we are. We have a significant deficit of professionals and then, when young people finish, the MIRs have other needs, other ways of thinking than our generation could have. People now do not have that rootedness, that we had before, or they do not mind going to other countries to work where they are given better working conditions or the possibility of having greater professional development.

Q. What needs to be done to make this exodus of specialists?

R. On the one hand, to increase the places both in the faculties and the MIR places for both family doctors and internal medicine. It is necessary to offer these people who finish, opportunities to develop professionally, especially so that they can stay in areas of difficult coverage. One of the things that should be favored so that these people can develop is to provide them with the necessary means to promote their training. As for the professionals who leave these areas of difficult coverage, it is necessary to encourage them to have some type of benefit both at an economic level, such as favoring transfers that make going to a hospital further away, with fewer resources, attractive. for those professionals. It is not just a matter of offering money, but of providing better working conditions. Today, there is more and more private healthcare, and it is no longer seen as a complement to the exercise of healthcare activity in public healthcare, but rather as an option. They are offered better economic and labor conditions, without having to travel. You have to find a balance there, but I would bet on allowing these people a correct and attractive professional development.

Q. What does it mean for you to be the second woman to preside over SEMI?

R. A tremendous pride, because I come from a family where there is no doctor, a normal, humble family. I have always wanted to be a doctor and once I was, I always wanted to be an internist. Because I saw that people could be served globally. When I started doing internal medicine and I saw the presidents and professors, I saw it as something unattainable. Now it is a pride to be here and to be able to lead this society. It is a challenge, because of everything that has been done since then, especially the last presidents with whom I have had a closer relationship. Therefore, at least try to ensure that the place that society has reached during this time is not lost, and if more progress can be made, the better, but at least maintain everything we have achieved. In short, it is a source of pride, a great challenge and effort, because I live in Zafra and work in Badajoz. But fortunately the Extremadura health service allows me to free myself to be able to attend the SEMI and my service makes up for my absences in the best possible way. In conclusion, it is a challenge, a source of pride and a lot of satisfaction and responsibility.

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