"It is key that in the faculties of Medicine an area of knowledge of primary care is generated"

• A health in crisis (III) Juan Torres: "We are facing the worst health crisis that the system has experienced in 40 years"
• A health in crisis (II) Gabriel del Pozo: "The Ministry of Health must also assume its responsibility for not having done the duties of planning professionals"
• A health in crisis (I) Carlos Rus: "Health in Spain is a social achievement and private a choice of the health model, both at the level of management and users"

Back in 1973, it was born thanks to the impulse of a group of rural doctors the Spanish Society of Rural Medicine, the germ of what is now Semergen. Its ninth president, José Polo García, comments that when this scientific society "pioneer in primary care" was founded 50 years ago, the country had more deficiencies than now, "that we are an economic power". Today, the health situation is complicated and primary care is wounded, he acknowledges, but believes that "if we want an in-depth reform and improvements in the short, medium and long term, it is better not with the electoral noise."

Madrid is going to close the chapter of the strikes by reaching an agreement, as has already happened in other autonomies. Has the issue been fixed? We will see if, in the end, the promises of the agreements are reflected and developed, because many of them are made with the urgency of protest and silencing the noise in this pre-electoral period. We must see the fine print, that the development of the proposals is feasible and tangible. One of the requests that has been covered is economic needs. Are they enough? They are important, but not unique. There are also a number of problems which are professional development itself, continuing training; of family reconciliation. It seems that we have put out fires, but we have left embers for ourselves. How do you assess that, on the one hand, it is agreed to limit agendas to 35 patients, but on the other hand it is agreed to pay for afternoon consultations? There is a certain mismatch, because, if in the morning we can no longer see 36 patients, in the afternoon how many do we see? And if the doctor already starts to be overloaded in the morning... It is still a bonus and cover the hole a little. Among the bureaucratic burdens are sick leave. The Primary Care Forum urged doctors as of January 9 not to sign those leaves that they considered not to be theirs. What follow-up or impact has the measure had? The implementation of any measure is always slow in the Administration and also in a State like ours, in a health system where people go through communities, it takes time ... With regard to refusing as such to make a document, from Semergen it has been pointed out a lot. I do not know to what extent a professional or a worker of the public system can refuse to sign certain documents. And the current legislation is clear: the professional who makes a diagnosis to that patient must sign the discharge. Keep in mind that, in the event of a resounding refusal to sign a document, the injured party is the patient. There are communities or health areas that can possibly do it in four days and the others can be slower. I don't like all-or-nothing measures.Has primary-hospital coordination improved? It is a pending issue and I think complicated in time due to many problems from structural to conjunctural. Steps have been taken little by little with computer systems and transversality, but there is still a long way to go. At the state level, active retirement has been temporarily approved for family physicians and primary care pediatricians. Do you think professionals will join? If we do not get young people to come because the situation is as it is, which is what those of us who are inside transmit and see how the situation is, then many colleagues may not prolong their working lives. Keep in mind that, although previously you could extend working life in an agreed manner, throughout the country the number of doctors who have done so has not been very high. Semergen is working on a plan for residents. How to reach young people to stay in health centers? We think the issue of fees is just another union issue. What we propose in our plan is a reform in several points. In the first place, that in the faculties of Medicine an area of knowledge of primary care is generated, the same as in the training period Cardiology, Nephrology or Neurology are studied. Hardly a doctor who does not know primary care can choose it. Secondly, that primary care be reformed by increasing resolution capacity and also that research in primary care be improved. In our resident plan, we also ask to encourage the guardian to have an interest and want to continue and instill the love of Family Medicine to that resident. Subsequently, that this MIR can be fully formed in that period; that it is not dedicated to solving papers and papers and papers, but to caring for patients, and, thirdly, we also advocate that contracts are not junk contracts and that an investment effort be made. In July of last year, the decree of new specialties was approved. For years the possibility of giving this entity to Emergency has sounded, and many communities have stated that its approval may be the solution so that young family doctors do not leave. Do you share this perception? It is a hotly debated issue and we think not. On the one hand, many family doctors go to the emergency room, but many others do not stay in Spain, they go abroad. On the other hand, how do I limit the specialty? Do I limit it to hospital emergencies or also to emergencies in health centers? Every time a new specialty has been generated, a great problem of homologation of titles has also been generated. Primary care is the gateway to healthcare. Now gender identity issues are added. What is the role of the family doctor? It is a sensitive issue. Until now diseases are always linked to what we call sex, but now we have diseases linked to gender. First of all, I believe that the family doctor must be prepared for any problem that exists both personally and family to be able to channel and treat and give you all the necessary resources. Also keep in mind that, just as there are typical pathologies of men or women, all patients who have received hormonal treatment or who have had surgery may present some pathology or side effect that the family doctor must also be prepared to address and make an early diagnosis. But we must treat the issue from a scientific point of view, not a media one. We are specialists in Family and Community Medicine. Mental health has become very important in recent times. Is Semergen working on any projects to improve care for these pathologies? In acting and handling, what is needed is time, because unlike other pathologies, which can be solved with a machine or an analytical, mental health what it needs is a correct anamnesis and a dialogue with the patient. It is difficult for the family doctor to attend if he has the agenda as we have, but that the national mental health plan I believe has worked and the management of this pathology by the family doctor for many years is carried out correctly in collaboration and coordination with the mental health teams. What happens is that if the family doctor is saturated and the mental health team is saturated... Well, solve the problem of saturation. In short, we need to have more time for the patient.

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