Sonia Moreno Madrid

Madrid

Updated Saturday, February 3, 2024-01:52

In the heart of Mancha there is

one of the most prestigious Ophthalmology teams in Spain

. The

Health Reputation Monitor of Hospital Services

places the Ophthalmology Service of the La Mancha-Centro General Hospital among the top fifteen, rubbing shoulders with large public hospitals and prestigious private monographic centers. It is a good birthday gift for the La Mancha hospital, inaugurated in Alcázar de San Juan (Ciudad Real)

30 years ago

as a regional center, and whose Ophthalmology Service was built from scratch. This is how its manager, the oculist

Fernando González del Valle,

remembers it: "We had nothing. We started operating with a box of instruments that I had bought in the United States when I finished my residency at [the hospital] La Paz, in case I had to go to the private one." During this time, González del Valle has struggled to maintain a

balance

between Sanchopancesque common sense - "what is more important, the digital medical record or caring for the patient?" - and quixotic idealism - "we set out to be the Mayo Clinic of La Mancha", and along the way he has had his colleagues as allies, because, as he remembers, "what makes the system itself good are the professionals and not the buildings."

With a reference population of 200,000 inhabitants, the service serves two hospitals: at the Alcázar de San Juan hospital they carry out subspecialized ophthalmology consultations (strabology, oculoplastics and orbit, glaucoma, cornea and vitreous retina) and also provide consultations at the hospital. in Tomelloso and in the Quintanar de la Orden clinic, in total they have about

40,000 consultations a year

. They perform nearly

3,000 surgeries annually

, many of high complexity in different sections, in addition to operating on cataracts and performing approximately

4,000 intraocular injections

for the treatment of age-related macular degeneration, diabetic macular edema and retinal vascular pathology, among other pathologies.

Multiple diagnostic and therapeutic techniques

have been introduced here

, many pioneering at the regional and state levels, and even

worldwide

. They were the first to perform a corneal graft in Castilla-La Mancha, in 1997, and to perform an endothelial corneal transplant, in addition to being the first public Eye Bank to preserve human corneas hot, in 2009. In 2016, they led carried out the first world surgery using its own technique of lens sac transplantation with ring implant, intraocular lens, cerclage, pars plana vitrectomy and cornea transplant. These are just a few examples of his achievements.

A ranking (from Mecor) places the Service he directs among the top 15 in Spain, rubbing shoulders with large publics, such as La Paz, Ramón y Cajal, Clínic and prestigious private ones, such as Fernández Vega and Barraquer. Did you expect that recognition?

We are very proud, although we never aspired to appear in a reputational index, I believe that perseverance, thirty years of daily work, has brought us here.

It is a great recognition for us

- a service with a vocation for public attention and located in the middle of La Mancha, the Spain that could be considered peripheral, or emptied, or at least not desired by many young professionals -

to rub shoulders with the most important centers of the Spanish ophthalmology

, which is undoubtedly one of the best in Europe. I think this shows that Spanish public health is capable of giving its patients the best possible care and that this careful care

depends on the involvement of health professionals in their own work

. In fact, the current Spanish health system is maintained, despite all the difficulties, thanks to the fact that the majority of doctors and nurses, and the rest of the primary and specialized personnel, feel the responsibility of doing their job as best as possible, even if they do not have with the necessary means.

Tell me about your team: how many professionals are there? How do you manage to retain talent?

We are 18 adjuncts and four residents, one per year. I have never wanted to have more than we are in a position to train with the means we have, since we do not intend for them to replace assistants to alleviate the care burden, and we lack more operating rooms, we have the burden that we have carried since the 2008 crisis and the subsequent cuts, and which has

worsened with the pandemic

(in practice it meant an entire year of operating rooms). As for the team, in these years a lot of people have left: the number of eye doctors who have passed is triple the number of those who are there now.

Despite all the talent that has left and thanks to which we have retained, the merit lies in having kept us

. It is one of the problems we have in public health in Spain. While in private healthcare, success leads to monetization, as they say now, to having more operating rooms and more resources, in public healthcare, being well recognized by patients brings more waiting lists, but not more resources. The truth is that today I can only offer the team pride in a job well done, for continuing to believe and maintain our convictions about respect for the care of the sick and the importance of personal relationships, between colleagues and with patients.

He affirms that you don't have to be a boss "at all costs." What do you mean by that?

When I arrived at the hospital, in 1994, the priority was to build a service from nothing, not to be the boss. I had just finished my residency in La Paz and I thought it would not be a good idea to start my career directing a service, so as deputy I committed to looking for my own boss,

a curious circumstance

. Fernando Martínez accepted the position until 1998 when he left for the Marqués de Valdecilla Hospital and then I assumed leadership. If we want good service, we also have to learn to say no. You cannot compromise with everything they ask of you, because, in the long run, limiting yourself to that results in poor care for the patient. In the end,

our obligation is to defend that ancestral relationship that has united those who heal and those who suffer for thousands of years

. The patient in front of you should be your only focus at that moment, no matter how long the waiting list is, that person deserves your full attention.

La Mancha-Centro Ophthalmology Service Team.Carmen ToldosAraba Press

"The equity of the system in the periphery is broken: you have excellently trained professionals in large hospitals, and you go to a town and no one has done the MIR"

More controversial are your opinions on digital medical records, why don't you like it?

They may be questionable and I understand that. I am not against digitization, far from it, but I am against accepting a program that has been designed without taking into account our needs, and that does not facilitate the collection of information or images. What is more important: having a digital history or caring for the patient? In many consultations,

people spend the day typing, because the programs are not well adapted to what we need

. What I don't want is to lose that relationship that in the end is what gives you reputation and patient satisfaction. They appreciate our way of working and, from my point of view, we must vindicate it. We should not give up looking into the patient's eyes, the traditional values ​​of Medicine.

Has that way of thinking brought you any problems?

A lot, but there are times when you have to stand up. I don't do it out of stubbornness, but because I don't want the convictions with which we began the service to be lost. We had nothing, but our idea, or at least mine, was to get a kind of Mayo Clinic in the middle of La Mancha; They may say that it is impossible, an absurd aspiration, but at least we had to try. We have aspired to that, but we have not achieved all our objectives, because

the structure of the system is very rigid and it is not conceivable that a great hospital or a great service exists in a town

, even though everyone knows that what it does good to the system itself are the professionals and not the buildings.

Based on your experience, how could professionals be attracted to centers with difficult coverage in rural areas in order to deploy and maintain quality care?

Perhaps some incentive or stimulus should be given, which could be economic, but also in terms of professional career, or time, such as more vacation days, or favoring research by leaving specific days for it. But we have to rethink what is happening now, and that is that to complete the contracts in that Spain where specialists do not want to go, doctors are hired who have not gone through the screening of our MIR system. We have the paradox that on the one hand, there are people who are now finishing high school and have made a great effort to have the grade with which to enter Medicine and pass the MIR and at the same time, you hire other people who are excellent colleagues, but who are not asked for the same selection criteria that you subject your own youth population to; Apart from the fact that you are removing doctors from other countries. And then

the equity of the system in the periphery is broken

,

because you have excellently trained professionals in large hospitals, and you go to a town and no one has done the MIR

. Thus, we aim to have different health services depending on specialization and academic criteria, which are very varied. In short, there should be an incentive of some kind for these hospitals to fill up, but not only to benefit the professionals themselves, but above all for the patients, who could be any of us.