Those unfair accusations against general practitioners

by Giuseppe Belleri

14 JANDear Director,
allow me to occupy some space in the letter column to reply to the veiled reprimand that Polillo and Proia address in the QS to “a GP” – that is, myself – for using the term lobby – however carefully quoted – against the composite alliance in favor of the dependence of doctors; the “reckless” use of the term was evidently referring to the variegated coalition and not to the GCIL Medici, as instead it has been improperly interpreted by colleagues. But the question of punctuation is irrelevant to the substance of the problem, which is the subject of this contribution.

If the term “lobby” was careless how to evaluate the accusation contained in the recent document of the CGIL Medici of “failure of the territorial care and assistance system, which dramatically demonstrated its ineffectiveness during the pandemic“Because of the”current organization of General Medicine, of the ‘single practice’ doctor, freelance, isolated from the system “which, moreover, would prevent” even from a regulatory point of view, the governance of the system“?

This representation personalizes the problems, does not consider the path dependence of events by mixing remote causes with proximal effects. Thus the CGIL Medici judges the primary care colleagues who for 2 years have been at the forefront to tackle the pandemic, in the first wave abandoned to themselves and then gradually equipped with the minimum tools to carry out their work, thanks to which in the fourth wave are performing “miracles” of efficiency by continuing, mind you, to follow the rest of the acute and chronic pathology “expelled” from the system to make way for Covid-19.

But anyhow, for the CGIL Doctors are only freelancers who pursue their corporate interests – awaiting the end of a comfortable ten-year contractual holiday – insensitive to collective ones and the NHS.

It is surprising that a medical union, albeit ultra-minor, to support a political proposal has joined the media denigration campaign of the GP, which has been running for over a year based on various generalizations and cognitive biases, corroborating the prophecy of Antonio Panti: “from heroes to scapegoats the step is shorter than it seems and the health service administrators, after leaving the family doctors without protection and support, now discover the serious shortcomings of the territory“.

Today the category pays the price of ten-year public policies in the name of disinterest, at best, and marginalization, at worst, but it is placed on the prosecution bench for the benefit of a public opinion eager to find the current responsible for the perverse effects of erroneous distal policies.

But this is the less significant side of the CGIL document, albeit unpleasant. What is surprising is the insistence of the criticism of the presumed free-professional character of conventional medicine seasoned with censorship of the “corporate interests of the most representative Professional Orders and Trade Union Organizations”; these are accusations that are the result of an early twentieth-century ideological prejudice, as if that professional dominance and monopoly on the free healthcare market which had been waning in the area for at least thirty years persisted.

On the other hand, there are no references to the debate on professionalism, as the third way between the Scylla of mercantile control over the professions and the bureaucratic Charybdis of administered medicine.

In the early decade of the century the market was the first agent of control over the health professions, with the modalities of New Public Management (NPM). Emblematic was the unsuccessful Lombard experience of Taking charge of chronicity, centered on the quasi-market with vertical competition between I and II level, whose terminal phase was decreed by Covid-19.

Then with the crisis of 2018 and even more with the pandemic, market prices plummeted to make room for the resurgence of health statism, equally at risk of centralization and bureaucratization. In this cultural climate the proposal to move to dependence is part of the attempt to exploit the window of opportunity of the epidemic crisis to “put in line” the riotous freelancers with agreements by imposing in the institutional agenda the subordination of MG to managerial-bureaucratic logic .

Even at the price of harmony, perhaps unconscious, with a public disqualification campaign that still borders on that sort of “blaming the victim” described by Panti.

On the other hand, the FIMMG document defending the agreed relationship, albeit in a somewhat predictable way, refers to the resources of professionalism, as the third way between neo-liberalism and bureaucratic drift. Yet according to the sociologists of the professions since the beginning of the century, classical professionalism, à la Freidson, has left room for a multiplicity of hybrid forms, in an attempt to reconcile managerial logics and professional autonomy at the organizational level, based on some general and quality self-control tools: accountability, benchmarking, auditing, clinical governance, guidelines, PDTA etc.

The limit of medical syndicalism was that it did not relaunch with conviction the challenge of organizational professionalism, of a community and reflexive matrix, due to the role of MG not subordinate to managerial but original and proactive logics. The opportunity was lost with the indolence that accompanied Balduzzi, which remained a dead letter and which is now finally being implemented with the PNRR after a decade of short-sighted disinterest.

In particular, AFTs can reconstruct from below that professional and training / teaching community, historically lacking in Italy and the remote cause of the critical issues present. Sometimes crises can also turn out to be opportunities for renewal, provided that we do not miss the opportunity to change practices, regardless of legal labels.

Giuseppe Belleri
MMG and SIMG Animator

January 14, 2022
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