During the pandemic, there were not only problems communicating with the public, but also within the National Health Service (SNS) and with users. The first was difficult to predict as no one had discussed or pondered how to communicate in times of an epidemic of this magnitude. The second was predictable as communication was difficult mainly for material reasons and users do not have easy access to their clinical records. This is an issue that needs to be addressed as part of the Recovery and Resilience Program (PRR).
Digitization within the SNS began between 2005 and 2009, and if you look at the numbers, a large investment was made in equipment. I admit that the elders, like me, viewed this as something terrifying because we ourselves had no appetite for the many functions of computers and clung to paper to hand over prescriptions, ask for analysis and other diagnostic tools and, highest break, write stories clinics. Paper-based files are now in the archives in the depths of hospitals and health centers and must be requested in order to be consulted. It is also true that this has broken the doctor-patient relationship and that the professional is often more preoccupied with looking at the screen and its bankruptcies than the patient’s face. And when you know that ordering an exam is just a click away, you don’t need to be physically observed. Indeed, telemedicine formalizes this pattern, which is expected to be largely reversible as it would result in the loss of essential features of the medical act. This has to be person-to-person and physical contact is essential.
However, digitization needs to be leveraged and is undoubtedly a huge step forward in registration, prescribing and safety. However, there is still a long way to go before the required communication and access are actually required. Once implemented, it had two immediate problems. The various NHS public bodies bought programs from different companies, which were often incompatible. For a while, at least in the hospital I stayed in, the rescue utility was inconsistent with that of the wards. The effects can be calculated. Because in the meantime the newspaper didn’t come and the phone had to work, with professionals moving around the different rooms. Later, a mobile phone was allocated in good time only for internal service and for the connection between the health centers and the hospital. This happy communication disappeared with the turning point of 2011. And there we opposed face-to-face meetings between hospital and health centers until 2013.
In addition to the difficulties of the programs, the institutions have a small number of high-level computer technicians who know how desirable they are to businesses and how poorly the government pays them. You were and are the front line for the complaints of the elders like me and those who are not fighting the slowdowns and blackouts. And what did we see when the pandemic broke out in March 2020? Although the media only speaks of hospitals, the majority of patients with Covid-19, several thousand, have been treated and monitored in health centers. A platform on which one of those “wonders” of ingenuity and goodwill was created, where Saúde 24 and health centers register patients with positive analyzes and quarantine contacts. At the peak in January 2021, some centers, particularly in Lisbon and Vale do Tejo, reached many hundreds of patients who needed to be contacted by phone daily, with a protocol that necessarily lists multiple symptoms. Anyone who has had Covid knows that this was done on a daily basis. To do this, the health centers have outdated telephone exchanges and old computer equipment. Of course, users couldn’t call the centers and complained. Not communicable because, or almost, those who do not have Covid. Fortunately, prescriptions and Covid analysis requests work via cell phone messages, showing the benefit of these means of distance communication despite these structural difficulties.
And how was the communication between the institutions? In their region, hospitals already have access to each other for complementary diagnostic tools. And hospitals have access to health centers. With the exception of the few local health units, the opposite is no longer the case, at least for the most part. On the other hand, the user does not have access to their process – medical history and exams – except for discharge notes when you have been admitted to the hospital. Moving from the hospital consultation to the health center consultation does not bring your process with it. If you are relocated to another area, you will need to apply for the process with the bureaucracies charged. When you need to go to a private service (e.g. hemodialysis) or do a summary that professional goodwill can work out or insufficient data to gather. And every time he see a doctor, he tells the story over and over again. All of this is exacerbated in psychiatry.
What did we know, but this crisis has worsened? A unique digital clinical file is required. This process belongs to the citizen and is confidential, depends on the user and it is necessary to establish legal rules (it is part of the secret of medical ethics and is closed by a code). This could be Health’s big digital investment in the PRR known as the Panzerfaust. As Costa Silva said in an interview with Deco Proteste (March 2021): “When it comes to SNS, the reaction from the media and society is: ‘More government spending is needed’. Is defending the health of citizens an expense of the state or an investment in the future of the country? (…) What’s happening? The metrics present are very formatted in a certain view of the world, based on the idea that the state must be minimal and that the state is only (…) hindering the pandemic that is open to all eyes: we need a minimally resourced national health service and prepared. So the suggestion is to change our mental paradigm and look at these two areas [a outra é a educação] as an investment and not as an expense. “So says the first author of the PRR.
In addition to speaking with good intentions, the NHS has tangible resources, including the unique digital clinical process. For the good of all of us, it would also be an instrument of social equality at a time when it has been dramatically challenged.