FNAM alerts on risk of compromising care for hospitalized patients

A The National Federation of Doctors (FNAM) today warned that the dispatch on support for external emergencies in case of increased pressure may compromise care for hospitalized patients at times of greater risk.

FNAM's position arises after last week's publication of an order that defines that doctors from internal hospital emergencies will have to support external emergencies when there are pressure situations, such as an exceptional turnout of patients and significant increases in waiting times.

After the Order of Doctors and the Independent Doctors Union (SIM), it is now the time for FNAM to challenge the order, which applies to doctors who have already exceeded the annual limit of additional work.

The federation considers that this diploma, in addition to accumulating scales and functions in the same doctor, “resuscitates serious doubts of legality” and does not add a single doctor to the National Health Service (SNS), only changing the place where these professionals are needed.

The FNAM recommends that doctors, in the face of each mobilization, require registration, as the order itself requires, and inform the head of staff in writing of the inpatients who are unstable to their responsibility.

It also asks that they inform their union of all situations in which the internal urgency is used to regularly supply the lack of doctors in the external emergency, bearing in mind that this situation is prohibited by the order.

He recalls that the doctor can only refuse to mobilize if he invokes a lack of competence and cannot do so, for example, because he has patients who are in hospital who are unstable to his responsibility and is threatened with loss of the remuneration incentive if he does.

“ The patients who are already hospitalized are the ones to be discovered”, he says.

It recalls that the internal urgency is the medical response to patients hospitalized outside the normal time, covering situations such as clinical deterioration, reassessments and new admissions and stresses that the reality of the NHS hospitals is very heterogeneous.

“There are units in which two internal emergency doctors provide assistance to about 600 hospitalized patients, while others have more adequate and proportional teams to the various specialties2, explains the FNAM, recalling that the order “is ignoring these differences”.

It adds that the diploma does not fix any minimum number of physicians who have to stay with the hospitalized patients, nor objective criteria for deciding a mobilization, which means that removing a doctor from the wards depends only on the criterion of the head of the emergency team, which has no way of knowing the condition of the hospitalized patients at that time, says.

The FNAM considers that the order creates different duties for physicians on the same scale, penalizing those who work most, and recalls that, by also covering doctors on prevention, it distorts this modality, which depends on the doctor's written agreement.

After the diploma was published, the Doctors’ Order warned of the risk of this response solution compromising care for patients who are hospitalized.

“ Precipitated solutions, based on ease of mind, worsen the disorganization of hospitals, hinder the functioning of the emergencies themselves and weaken the follow-up of hospitalized patients,” he said.

Also the Independent Doctors Union (SIM) expressed “deep concern” with the order claiming to be “particularly objectionable” that a regime of incentives aimed at remunerating the extraordinary effort of doctors “can be used to justify the accumulation of care responsibilities”.