The family doctors of Messina take the field against the draft reform of the Minister of Health Orazio Schillaci on general medicine: “Your doctor will no longer exist” is the title of the letter signed by Giuseppe Zagami, deputy secretary of FIMMG Messina, the Federation that brings together general practitioners and represents the most important union in the category.
Here is the text of the letter:
Your doctor will no longer exist: letter from a family doctor
Dear patient, your doctor, at least as you have known him until now, will no longer exist. In recent days you may have heard of a reform of local medicine, linked to the development of Community Houses. It is an important change, presented as necessary to make the system more efficient and organized. But inside this transformation lies something that concerns our relationship very closely.
The heart of family medicine has always been one: your freedom to choose.
You choose your doctor. It’s not a bureaucratic detail. It’s what gives meaning to everything. This is why, every day, I try to earn your trust: with listening, with responsibility, with commitment. It’s the reason why I decided to do this profession.
Being chosen means responding to someone, not something. It means knowing that my work has value because it is recognized by you, not because it is measured by an indicator.
The reform proposed by Minister Schillaci, however, introduces a profound change: the transition from a system based on your choice to one based on objectives and indicators defined by the organization.
Translated into simple words: I risk no longer being guided primarily by what I think is best for you, but by what I have to achieve according to criteria established elsewhere.
And here a question arises that I cannot ignore: what happens to the treatment when it competes with a goal?
A system built on corporate objectives inevitably tends to favor what is measurable, standardizable and controllable. But medicine, real medicine, is made up of complexity, individuality, decisions that cannot always be traced back to numerical indicators. The danger therefore is that I could transform into an executor of rigid guidelines, more attentive to respecting spending constraints than responding to your specific needs.
In this scenario there is a risk of becoming “governable” not in the virtuous sense of coordination, but in the more problematic sense of control. Clinical choices may be guided not by what is best for you, but by what is compatible with the limits imposed. It is a paradigm shift that calls into question professional autonomy and, with it, the very quality of care.
Then there is another aspect that worries me, and it concerns the future of the system as a whole. When a job loses autonomy and meaning, it becomes less attractive. And when a system loses attractiveness, it does not remain immobile: it weakens. Times are extended, availability is reduced, space is created for a parallel offer, often accessible only to those who can afford it. This is how, slowly, we move from a universalistic model to a selective one.
It is not an issue that concerns only us doctors. It affects all of us as citizens. It’s about you.
It’s about the right to be followed by someone you choose. It’s about being seen as a person and not a number.
Family medicine has always been the first point of contact, the closest place, the one where prevention and treatment truly meet. Defending it does not mean opposing change, but asking that change not lose sight of what matters.
We are in a complex historical moment, in which transformations are rapid and often inevitable. But precisely for this reason it is necessary to be aware. We doctors must be aware of our role and the responsibility it entails, remaining united in defense of all public health. You must be aware of the value of the system that still exists today and of the risks it is running.
I would like to continue doing my job as I have always done, putting your health at the center and not a variable subordinate to economic balance, unfortunately I don’t know if they will allow me.
Health must remain the center, like your freedom to choose who you want to be followed and cared for throughout your life.
I felt the need to tell you, clearly and honestly. Because our relationship is not a given and because the future of your care also concerns the choices that will be made today.
With respect and responsibility,
Your family doctor
Giuseppe Zagami