Jesús Díez Manglano chairs the Spanish Society of Internal Medicine (SEMI) and claims the holistic vision of internists to treat patients that was revealed during COVID-19.
Is Spanish internal medicine healthy?
I think the pandemic has revealed that internal medicine is a fundamental specialty. We are doctors working in the hospital, who have a holistic view of patients, and this has been demonstrated with COVID-19. It is applicable to all infectious diseases, because these are pathologies in which the only problem is infection. We have seen many extrapulmonary manifestations of COVID-19. We are the doctors who get along best with those in primary care because of this holistic view of the patient; they work in the outpatient setting, and we in the hospital setting. We must keep in mind that we live in a demographic moment in which people do not have a single disease, but several. Therefore, a global vision is richer. Yes, he is in good health, but it is true that, due to the aging population, we believe that it is necessary to increase the number of jobs for internal medicine residents.
Are there not enough inmates in our country?
We need to meet the need I just mentioned. In addition, in the next 10 years our health system will undergo a significant renewal of the medical staff who are about to retire. We need a spare part, and to have it you have to start working and planning it now.
How does it work on this line?
We make this statement, but the ministry and universities must also take this need into account.
What are the weaknesses of internal medicine?
Among the areas for improvement is the increase in the presence of internal medicine in Spanish universities. The accreditation system that ANECA has tends to favor more the accreditation of people who are dedicated to very specific fields and not to those who have a global vision, as is the case of interns. There are fewer and fewer interns in the faculties and they are fundamental for some disciplines of the faculties, such as pathophysiology, general pathology or medical pathology.
Is presence management important?
Internists are very professional doctors. Sometimes, in our dedication to the clinic, we forget about management. Doctors of any specialty must have not only clinical knowledge, but also clinical management. For this reason, we make a special effort on the part of SEMI to provide knowledge about clinical management.
And the investigation?
We have very good researchers in specific aspects, such as autoimmune diseases, lipids, heart failure. Research in these areas is important due to the aging population that has chronic diseases. This is well known to interns, but it is easier for research funding agencies to understand more specific projects.
How can this situation be improved?
We make an effort to prepare interns in research well, to make society and regulatory agencies understand this need, especially given the demographic and health situation we live in. We also have a very good relationship and carry out joint projects with patient associations, which sometimes understand the situation better than the regulatory agencies, so that these needs can be transferred to the regulatory agencies and the projects can be funded.
Were some of the chronic pathologies treated by internal medicine neglected during COVID-19?
As a consequence of the necessary needs in hospitals and health centers, some consultations were eliminated and others became non-face to face, by telephone. This could have harmed a certain type of patient. We also noticed patients who made appointments but did not come out of fear.
What needs to be improved in the care of chronic patients?
We have the global vision. Organizational efforts by health authorities are needed. The national strategy for tackling chronicity was launched, and the development by the autonomous communities was very different, some did not approve it. We believe that this should be done through the Interterritorial Council or through specific working groups, which should establish a common approach to chronicity in all the Autonomous Communities. A key issue is to agree with all regional services so that the clinical history can be shared throughout the country. The medical history programs of all the Autonomous Communities must be compatible, so that they can be accessible anywhere and a patient can receive quality healthcare at any time.
What are the priority objectives of SEMI?
Meet the needs of our partners, with continuing education, teacher training for residents and research. We have some aspects that we consider important due to the situation we are experiencing due to the pandemic. It put the whole health system in tension and we had to make decisions that raised ethical questions. For this reason, we believe that we need to address the bioethics of our society.
What are those issues that have been raised in the pandemic?
Above all, the administration of certain treatments, the administration of mechanical ventilation to certain patients, proposing to patients the use of drugs for which there has not yet been enough research to verify their usefulness. We now have more data, but at the beginning of the pandemic we used drugs that we considered useful, but without any evidence in this regard. This is an important ethical question. We also had patients who, due to the health organization, were hospitalized and could not receive visits. The fact that a patient is alone when experiencing a situation of weakness, with an acute and unknown situation, in which fear and worry are important, also raises many questions.
Apart from the pandemic, are there any relevant ethical issues?
There are various problems related to euthanasia. Now the law is being processed. SEMI, in January, published a clinical practice guide on end-of-life care, good patient care practices.
What tools does SEMI have to conduct the training?
Residents have their own training program in each hospital. As a company, we have a summer school for resident doctors for their training. In addition, some Spanish residents attend the European summer and winter school. For both our partners and our residents, we have an online teaching platform that develops between 30 and 50 courses per year. Since its inception, there have been over 17,000 participants. We have an agreement with the University of Barcelona with the SEMI department and with Menarini, where specific and specific courses for interns are developed, although they are open to other specialists. There we do a master’s degree in autoimmune diseases, diabetes, infectious diseases, chronic disease care, multi-pathological patients, emergencies, cardiovascular diseases, heart failure …
Were all courses maintained during the pandemic?
The master’s degree in diabetes was maintained, and the master’s degree in infectious diseases was postponed, because during the pandemic our partners had an overload of work and the start with new programs was not adequate.
How was the training conducted?
An online webinar program was launched in the afternoon during the second half of 2020. 50 were addressed to our partners on a wide range of issues, from pandemics and coronavirus to diabetes. , autoimmune diseases, COPD …
Do you have specific courses for MIR or young doctors?
Doctors in training can be enrolled in all our courses. But there are some courses that are specific to them, such as summer school. These consist of a two- or three-day stay attended by 50 resident physicians, where they can participate in workshops and discussion sessions on clinical cases. This year it had to be done online. There are also some courses that are open to all members, but are very much aimed at resident doctors. So are the clinical reasoning courses, which deal with the analysis of complex cases, so that the doctor in training can learn to reason how to solve its complexity and simplify it in order to clarify what happens in each case.
Are they related to other scientific societies in the training courses?
We have our typical teaching platform, SEMI. In addition, we carry out joint programs with other companies, such as the master’s degree in heart failure, which we do through the IMAS Foundation. SEMI and the Spanish Society of Cardiology (SEC) participate in this. It is common and is addressed to both internists and cardiologists. We also have another course for resident physician tutors, which was conducted with the foundation and the SEC, the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) and the Spanish Society of Digestive Pathology (EDPS).
What cross-cutting areas do you work with the most?
We are open to working with any company with which we reach an agreement. In addition to those mentioned, we carry out joint actions with those of the Mayor. For example, we now have an agreement with the Spanish Society of Medical Education, where we do a specific course on our platform attended by the State Council of Medical Students and we also want to do a summer course at the University of Alcalá de Henares .
How is your relationship with the City Hall?
We have a very good relationship with the three primary care companies. In fact, with semFYC we organized the congress on chronic patient care for 11 years. With SEMERGEN and SEMG we also have joint projects.
What is the role of FACME in relation to other scientific societies?
We have specific agreements with different scientific societies. FACME is a federation of different scientific societies that can organize several events with the participation of different societies, such as the COVID congress that was organized last year and which it returns. It is organized by FACME and the collaboration with different scientific societies is promoted.