Querida amiga, querido amigo,
No quería marchar sin antes dejarte esta carta personal de despedida porque, como sabes, todo en la vida suele tener un fin. Por una parte siento alegría por lo mucho conseguido pero por otra tristeza al contemplar el derrotero por el que va caminando la medicina.
Desde el comienzo de los tiempos, los primeros sanadores desarrollaron con esfuerzo y sagacidad diversas aproximaciones que ayudaban a los seres humanos a caminar por la senda de la salud. Fue necesario viajar lejos, contemplar y probar, se precisó de gran paciencia y, pese a todo, los resultados nunca fueron excesivamente brillantes. Hasta que llegó la revolución científico-técnica. Hoy disponemos de la medicina más potente de la historia gracias a todos los avances que atesora y a sistemas que amplían enormemente su poder y lo trasladan a incontables territorios y personas.
Tanto esplendor tiene su lado oscuro. La salud se ha convertido en un bien de consumo y como tal todos la desean. Las expectativas de salud son cada día mayores, lo que disminuye en proporción la tolerancia al malestar. Esto llega por un lado hasta el punto de que algunos crean nuevas enfermedades para poder vender las correspondientes pruebas y tratamientos y por otro a que ante cualquier pequeña incomodidad lo normal sea acudir a una consulta. Esta mercantilización ha transformado los grandes Sistemas Sanitarios en supermercados industriales de servicios de salud y a los profesionales en operarios de los mismos.
La parte humana de la medicina, su espíritu, va dejando de tener cabida en este orden de cosas dado que para ejercerla hace falta algo de lo que cada vez hay menos: tiempo para hablar. La dimensión de humanidad del profesional de la salud es algo artesanal basado en la confianza, que se construye lentamente según avanza su conocimiento de los pacientes que trata. Hoy los Sistemas Sanitarios se basan en la eficiencia y la productividad como primer valor para alcanzar un beneficio lucrativo en los privados y de sostenibilidad en los públicos. La atención a la salud es un producto caro que hay que amortizar y para conseguirlo no hay más remedio que presionar al profesional que es la parte más flexible y vulnerable del sistema. Tocará ver más pacientes al día, hacerlo más rápido y trabajar más deprisa.
La sobrecarga sanitaria es un hecho globalizado que ha ido progresivamente en aumento, aliviado en parte por los avances tecnológicos. Pero llega un punto en que al profesional no le es viable seguir siendo humano y entra en modo supervivencia. Es en ese momento cuando el Espíritu de la Medicina tiene que marchar. Queda el aspecto técnico, quedan la ciencia y la tecnología, queda el sistema, pero algo sutil y delicado se va por la ventana, algo que expulsan el maltrato institucional, el abuso, la prisa, el agobio y la desmoralización del personal.
Un sistema que pierde su alma es un sistema desalmado. Esto bien lo saben los incontables profesionales quemados, agobiados o superados por la presión mantenida del sistema y sus gestores por un lado y las expectativas y necesidades de los pacientes por el otro. Algo que los que aun no se quemaron temen sobremanera al ver a tantos compañeros en llamas. No es posible humanizar un trabajo que maltrata a sus trabajadores porque nadie es capaz de dar lo que no tiene. Por eso, como Espíritu de la Medicina, he de marchar. Lo hago sin acritud sabiendo que dejo atrás mucha buena gente. Lo hago como lo hace el aroma de la rosa que el verano secó, o del fresco rocío que el rigor del sol termina evaporando.
Si te encuentras con algún profesional que aún no se quemó del todo cuídalo. No hacen falta aplausos, ni nada parecido. Tan solo darse cuenta de que nuestros problemas personales, sociales o existenciales no tienen solución médica y por lo tanto no es posible delegar en los sanitarios todo el malestar inherente a la vida.Y a la hora de votar revisa si al político de turno le importan algo tus profesionales sanitarios.
Espero que nos podamos encontrar cuando algún día me necesites en tu tiempo de enfermar, tu ancianidad o en la proximidad de tu muerte. No será fácil, prometo hacer todo lo posible por estar pero necesitaré tu ayuda, acuérdate.
Con cariño.
El Espíritu de la Medicina.
Farewell to the spirit of medicine
Dear friend,
I didn't want to leave without giving you this personal farewell letter because, as you know, everything in life usually has an end. On the one hand I feel joy for what has been achieved, but on the other hand I feel sadness when I contemplate the path that medicine is taking.
Since the beginning of time, the first healers developed with effort and sagacity various approaches that helped human beings to walk the path of health. It was necessary to travel far, to contemplate and to try, great patience was required and, in spite of everything, the results were never excessively brilliant. Until the scientific-technical revolution came. Today we have the most powerful medicine in history, thanks to all the advances it has made and systems that greatly increase its power and transfer it to countless territories and people.
Such splendour has its dark side. Health has become a consumer good and as such everyone wants it. The expectations of health are greater every day, which diminishes in proportion the tolerance to the discomfort. This has reached the point where some people create new illnesses in order to sell the corresponding tests and treatments, and where any small discomfort is usually treated in a consultation. This commercialisation has transformed the large National Health Systems into industrial supermarkets of health services and the professionals into operators of the same.
The human part of medicine, its spirit, is no longer able to fit into this order of things, since to practice it, something is needed that is increasingly lacking: time to talk. The human dimension of the health professional is something handmade based on trust, which is slowly built up as his or her knowledge of the patients he or she treats advances. Today, health systems are based on efficiency and productivity as the first value to achieve a profitable gain in the private sector and sustainability in the public sector. Health care is an expensive product that has to be paid for, and to achieve this there is no choice but to put pressure on the professional who is the most flexible and vulnerable part of the system. He or she will have to see more patients a day, do it faster and work longer.
Healthcare overload is a globalised fact that has been progressively increasing, partly relieved by technological advances. But there comes a point when it is no longer viable for the professional to remain human and he or she enters survival mode. It is at this point that the Spirit of Medicine has to go. There is still the technical aspect, there is still science and technology, there is still the system, but something subtle and delicate goes out of the window, something that is expelled by institutional mistreatment, abuse, haste, oppression and demoralization of the staff.
A system that loses its soul is a soulless system. This is well known by the countless professionals who are burned, overwhelmed or overcome by the sustained pressure of the health system and its managers on the one hand and the expectations and needs of the patients on the other. This is something that those who have not yet been burned fear greatly when they see so many colleagues on fire. It is not possible to humanize a job that mistreats its workers because no one is capable of giving what they do not have. That is why, as the Spirit of Medicine, I must leave. I do this without acrimony, knowing that I am leaving behind many good people. I do it as does the aroma of the rose that the summer dried up, or the fresh dew that the rigor of the sun ends up evaporating.
If you come across a professional who hasn't been completely burned, take care of him. No need for applause, or anything like that. Just realize that our personal, social or existential problems have no medical solution and therefore it is not possible to delegate to the health care professionals all the discomfort inherent in life.
I hope that we can meet when you need me one day in your time of illness, your old age or in the proximity of your death. It will not be easy, I promise to do my best to be there but I will need your help, remember.
With love.
The Spirit of Medicine.
告別醫學精神
自動翻譯，對錯誤感到抱歉。
親愛的朋友，
我不想在不給您這份個人告別信的情況下離開，因為正如您所知，生活中的每件事通常都將結束。一方面，我為所取得的成就感到高興，但另一方面，當我考慮藥物正在走的道路時，我感到悲傷。
自從開始以來，第一批治療者就用各種努力和智慧來發展，這些方法幫助人類走上了健康之路。有必要走得更遠，進行思考和嘗試，需要極大的耐心，儘管如此，結果永遠不會過分輝煌。直到科學技術革命來臨。今天，我們擁有歷史上最強大的藥物，這要歸功於它取得的所有進步以及大大增強其功能並將其轉移到無數領土和人民的系統。
這樣的輝煌有其黑暗的一面。健康已經成為一種消費品，因此每個人都想要它。每天對健康的期望越來越高，這相應地降低了對不適的耐受性。這已經達到了這樣的地步：有些人會生出新病以出售相應的測試和治療方法，並且通常會在諮詢中治療任何小不適。這種商業化已將大型的國家衛生系統轉變為健康服務的工業超級市場，而專業人員則轉變為該系統的運營商。
醫學的人為部分，即其精神，不再能夠適應這種事物的順序，因為要實踐它，需要越來越少的東西：說話的時間。衛生專業人員的人文維度是建立在信任基礎上的東西，隨著他或她對所治療患者的了解的提高，這種能力逐漸建立起來。今天，衛生系統以效率和生產力為基礎，這是在私營部門和公共部門實現盈利的第一價值。醫療保健是一種昂貴的產品，必須付費，要實現這一目標，別無選擇，只能給專業人員施加壓力，因為專業人員是系統中最靈活，最脆弱的部分。他或她將不得不每天看更多的病人，做得更快，工作時間更長。
醫療保健超負荷是一個全球化的事實，已經在逐漸增加，但隨著技術的進步而得到部分緩解。但是有一點說明，專業人員不再具有生存能力，而他或她進入生存模式。正是在這一點上，必須要有醫學精神。仍然存在技術方面，仍然存在科學技術，仍然存在系統，但是一些微妙而微妙的事情消失了，這是由於機構的虐待，虐待，匆忙，壓迫和士氣低落而驅散的。
失去靈魂的系統就是沒有靈魂的系統。一方面，無數的專業人員因衛生系統及其管理人員的持續壓力，另一方面又由於患者的期望和需求而被燒傷，不知所措或克服，這是眾所周知的。那些還沒有被燒死的人看到如此多的同事著火時就非常擔心。由於沒有人能夠提供他們所沒有的東西，因此不可能人性化一種會誤傷其工人的工作。因此，作為醫學精神，我必須離開。我知道自己會留下很多好人，所以毫不費力地這樣做。我做的就像夏天干the的玫瑰的香氣，或者是嚴酷的陽光最終蒸發掉的新鮮露水一樣。
如果您遇到沒有被完全燒掉的專業人員，請照顧他。無需掌聲或類似的掌聲。僅僅意識到我們的個人，社會或生存問題沒有醫療解決方案，因此不可能將所有生活中固有的不適感委託給醫療保健專業人員。
希望您有病，年老或臨終時有一天需要我們時，我們可以見面。並非易事，我保證盡我所能，但請記住，我需要您的幫助。
帶著愛。
醫學精神。
Dear friend,
I didn't want to leave without giving you this personal farewell letter because, as you know, everything in life usually has an end. On the one hand I feel joy for what has been achieved, but on the other hand I feel sadness when I contemplate the path that medicine is taking.
Since the beginning of time, the first healers developed with effort and sagacity various approaches that helped human beings to walk the path of health. It was necessary to travel far, to contemplate and to try, great patience was required and, in spite of everything, the results were never excessively brilliant. Until the scientific-technical revolution came. Today we have the most powerful medicine in history, thanks to all the advances it has made and systems that greatly increase its power and transfer it to countless territories and people.
Such splendour has its dark side. Health has become a consumer good and as such everyone wants it. The expectations of health are greater every day, which diminishes in proportion the tolerance to the discomfort. This has reached the point where some people create new illnesses in order to sell the corresponding tests and treatments, and where any small discomfort is usually treated in a consultation. This commercialisation has transformed the large National Health Systems into industrial supermarkets of health services and the professionals into operators of the same.
The human part of medicine, its spirit, is no longer able to fit into this order of things, since to practice it, something is needed that is increasingly lacking: time to talk. The human dimension of the health professional is something handmade based on trust, which is slowly built up as his or her knowledge of the patients he or she treats advances. Today, health systems are based on efficiency and productivity as the first value to achieve a profitable gain in the private sector and sustainability in the public sector. Health care is an expensive product that has to be paid for, and to achieve this there is no choice but to put pressure on the professional who is the most flexible and vulnerable part of the system. He or she will have to see more patients a day, do it faster and work longer.
Healthcare overload is a globalised fact that has been progressively increasing, partly relieved by technological advances. But there comes a point when it is no longer viable for the professional to remain human and he or she enters survival mode. It is at this point that the Spirit of Medicine has to go. There is still the technical aspect, there is still science and technology, there is still the system, but something subtle and delicate goes out of the window, something that is expelled by institutional mistreatment, abuse, haste, oppression and demoralization of the staff.
A system that loses its soul is a soulless system. This is well known by the countless professionals who are burned, overwhelmed or overcome by the sustained pressure of the health system and its managers on the one hand and the expectations and needs of the patients on the other. This is something that those who have not yet been burned fear greatly when they see so many colleagues on fire. It is not possible to humanize a job that mistreats its workers because no one is capable of giving what they do not have. That is why, as the Spirit of Medicine, I must leave. I do this without acrimony, knowing that I am leaving behind many good people. I do it as does the aroma of the rose that the summer dried up, or the fresh dew that the rigor of the sun ends up evaporating.
If you come across a professional who hasn't been completely burned, take care of him. No need for applause, or anything like that. Just realize that our personal, social or existential problems have no medical solution and therefore it is not possible to delegate to the health care professionals all the discomfort inherent in life.
I hope that we can meet when you need me one day in your time of illness, your old age or in the proximity of your death. It will not be easy, I promise to do my best to be there but I will need your help, remember.
With love.
The Spirit of Medicine.
告別醫學精神
自動翻譯，對錯誤感到抱歉。
親愛的朋友，
我不想在不給您這份個人告別信的情況下離開，因為正如您所知，生活中的每件事通常都將結束。一方面，我為所取得的成就感到高興，但另一方面，當我考慮藥物正在走的道路時，我感到悲傷。
自從開始以來，第一批治療者就用各種努力和智慧來發展，這些方法幫助人類走上了健康之路。有必要走得更遠，進行思考和嘗試，需要極大的耐心，儘管如此，結果永遠不會過分輝煌。直到科學技術革命來臨。今天，我們擁有歷史上最強大的藥物，這要歸功於它取得的所有進步以及大大增強其功能並將其轉移到無數領土和人民的系統。
這樣的輝煌有其黑暗的一面。健康已經成為一種消費品，因此每個人都想要它。每天對健康的期望越來越高，這相應地降低了對不適的耐受性。這已經達到了這樣的地步：有些人會生出新病以出售相應的測試和治療方法，並且通常會在諮詢中治療任何小不適。這種商業化已將大型的國家衛生系統轉變為健康服務的工業超級市場，而專業人員則轉變為該系統的運營商。
醫學的人為部分，即其精神，不再能夠適應這種事物的順序，因為要實踐它，需要越來越少的東西：說話的時間。衛生專業人員的人文維度是建立在信任基礎上的東西，隨著他或她對所治療患者的了解的提高，這種能力逐漸建立起來。今天，衛生系統以效率和生產力為基礎，這是在私營部門和公共部門實現盈利的第一價值。醫療保健是一種昂貴的產品，必須付費，要實現這一目標，別無選擇，只能給專業人員施加壓力，因為專業人員是系統中最靈活，最脆弱的部分。他或她將不得不每天看更多的病人，做得更快，工作時間更長。
醫療保健超負荷是一個全球化的事實，已經在逐漸增加，但隨著技術的進步而得到部分緩解。但是有一點說明，專業人員不再具有生存能力，而他或她進入生存模式。正是在這一點上，必須要有醫學精神。仍然存在技術方面，仍然存在科學技術，仍然存在系統，但是一些微妙而微妙的事情消失了，這是由於機構的虐待，虐待，匆忙，壓迫和士氣低落而驅散的。
失去靈魂的系統就是沒有靈魂的系統。一方面，無數的專業人員因衛生系統及其管理人員的持續壓力，另一方面又由於患者的期望和需求而被燒傷，不知所措或克服，這是眾所周知的。那些還沒有被燒死的人看到如此多的同事著火時就非常擔心。由於沒有人能夠提供他們所沒有的東西，因此不可能人性化一種會誤傷其工人的工作。因此，作為醫學精神，我必須離開。我知道自己會留下很多好人，所以毫不費力地這樣做。我做的就像夏天干the的玫瑰的香氣，或者是嚴酷的陽光最終蒸發掉的新鮮露水一樣。
如果您遇到沒有被完全燒掉的專業人員，請照顧他。無需掌聲或類似的掌聲。僅僅意識到我們的個人，社會或生存問題沒有醫療解決方案，因此不可能將所有生活中固有的不適感委託給醫療保健專業人員。
希望您有病，年老或臨終時有一天需要我們時，我們可以見面。並非易事，我保證盡我所能，但請記住，我需要您的幫助。
帶著愛。
醫學精神。
1 comentario:
Siempre tan lúcido. "No es más triste la verdad, lo que no tiene es remedio"
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