Internal Medicine, a versatile specialty in the Emergency Department

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There are difficult times for Health in Portugal, particularly for sick Portuguese people. The SNS seems to be collapsing and new complications and discontents are discovered every day, all of them on a concrete basis.

The problem is systemic, but what is being talked about is the Emergency Services (SU). There are a large number of patients, waiting times are long, there is a lack of coverage of shifts in the emergency room, professionals are exhausted and patients are tired. What is certain is that Portugal is the OECD country with the highest number of resources for Emergency Services per 100 inhabitants, around 16 thousand episodes per 24 hours. Of these, about 41%-42% are patients (usually screened with green or blue wristbands) who, although in need of quick medical care, would not need to be treated in an ED, where other more emerging patients may go unnoticed and, there, the damage is irreversible.

So what’s going on? Do less seriously ill patients go to the emergency room because they are not literate? Why do you like to wait hours in a confined space full of other patients? Why do you want to do a lot of exams? Of course! These patients have no alternative because they cannot find a solution to the problem outside the hospital.

Therefore, one of the constraints is undoubtedly upstream and outside the hospitals.

The EDs of hospitals are designed to care for patients with acute illness who need special care.

There is a need to reinforce the Primary Care network, in the Health Centers with specialists in General and Family Medicine and with other health professionals who will follow the chronically ill, who are well aware of their social and family context and who, in case of decompensation can serve them in good time, avoiding the inevitability of resorting to hospital EDs. Health Centers need to be open later, equipped with some complementary tests that can support diagnostic or therapeutic decisions.

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