Raquel Braga | Challenges and Opportunities in Portuguese Medicine

Raquel Braga: It was very nice to meet again after the pandemic.  It was great to meet all my colleagues and to see how they are managing their daily lives, both in caring for patients and coping with all the changes in our country due to this current crisis, which I think is happening everywhere.  It was superb to know that people are still enthusiastic and have a commitment to do better.  We also had the privilege of having Iona Heath with us to start the conference.  Her energy is always fantastic.  And it was very emotional to hear her describe how we can make the difference (to patients) despite everything that is happening, and even in the face of doctor burnout.

DMacA: You gave a keynote address yourself.  Tell me about your keynote address and the topic you covered.

RB: My keynote was about teaching uncertainty in medicine. It seems to me that this a particularly important subject now because of Covid, with changes both in the symptoms and in the illness. What I stressed was that uncertainty is a normal process in medicine, at all ages, and in all the phases of our career.  But, there are some strategies we can use to deal with uncertainty.  And, those strategies which can help us best face uncertainty in dealing with patients include technology, decision support tools, telemedicine, electronic health records, online resources, wearable technology, and the fundamental skills of being  family doctors (which are) knowing patients and involving patients in decision making processes. All these strategies can be used to help cope with uncertainty and to deal with the challenges of difficult clinical cases.

DMacA: You spoke earlier about the crisis facing medicine, and indeed facing primary care, how is that crisis affecting doctors in your country?

RB: Very much.  We are facing both a crisis, and lack of investment. People don’t feel motivated either in their personal medical career or in the National Health System. So, we have many young doctors leaving to go to other countries, leaving the National Health System, searching for better work conditions of work, not only remuneration, but in respect from other colleagues and from patients.  We are now also losing many doctors who are reaching the end of their careers.  And, although we have been making big efforts in undergraduate and postgraduate medicine, and we have many young doctors who have undergone good quality vocational training, there are no places for them in the National Health System because of financial constraints.  So, it is very hard to motivate these young doctors. They had to have very good grades to enter medical school, and we are asking them to motivate themselves to face these challenges; bad work conditions, poor remuneration, and a lack of respect from their peers, the government, patients, and society. So, we are now facing a crisis. We have patients that don’t have a family doctor, and yet we have specialists in general practice who will be lost because of the lack of investment in people by the health ministry.

DMacA: Where do these doctors go, and what do they do if they cannot get into postgraduate training, or into general practice?

RB: Some of them leave for other countries where they are very well remunerated in comparison with Portugal. Others go to the private sector where they find employment placement near their homes.  But, in Portugal this is not (just) a problem of rural and coastal areas because in Lisbon, and in the areas near Lisbon, there is currently a major shortage of family doctors. I expect it is because it’s so expensive to buy a home but also because the health centres are in very bad condition. We have inequalities even in the capital of Portugal. We have people who have very good access to Primary Health Care and hospitals, and we have some people that don’t. And, of course, this concerns everyone.

DMacA: Does that affect medical schools and the numbers of students going into medicine?

RB: I heard that last year many medical students in my university, even those with very good results, left in the first year. So, I think that illustrates how bad the situation is, and the lack of motivation to continue.

DMacA: That sounds very difficult. How is that affecting research and, in particular, your own research career?

RB: That affects research because we have to deal with clinical commitments so we don’t have time to do much more. And, that’s not good.

DMacA: It’s a very bleak picture,  isn’t it. Have you any positive notes to finish?

RB: The positive note is that we have a tradition of very good vocational training and we have a very good tradition of undergraduate education.  So, it is possible to reverse this situation if there is money and a willingness. I hope the Ministry of Health will start to think more about recognising our profession and how important it is, and how it makes a difference every day, and how it made the difference during the pandemic working with people in the field. And, that they reverse this trend so that we may continue what we were doing during the last decade.

DMacA: It’s very nice to finish on a positive note and I hope we see the changes that bring  these young well-trained doctors back into practice. Raquel as always it’s lovely talking to you thank you very much indeed.