Cardiology in the Algarve: The progressive involution of care! A true emergency!

Cardiology in the Algarve: The progressive involution of care! Identify the causes and move towards the necessary solutions! A true emergency!

I am writing this article in a privileged position, as I am a resident of the Algarve, I am a cardiologist, I worked at CHUA in the cardiology service from 2006 to 2021, and am currently collaborating with another NHS hospital (Hospital do Espírito Santo in Évora), which it allows me to have a proper analysis of the problems and propose solutions for a very serious problem that requires action, not only urgent, but emerging!

What was cardiology in the Algarve in the first decade of this century?

Cardiology in the Algarve was known for being one of the most differentiated and best functioning services at Hospital de Faro, with a Via Verde Coronária that placed him at the top of indicators at national and European level for the provision of care to patients suffering from acute myocardial infarction in the region. In addition, it gave a differentiated response and responded to the needs of the population, having progressed during that decade in the level of care it provided to the population.

Everyone knew that there was a great asymmetry in cardiology care in the region between the Hospital de Faro and Portimão. However, solutions were found so that the level of care reached the entire population of the region.

The environment in the cardiology service was very good and it got stronger, with a team spirit such that it was one of the areas of the hospital where, for example, nurses competed for a place. There was enormous pride on the part of all the professionals in what they were doing and everyone was working for the good of the population and solving their problems.

How are we currently?

Currently, cardiology in the Algarve has a number of medical professionals unable to respond to needs, with waiting lists growing every day, despite all of them doing their best and a little more than is humanly acceptable. There is a level of exhaustion, dismay and often despair in the team that has reached its peak in the last two years and it will be unsustainable to keep it.

At the level of other professionals, the same thing happens: in the last two years, we have seen a stampede of nurses from the cardiology service, completely exhausted teams, ratios of patient per professional far above acceptable, an opinion given recently by the order of nurses. These professionals are giving everything they can and a little more, however they are completely exhausted and unmotivated.

If we continue to the class of cardiopneumology technicians, secretariat and operational assistants, we see the same thing.

We are in a situation of need for an emergent intervention to avoid a rupture in the ability to provide urgent cardiology care to the population, I will not say that the others are also necessary, because then we have overcome the rupture in the system.

Will it be like this across the SNS?

The situation is not the same, so much so that there are cardiology services that are in the opposite direction. I can give several examples, but the most paradigmatic is a cardiology service that has always had difficulties, were it not for a service in a hospital in the interior of the country and in the Alentejo, as is the case of the Hospital do Espírito Santo, in Évora.

In this hospital, professionals are also scarce, but the same spirit that existed two decades ago in the Algarve exists in its teams.

Despite the problems, they have been able to respond to the population, they are increasing their capacity and differentiation, they have not had a waiting list for cardiology consultations for a few months, they have the capacity for differentiated echocardiography, coronary intensive care, cardiac and coronary AngioTAc, cardiac MRI , Interventional hemodynamics and electrophysiology, percutaneous implantation of aortic valves, they even perform some heart surgeries.

We are not talking about a hospital in Lisbon, where everything is easily achieved, we are talking about a hospital in the interior that a few decades ago did not have the hemodynamics that already existed in the Algarve.

What happened at Cardiologia do Algarve?

The degradation of health care in the area of ​​cardiology occurred mainly in recent years, with worsening in the last three years, given the attitudes taken by those who run the institution.

We are witnessing a stampede of cardiologists, for various reasons, but above all due to the lack of conditions to apply the level of differentiation they have, associated with an over-human work overload. In any other hospital in the SNS, they have a lower burden, more adequate treatment and greater respect for those who run them, and a greater possibility of dedicating themselves to the areas in which they have differentiated themselves.

Let's give some examples of occurrences to verify what cannot happen in the future: we had colleagues who left the hospital because the investment in the upgrade of the hospital's magnetic resonance equipment, which would be paid for in about a year, as the tests are being carried out and paid for by the private sector.

We had colleagues who left because the hospital did not acquire AngioTAC equipment to perform cardiac and coronary CT scans, as planned. As a result, they are now in the private sector carrying out the exams that are paid for by the public hospital.

We had the same situation in echocardiography, with equipment being acquired only very late with the technology that existed in other hospitals.

We have recently had positions taken by those who run the hospital, which they were, disrespectful to cardiology professionals and arrogant, with “screams” and “screams” in the cardiology service, trying to forcibly impose changes that, according to professionals, jeopardize the safety of patients. patients who are treated there.

We had the complete degradation of the well-being that they had in the work of the nursing team, with measures imposed that were clearly meaningless and with an arrogance and imposition never seen until now. The result was the departure of the most experienced nurses from the service and, nowadays, nurses do not want to go to the cardiology service to work… What a change!!

We had situations in the last two years, with the administration ordering a security guard to go to the Cardiology Service to end the so-called “party” that was taking place.

Unbelievable, when what was happening was a differentiated training of cardiologists in hemodynamics from other hospitals in the country, who were learning to perform a differentiated technique with the team of Faro. They were just in a meeting between cases eating a sandwich to continue right away! Not long ago, a hemodynamics colleague from another hospital told me that he did not know how it was possible for what he saw to happen in Faro!

These examples clearly show that we have problems of various types and those that have led to the greatest negative impact do not cost money, it is about knowing how to be, respecting people and professionals, knowing how to lead instead of imposing yourself.

What are the solutions and when?

Several measures will be needed aimed at attracting and retaining professionals, improving the conditions for providing care, reducing the current overload of professionals and increasing the capacity of the service.

Some of the solutions have already been announced and are expected to be implemented in the short term, but there are measures that are essential:

1. The change of hospital directors has already been announced as essential, by the executive director of the SNS and the words of Mr. Minister of Health recently at the inauguration of the simulation center at the Faculty of Medicine of the University of Algarve, which will soon see this change in the leaders of the Algarve. It is expected that the new leaders have the appropriate attitude towards hospital professionals, with the ability to respect them and involve them in solutions.

2. The AngioTAC equipment has already been tendered by CHUA as part of the ptCRIN and ptCAC projects that the ABC academic center was able to obtain, obtaining European funds to support its acquisition;

3. Magnetic MR equipment is also in the process of being acquired by the ABC academic center, with capacity for cardiac MR and all the necessary differentiations;

4. In the same tender, ABC proceeded with the acquisition of differentiated cardiac ultrasound equipment for training and research that, if there is a return to the bet of the new hospital administration on the university character of the Hospital, will be available to the cardiology service;

5. It is urgent to increase the number of nurses and fulfill the ratios legally defined minimums for the safe provision of health care in the cardiology service and in the coronary intensive care unit;

6. It is urgent to build a new room for hemodynamics and interventional cardiology, the existing one is completely impossible to provide an adequate response to the population;

7. It is urgent that the administration be able to motivate professionals and contract, internalizing, the performance of procedures that can be internalized in the structures of the SNS. This situation has not progressed in the Algarve, who knows why, but maybe one day those who run the institutions should explain why solutions that are in practice in other hospitals and, were proposed by professionals in the Algarve, were never implemented;

8. It is necessary to certify the quality of the cardiology service, making it a training service for medical students and with the capacity to become a Reference Center in some national areas;

9. It is essential that the new service director, whom I take this opportunity to congratulate for his position, has a development plan that involves all groups of professionals, that is discussed and complemented with their contributions and that he has the means on his part management to be able to implement it. I emphasize that I consider it urgent to reduce the current overload of professionals to avoid the complete collapse of cardiology care and make the service attractive.

There is still hope!

I also mention that I have great hope that these and other measures will be implemented and the area of ​​cardiology in the Algarve will once again become a reference area, occupying its due and deserved place in national cardiology. The Algarve people need this change urgently and that all obstacles to its implementation be removed immediately.

My great acknowledgment goes to all cardiology professionals in the Algarve who have heroically resisted all this overload, continuing to do their best and a little more to help as many people as possible from the Algarve and visitors to the region. Many, many, many thanks to everyone!! I can say that I learned a lot from you and, above all, I had pleasure working alongside you, I know what you are worth, what you are and how you have been suffering lately!

The Algarve and anyone visiting the Algarve deserve the best cardiological health care! Let us all believe that the necessary changes will take place and that this phase we are going through will be just a dark phase in the history of cardiology in the Algarve in a few years.

Emerging action is needed to save cardiology and thus save many lives in the Algarve. Let's believe that the current national leaders will also look into the cardiology area for the region!!

Thank you in advance for the hope left by Mr. Minister of Health and Mr. Executive director of the SNS, who will certainly now move on to action!


Author Nuno Marques is a cardiologist and Associate Professor at the Faculty of Medicine and Biomedical Sciences at the University of Algarve


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