CAP Jaume I doctors denounce the referral system to the psychologist
The general practitioners of the CAP Jaume I of Tarragona have reached the limit. The doctors have sent a letter to the management of the center and to the director of primary care at the Institut Català de la Salut (ICS), Daniel Ferrer-Vidal, showing their discomfort with the current referral system for patients with psychological or psychiatric pathology. The circuit marks that it is the same family doctor who meets with the psychologist to explain what is happening to the patient, who has previously visited. From then on, it is decided which treatment to start. The GPs assure that it is a cumbersome circuit, which alters their consultation and their day to day. In addition, they add that most doctors choose to treat the ailment themselves and, in this way, avoid the entire procedure. The group asks that the referral to the psychologist and psychiatrist be done through the same channels that are used to refer the patient to any other specialist.
For its part, the Department of Health, together with the providers –including the Catalan Institute of Health–, are working on the possibility of launching a model of virtual interconsultation, which improves the lives of both the general practitioner and the psychologist or psychiatrist.
The origin of this problem dates back to 2018, when CatSalut decided to incorporate psychologists, psychiatrists and nurses from the Institut Pere Mata – the only provider of mental health services in the territory – into the primary care teams. In this way, the family doctor continued to visit low-complexity cases, but his team had a professional specialized in mental health, in case it was necessary to attend to a more complex case. If things were more serious, then the patient was referred to a mental health center. The objective was to decongest these facilities and put an end to the long waiting lists and the endless queues at the doors of the CSMA and CSMIJ –Centre de Salut Mental d'Adults e Infantil-Juvenil del Institut Pere Mata–, located on Carrer Rovira i Virgili .
The intention of the Department was that low-complexity psychological problems, such as anxiety, loss of a family member, grieving processes or losing a job, would be treated in the CAPs, while the mental health centers would deal with more complex pathologies. serious.
The arrival of the pandemic
So far everything is correct. The problem has come with the emergence of the pandemic in our lives. Cases of mental health problems have multiplied and primary care centers, the gateway to the health system, cannot cope.
When the patient arrives at the clinic, it is the family doctor who attends to him. It has 12 minutes. The doctor must decide if it is a mild case or, on the contrary, a psychologist or psychiatrist should be consulted. If so, the family doctor goes to the specialist's office, who visits the outpatient clinic once or twice a week. "We wait for each other in the waiting room, as if we were patients, until the psychologist manages to attend to us between his consultations," explains a doctor from the CAP Jaume I, who adds that "we are not in the mood to waste time in this way, bearing in mind account the overload of work that we have». The physician must remember each of the cases. That is when the psychologist decides whether to treat you in the outpatient clinic or refer you to a primary care center.
With this scenario, the general practitioners of Jaume I decided last Friday to transfer the discomfort to the management of the center and the ICS through a letter. The letter said that this referral system "alters and interferes with the care work of the consultations", and asked that the procedure be done "via clinical order". In addition, he proposed that the specialist be the one to contact the family doctor in case of doubt.
"We want it to be clear that our claim aims to ensure that the patient is better cared for and care is more agile," says one of the family doctors. It should be remembered that this way of operating is repeated in all Catalan primary care centers, whether they are from the ICS or from another health provider.
For its part, from the Regió Sanitària Camp de Tarragona they assure that they are working, together with the providers involved, on the possibility of launching a "virtual interconsultation" model, which allows the primary care professional "to send, asynchronously, a consultation with a mental health professional”. The latter must respond within a period of time agreed between both.