Internal medicine has carried the bulk of the care of patients with COVID-19 behind its back, highlighting the strategic role of this multidisciplinary specialty for the health system.

Health personnel attending to a patient admitted to the ICU.

Internal medicine is the specialty that underpins healthcare in hospitals. Internists bring together knowledge from various specialties to provide an comprehensive care for the sick, whatever your ailment. During the pandemic, this specialty has been the first line of defense against the coronavirus, having treated about 80% of hospitalized noncritical COVID-19 patients, according to data from the Spanish Society of Internal Medicine.

The quality of patient care, its cure and hospitalization times depend to a great extent on the work of internists. In the case of a disease such as COVID-19, the work of internal medicine specialists has made it possible to give an coordinated response in hospitals to attend to the health emergency, also collaborating with the rest of the specialties involved.

“We are the family doctor in hospital centers, attending emergencies and coordinating the needs of the patient in the center, taking the hospitalization of COVID-19 patients together with other patients”, Explains Dr. Ángel Charte, head of the Internal Medicine Service of the Hospital Universitari Dexeus, in Barcelona.

Dr. Ángel Charte.

Dr. Ángel Charte.

Since most of the noncritical positive cases that reached hospitals were treated in internal medicine, these services had to restructure in record time. “At the emergency level, new teams had to be created, reorganized the internal system of boxes, triage and isolations, and above all, make well-differentiated clean and dirty circuits. Coordination between the emergency department, ward and ICU had to be excellent”, Clarifies Charte. In the hardest moments of March, this hospital had more than 200 patients admitted with COVID-19. New patient care committees were also created to study the different prognoses of the disease and, in the consultations, “everything was transferred to telematics.” “They were complicated days but team union, the collaboration with the hospital and the support of the Quirónsalud group was what allowed us to successfully assume the care burden ”, concludes the internist.

First weeks of uncertainty and collective effort

Looking back at this year, and with all the road already covered, the mistakes made are clearly seen, most of them as a consequence of ignorance and forced improvisation for the moment. However, far from being anchored in ‘what could have been done’, Dr. Daniel Carnevali, head of the Internal Medicine Service of the Quirónsalud Madrid University Hospital, prefers to emphasize that “the whole of society, and the healthcare field in particular, made a collective effort to adapt to this situation“.

Dr. Daniel Carnevali.

Dr. Daniel Carnevali.

“From heads of service to auxiliary, health and non-health personnel, they were present helping. Nobody got in profile and everyone did what they could. More than mistakes, I would highlight the awareness and responsibility that the entire healthcare community showed in this difficult situation and explosive ”. Although it is also true that this effort has taken its toll on the collective, which “remains at the foot of the canyon and will not give up, but we are physically and psychically exhausted”Says Dr. Charte. A SEMI report reveals that 8 out of 10 internists have seen their working hours increased in the hospital during the pandemic.

In some moments at the beginning of the pandemic, aspects such as the lack of diagnostic means revealed deficiencies in the health and research system, showing the strategic role of these sectors to act in an emergency. Dr. Carnevali recalls that “in Spain we have seen that the biotechnology sector was not prepared for this pandemic and we have been very dependent on the outside. We have been late to the possibility of incorporating diagnostic technology, particularly PCR, which was slow to arrive and was initially manual and very slow. That has now changed enormously and almost all hospitals and laboratories can perform mass PCR”.

We are doing a lot of phone consultation, which was exceptional before

Doctor Charte during the first wave.

Doctor Charte during the first wave.

The express learning of those first months has proven the adaptability of the toilets and with them, also that of the system. “The pandemic forced us to integrate more and more areas of the hospital for COVID-19 patients, which led us to 90% of the people who worked in the hospital were dedicated entirely to COVID-19 patients”, Says Carnevalli. As a result, the internist declares, “we have put aside particularities of services. They all went to work in unison. That requires a lot of communication and teamwork skills. One of the best practices has been the possibility of designing multidisciplinary and multiprofessional work teams with enormous efficiency ”.

Changes that are here to stay

In just one year, it has gone from absolute ignorance about a new virus to the arrival of several vaccines to combat it. It can be said that the coronavirus has driven new ways of doing medicine, for example in diagnostic methods. “The increasingly widespread use of molecular technologyIn particular, PCR for the diagnosis and monitoring of many infectious diseases is a reality that has become popular with COVID-19, but that is going to be explosive. We have multiple panels for diagnosis that it will allow us to speed up the diagnosis of many diseases and their follow-up”Says Dr. Carnevalli.

Many resources are still required to be an essential pillar in the health system

Another technological leap that has taken place in the healthcare field, and that seems to have come to stay, is the telemedicine. “We are doing a lot of telephone consultation, which before was exceptional, and that It will be incorporated for stable patients in whom coming to the consultation does not add value, such as to view test results or monitor parameters. But the telephone is not going to replace the face-to-face visit of patients who need to be seen face to face ”, assures the internist.

With a global health problem like the coronavirus, “the entire system, public and private, puts its resources at the service of society”. But this must be a round trip. The pandemic seems to have brought internal medicine services out of oblivion, along with others such as epidemiology or public health, but Dr. Carnevalli concludes that are still necessary “many resources so that they become an essential pillar in the organization of the health system ”.