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To: Portugal - CONTRIBUTION TO THE ORAL HEALTH IN PORTUGAL (secular Suggestions on three topics for a national project covering Dentistry).
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I - MEDICINE IN DENTISTRY
NATIONAL HEALTH SERVICE
Someday the balm of science had to come to the wounds of the suffering people Miguel Torga (April 11, 1978). When Miguel Torga anticipated that the victory would prove to be the National Health Service, would not think that part of the anatomy would be mutilated in the planning of basic health care in Portugal.
While in November 1974 to be provided in grants to launch the foundations of the National Health Service (SNS in Portuguese language) to provide free and universal health care oral, 30 years later after the creation of the National Health Service, the Dentistry is a gap indefinitely postponed in the SNS.
Since, the importance of Oral Health in the overall balance of the human body and having established the importance of dentistry in conjunction with the various medical specialties, it is incomprehensible that the provision of oral health care is ignored in the model of the Portuguese National Health Service.
Whereas the current prime minister classifies the SNS as the great social achievement of modern democracy, the conditions are created to achieve this demand was the creation of a public health system. It is essential to sensitize the state to the inclusion of Oral Health in the SNS as it complies with the constitutional imperative.
Despite the advances and retreats on the concept of a public health service in Portugal is important to alert the person coordinating the study on the sustainability of the SNS - Jorge Simões - acknowledges that the only service where there is a universality in the SNS dentistry. Moreover, it admits that the amount wasted in the conventions should be applied in the care of Oral Health.
In counterpoint to this assessment we have the shocking realization that the Health Minister, Ana Jorge, confesses that she did not know how many accounts would cost to put dentists in all health centers. Becomes more embarrassing situation when the Ministry of Health says it is faster to make agreements with the private than creating a public oral health service. This carefree ignorance is the testimony that in thirty years was not a plan for structural integration of Dental Medicine in Health in Portugal.
Knowing the basics of argumentation that led António Arnaut to create the National Health Service is easy to show that no alternative (either a system of co-payments, is a system of opting out or a system of public-private partnerships) will reduce the charges the state nor the other hand improve the healthcare provided. As the Arnaut said, such partnerships are only of interest to investors because it guarantees them, in advance, pay a profit without any risk.
Thus, the current model check-dentist, is a missed opportunity where we can see not only a waste of exchequer, as the breach of the fundamental pillars of the National Health Service: their universality and gratuity.
Is it not that the report of the World Health Organization, 2007 states that the publicly funded oral health care system in Portugal is not comprehensive. A program that demeans prevention, which emphasizes the curative treatments, which disclaims intervention at school level and does not ensure universal protection, global, multidisciplinary, and planned can only be classed as incomprehensible!
António Arnaut as advocated in May 16, 1979 (date of the closing speech of the parliamentary debate of the National Health Service) a public health project must provide for the articulation with private institutions only in exceptional cases. Adding to the enormity of euros spent (almost) inconsequential in the initiative dental check and adding funds injected into subsystems and conventions could create a public dentistry without any disruption on the State Budget.
A system of public-private partnership should be considered only in areas adjacent / extreme situations where it is not feasible to provide dental or medical services when the responsiveness of the state is insufficient to ensure the integrity of the patient. Thus, as in many other medical disciplines, the National Health Service and private health institutions should exist without jeopardizing the freedom of patient choice, the universality of care or even the survival of each of these alternatives (as is found in all medical specialties in 30 years of National Health Service).
These general remarks it is inevitable considering that the National Health Service has not yet reached their motto while dentistry is not considered as an integral part. The dentists should be viewed as an investment rather than a cost.
Thus it is crucial:
- Change the lines of thought of the Order of Dentists who finds it easier and cheaper to articulate the private clinics than to create a National Health Service with Integrated Dental Medicine (RTP1 - June 16, 2009);
- Develop a national plan of action focusing on prevention intervention at school level;
- Integrating dentistry in all health centers, family health units and other public health institutions so that these structures could be provided all the basic treatments (preventive and curative) Oral Health;
- Include Dental Medicine in emergency services of all local council and district hospitals;
- Introduce the concept of peripherals to once every dentist graduates to ensure a comprehensive coverage of oral health care (but forgotten over the explicit wishes of the outgoing Secretary-General to establish an unpaid internship);
- Insert Dental Medicine in multidisciplinary teams of central hospitals so that we can respond effectively to all clinical cases complex and differentiated.
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II - BUILDING A CREDIBLE PROFESSION
FOUNDED IN PRACTICE
Leopard dies when leaves your skin. Man dies when it leaves its reputation (Chinese proverb). Between common sense has not always existed a positive association between dentistry and the qualities of integrity, credibility and professionalism. Are mainly cultural and historical reasons that lead to this conclusion: the guesswork who cared for years the oral health of populations, such as pain symptoms who lived with the daily routine, never contributed to building the consideration that deserves Dentistry.
However, the class of dentists also has its share of responsibility in the lack of social appreciation of his work. It is for the dentist himself fighting for his credibility in the overall provision of health care. The respect of a letter should begin the exercise by themselves.
So are dentists who should develop their manual of good practices and demand, through the structures created for this purpose, the ethics and codes are applied in everyday clinical practice. Any profession organized in a cooperative has the duty to criticize the bad practice. Thus, in addition to a professional code of points in a broad sense, it is essential to create lines of concrete and explicit conduct for the various professionals.
Thus it is imperative to create a manual of best practices and structuring teams, so qualified and independent, oversee the conduct of dentists. Within this guide to good practice should include, for example, guidelines in the field of therapy since, despite the dentist have a wide option of prescription, it should limit this power to a particular therapy should not prescribe medications that are not in scope of his clinical practice. They must also dentists, through a consensus with other professional groups, and determine common areas of action distinct from dentists, doctors, dentists, medical specialists in maxillofacial surgery and to hygienists.
It is also essential to establish the legitimacy of the dentist performing the duties for which it was formed or prepared, including consultations with smoking cessation or aesthetic treatments such as botulinum toxin.
Also to structure a credible image of their profession, the canons set for good clinical practice should depart from the logic of the market that have been exposed through shocking advertising campaigns and marketing techniques. It is essential that patients can distinguish that a dentist is different from toothpaste and a retailer that logic is not applied to the provision of health services.
Finally, the credibility of the profession of dentist is also the respect that should exist between colleagues. Through legislation, dentists must enact an enabling solidarity to fight against under-employment which we realize and apply the logic of dignity among those who hired labor are hired.
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III - EXCELLENCE IN SCIENCE,
ACCURACY IN EDUCATION
Education and human capacity are synonymous (Francis Bacon). Despite his obsession with the mouth movements and the anatomy of the teeth, Francis Bacon never imagined being cited to illustrate the importance of education in the quality of dentistry. The excellence of the dentist goes through their superiority in terms of education, science and ongoing training.
At the level of education, university education is facing a big problem: way too many professionals with skills that are too fragile. If it becomes worrisome excess of professionals, more disturbing is the lack of preparation with which they leave for the labor market. Taking advantage of the Bologna Process, institutions of higher education increased the number of jobs created and multiple types of graduate school to tackle the funding problems they faced.
Thus, while it robs knowledge on pre-intentions have witnessed a declining trend of the powers conferred on graduates dentists. All this to justify the creation of specialized courses and to secure lucrative jobs in the domes of teaching. Contradictory as it seems it is taught to students today less than at the time of the firstborn Canteras.
Thus, there is urgent need to interfere constructively at the level of Higher Education. Recent history shows that self-regulation is inconsistent and the Order of Dentists to press these institutions to adapt the numerus clausus the needs of the labor market, to establish principles of excellence in school curricula and inculcate a doctrine of accuracy where inbreeding and terrorizing the students become a vague memory of the past
Moreover, for a dentist to reach a level of superiority is essential that recycle their knowledge. Thus, it is essential to promote conferences and trainings that more than vanity fairs and brands of materials, asserting themselves as scientific events of reference. This calls for an annual conference with a smaller range of subjects and knowledge that promotes quality. A smaller number of rooms centered on issues of relevance are fundamental changes to make a difference in this event. Credibility to this conference will be crucial that the inevitable events associated business move away from the decadence of a simulator game situations.
This conference, as other mandatory training which should be promoted by the Order of Dentists, should be part of a credit system upgrade required.
Like other professional bodies, the Order of Dentists (OMD in Portuguese language) should require the recycling of serious professional dentistry. Concomitantly, the dentist should be supported in their everyday clinical practice. The creation of a group of clinical decision support is a key idea to achieve the short period of time in order to assist the dentist in more complex clinical situations.
Also in this context the creation of guidelines (which are more than translations of foreign documents), it is essential to guide and protect the dentists in their practice.
To complete this triad of obtaining primacy in dentistry is essential to foster the creation of knowledge, stimulate research in dentistry and deny the doldrums of small amounts that we observe the creation of review articles.
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RECYCLE THE ORGANIZATION, INNOVATION APPROACH, dreaming about the future - Only the wisest and stupidest of men never change for men (Confucius).
The Dentistry in Portugal requires an openness to society and simultaneously to a restructuring of its guidelines. We need a new leadership with greater statesmanship. The Order of Dentists to think more globally, to defend doctors and dentists in particular, fighting for the common good of the population.
You need a break from this desire to maintain the status quo and achieve more of what is considered satisfactory. It is time to promote the prestige of the profession and to democratize access to medical and dental care. That dentistry is done according to art.
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