The recent pandemic of the SARS-CoV-19 disease has been a global event with consequences that can significantly modify the habits and customs of our society, although only time will tell how these social and cultural changes will persist. It could be that we are inaugurating a new stage in the history of humanity that will change the way we relate to the world. It is not a trivial matter, but it is important to remember that the future is not predetermined and it depends on what we do as a society.
This health crisis has made contemporary society aware of the limitations of medicine and our extreme vulnerability. Managing catastrophes is always very difficult and complicated, however, even in the worst situations it is advisable to remain calm in order to make as prudent and sensible decisions as possible.
In this pandemic, the health system has been overwhelmed and unusual events have occurred. For example, ophthalmologists (and other specialists) have been called upon to collaborate in care work in relation to COVID-19 disease. It may be that some fellow ophthalmologists question the legitimacy of this call as they lack the professional competence to care for patients with non-ophthalmological diseases, and I therefore consider it appropriate to recall the regulations of the Code of Medical Ethics, which is mandatory.1 The Code of Medical Ethics, Chapter II, General Principles2 reads as follows:
Article 5
3. The primary loyalty of a physician is to his patient, and the patient's health must come before any other convenience. A physician may not withhold care for fear that the patient's illness or circumstances will pose a personal risk to him or her.
Article 6
- 1.
All doctors, whatever their specialty or the way they practice, must provide emergency assistance to the sick or injured.
- 2.
A doctor shall not abandon any patient in need of his care, even in the event of a disaster or epidemic, unless he is required to do so by the competent authority or there is an imminent and unavoidable risk to his life. He/she shall volunteer to assist in the provision of health care.
These articles can also help to understand our welfare obligations and that the protective measures recommended by scientific societies cannot always be required.3 Situations of resource scarcity must be managed from the point of view of commitment, in order to attempt a fair distribution which will always be very difficult and problematic.4
Our experience at the Ophthalmology Service of the University Hospital of Burgos, in which we suspended all scheduled activities during the pandemic, has been one of a surprising decrease in the demand for care, i.e., we have had a disconcerting decrease in ophthalmological emergencies and hardly any requests have been made for treatments involving intraocular injections. Therefore, there is a suspicion that the Public Health Service was immersed in an oversized ophthalmic care situation. It is assumed that after every crisis we should learn to improve our professional activity and it would be very beneficial to rethink our healthcare work.
To conclude this editorial, I would like to express my serious doubts about the solutions proposed by the public health authorities to manage the return to normalcy, which will apparently modify our work very significantly. The most significant change is the proposal to introduce telephone consultation in all public health care, not just for specific cases. In addition to the fact that telephone care is not very feasible in our specialty, it is not in accordance with the Code of Medical Ethics which, in Chapter IV, Quality of Medical Care, reads as follows:
Article 26
- 3.
The clinical practice of medicine by means of consultations exclusively by letter, telephone, radio, press or internet, is contrary to deontological rules. Correct action inevitably implies personal and direct contact between doctor and patient.
- 4.
It is ethically acceptable, in the case of a second opinion and medical reviews, to use e-mail or other means of remote communication and telemedicine, provided that mutual identification is clear and privacy is ensured.
- 5.
Patient orientation systems, by means of telephone consultation or telemedicine, are in accordance with medical deontology when used exclusively as an aid in decision making.
To conclude this story, widespread telephone consultation involves a deterioration in the quality of care for patients in addition to being a very alienating job for the doctor who becomes a health tele-operator. We should not leave this inheritance to our younger colleagues and it would be very sad if the words of the 15th century Spanish poet Jorge Manrique were true: “any past time was better”.5
Please cite this article as: Jiménez Benito J. Análisis discursivo de la pandemia COVID-19 desde la oftalmología. Arch Soc Esp Oftalmol. 2020;95:419–420.
