Brazil’s public health system, the SUS, is well-known for its contributions to Brazil’s poorest communities. Offering outpatient and emergency services, SUS has gained great international recognition.
Vaccines, laboratory tests, prenatal care, and even oncologic wards are some of the services offered by SUS. The daily care of the Brazilian population is in the hands of these health care providers. Despite the huge responsibility placed on the nurses and doctors of the basic health units (UBS) and emergency care units (UPA), they still strive to offer much to the people.
Every year 180 million Brazilians access SUS. Even those who live in remote areas find that health care often reaches them when needed. However, there are significant complications, one of the most critical being the lack of health care providers compared to the system’s demand. Often, doctors and nurses must rush through appointments to attend to everyone in need, which can lead to shorter consultation times and the risk of misdiagnoses.
Time of consultation: one of the biggest challenges of the health care providers
The public health system in Brazil does not stipulate a specific duration for consultations, but there is an unspoken rule where physicians typically see 3 to 4 patients per hour, allotting 15 to 20 minutes per consultation, according to one interviewer. This is a contentious topic in the medical field, as some doctors believe this time is sufficient, while others feel more time is needed to provide quality care.
Dr. Giorgio Vanelli, an orthopedics and traumatology physician, shared his experiences in the public and private medical fields during an interview. Vanelli believes the required consultation time varies among specialties, particularly those that are more subjective than his own.
“Orthopedics is objective. I believe that in my specialty, I can understand a patient’s complaint in a couple of minutes,” he explained.
Specialties can vary the time of consultation
Medicine is a diverse field with numerous specialties, some more objective than others. For instance, while orthopedics may require physical exams or scans, specialties like psychiatry rely heavily on the patient’s narrative. Vanelli, acknowledges this distinction, noting that while he can attend to 3 to 4 patients per hour, other doctors might not be able to.
As a physician practicing in both public and private sectors, Vanelli has observed issues in both systems. Despite its challenges, he believes that some of his worst experiences occurred under health insurance plans.
In this context, doctors often face even shorter consultation times, seeing 6 to 8 patients per hour, which translates to less than 10 minutes per consultation. For this reason, Vanelli eventually chose to work solely in private practice and stepped away from health plans.
Although, Vanelli is an advocate for SUS, he also acknowledges its shortcomings. The lack of infrastructure and technology in public health directly affects patient care. In his private practice, Vanelli has access to more time, resources, and in-office treatments, such as acupuncture, allowing for more thorough anamnesis and physical examinations.
Not only graduates suffer from this, medical students also have to rush with patients in their internships
Valentina (a fictional name), a former medical student, also shared her experiences as an intern in UBS, which led to a change in her academic path. She recounted a poignant moment when she treated a homeless man who came to UBS for wound cleaning and bandaging. She observed how others mistreated him due to his housing status and hygiene.
“At one point, he said I was the only one who touched him, as if everyone else was disgusted by him,” she recalled.
Valentina, also highlighted the limited consultation time as a significant issue. She described the pressure to rush through appointments to see 3 to 4 patients per hour, even though she felt this was insufficient.
“I couldn’t do it. I don’t think it’s ethical. My morals didn’t align with dismissing patients after 10 or 15 minutes of consultation. It was never enough for me to care for them,” she said.
At the end of each interview, I asked both interviewees the same question: “What would be the ideal length of a consultation for you?” Both agreed on the same answer: one hour. This idealistic view of dedicating one hour to each patient underscores the need for more personalized care.
Despite its flaws, SUS is an internationally recognized program and remains the primary means of accessing health care for many Brazilians. Many exams and care are available in Brazil thanks to SUS.. This is why it is crucial to defend and improve the program, even as we acknowledge its challenges.
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The article above was edited by Larissa Prais.
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