This is question number 84 of the MIR 2024 exam, related to the diagnosis of a doctor who works excessive hours, considering it “stigmatizing mental health” and “a lack of respect” for Primary Care professionals.
The doctors go further and in addition to considering its withdrawal for trivializing the work overload faced by the medical profession in general, the unfortunate question does not add any clinical value to the test. What’s more, he believes that it discourages future doctors, especially those who work in health centers.
Although no member of the Ministry intervenes in the preparation of the questionnaire, Health has apologized and will propose to the independent Qualifying Commission to challenge the exam question to withdraw it due to the discomfort it has generated and replace it with another reserve question.
The question presented the case of a 50-year-old doctor who “frequently accumulates delays of 2 hours in the consultation, creating some conflict, although he is the one with the smallest number of patients”, and that “he starts his workday earlier of the hour to plan and advance his work, but he is always the last to leave.
According to the questionnaire, this doctor is “very perfectionist” and, between patient visits and bureaucratic tasks, he barely has time for anything, not even “to go to the gym” or have a “social life.” The aspiring doctors had to answer if this excess of perfectionism is a symptom of a personality disorder such as schizophrenia, schizoid disorder or obsessive-compulsive disorder.
Health argues that the question “can be seen as a lack of respect” in the face of an everyday situation that reflects the health overload that the medical profession regularly denounces: “the need for many professionals to extend their working hours to respond to the needs of their patients.” patients.” It will also allege that, in a context of special focus on actions to improve the mental health of the population and professionals, its content may be “stigmatizing.”
“The Ministry of Health regrets the question of the MIR exam, regarding the diagnosis of a professional who carries out his clinical activity working excessive hours, and considers that his withdrawal should be considered,” Health says in a statement. “Given the discomfort caused by question 84 (model 0) of the last MIR exam, the Ministry of Health wants to apologize and, at the same time, show its disagreement,” argues the department led by Mónica García.
“People who are in a situation of precariousness and work overload tend to blame themselves and express the organization’s shortcomings as their own problem. This makes it difficult to detect them and puts them at risk, not only of carrying the blame for “not arriving.” , the ministry continues, “but also of ending up being pathologized and singled out from the outside, adding stigma to their own suffering.”
“People who find themselves in a situation of precariousness and work overload tend to blame themselves and express the organization’s shortcomings as their own problem; this makes it difficult to detect them and puts them at risk of not only carrying the blame for not arriving, but also also of ending up being pathologized and pointed out from the outside, adding stigma to their own suffering,” the Ministry maintains.
The committee of experts of the Qualifying Commission, if it accepts the Health proposal, is made up of five or six professionals with diverse backgrounds and experience in education and specialized training, but none from the Ministry, reports Efe. Each of them is supported by between 10 and 15 collaborators.
These experts collect, for more than six months, proposals from collaborators, rate their difficulty, rework and select the test questions: they begin to work between April and May on the following year’s test. Once they are selected and the questions are delivered, they go directly to the company that was awarded the printing, so the qualifying committee knows about the exam at the same time as the people taking the exam that day.
Different organizations that bring together Primary Care specialists, such as the Spanish Society of Family and Community Medicine (SemFYC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General and Family Physicians (SEMG) or AEN Salud Mental have also shown their disagreement with the question.
“The question defines a situation in which a doctor presents a picture with certain attitudes, behaviors and thoughts, to which future MIRs must respond with diagnostic guidance. When drawing up the profile, the volume of work, bureaucracy, and the paperwork that add to the complexity of the daily schedule of visits to which this doctor responds,” says SemFYC in a statement.
“It has been assumed that the person referred to is a specialist in family and community medicine by talking about quotas, bureaucracy and paperwork, without any of these concepts being exclusive to this specialty. This interpretation only contributes to the creation of meanings that are constructed, conditioned and accepted in a negative way for a specialty and a healthcare setting, specifically and almost exclusively,” these primary doctors point out.
The question also outlines “a discouraging reality for future specialists, to whom it is directed,” he adds. Whether or not it is a specialist who carries out her work in Primary Care, we consider that using this example is unfortunate. “We are the group of health professionals in the country who are experiencing a tough work situation that requires urgent measures to lower the pressure.”
“Thirdly, a good part of this debate has come from the background and focus of the question, which pivots more on the description of a circumstance. As a scientific society, we must defend a MIR examination model oriented to clinical questions of value for patients. recent graduates: the MIR questions must be consistent with the clinical reality of the exercise in the SNS.
Finally, we want to try to understand the substance of the question asked and we maintain that, although it fails in the form, place and moment, it is absolutely pertinent to talk about mental health among the medical community: doctors also suffer from mental illnesses, and Making this reality visible is necessary. And emphasize that in the aforementioned MIR exam question the fifth most frequent possibility is forgotten, burnout.”
“We appeal to the common sense of the evaluation court and those responsible for the Ministry to redirect this situation. And we wish all the MIR 2024 applicants who have already decided or will decide to choose Family and Community Medicine, that they have selected the correct answer and that “This is just one more step in your choice of position.”
