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His Excellency the President of the Portuguese Republic
Professor Aníbal Cavaco Silva
His Excellency the Minister of Health –
Prof. António Correia de Campos
Her Excellency the President of the Parliamentary Health Commission
Dr.ª Maria Belem Roseira
His Excellency the President of the National Executive Board of the
Ordem dos Médicos – Dr. Pedro Nunes
The President of European Federation of Internal Medicine
Professor Stefan Lindgren
The President of Sociedade Portuguesa de Medicina Interna
Dr. Carlos Dias
The Representative of the American College of Physicians –
Dr. Donna Sweet
Presidents of National Scientific Associations
To all of you here today
Ladies and Gentlemen
Dear Colleagues
It is a great honour for Internal Medicine to welcome such auspicious guests to the official opening ceremony of this Congress.
Thank you for being here today.
Please allow me to express my gratitude to his Excellency the President of the Republic whose presence honours this event, and is, in itself, a demonstration of the high regard he has for our speciality.
Your presence, Mr President, is an extremely strong incentive for all internists to remain faithful to and determined in the mission they have chosen to fulfill – to be excellent doctors serving their fellow citizens – and in this way, they continue their hard work contributing towards the quality and sustainability of our health systems.
I would also like to thank his Excellency the Minister of Health for Portugal, Professor António Correia de Campos, who has graced us with his presence at many significant events in the history of National Internal Medicine.
This European Congress takes place precisely 125 years after the first ever Congress of Internal Medicine held in Wiesbaden, Germany from the 20th to the 22nd of April. It was there that Internal Medicine was born as a branch of Medicine, becoming autonomous as a speciality. It is with great pride that we therefore celebrate this anniversary, although today, just as then, we face enormous challenges.
What is the future of Internal Medicine in Europe?
What does Europe want from its internists?
In celebrating the Wiesbaden Congress, the European internists are fully aware of the need to reposition their speciality in the present day transformation of Health Systems. For us, this transformation is an opportunity to give greater value to Internal Medicine.
Throughout its existence, Internal Medicine has provided unequalled services to the community and to Medicine, both in Europe where it was born and in the United States where it was implemented and developed with Osler, and from then on, to the rest of the world. Throughout its history it has contributed towards major advances in Modern Medicine which allows us to benefit from the present day standard of health.
Internists are on the front line providing care in emergency services, on the wards, in the coordination between primary care units and hospitals, and more recently, in palliative and continued care. Their importance has been evident in both the study and treatment of new diseases as well as in the implementation of new measures for hospital organization.
Internists have also played a prominent role in the creation and development of Intensive Care Units as well as dealing with new infections, such as the HIV virus for example, not forgetting the less frequent pathologies which have a high social impact, such as auto-immune diseases.
In a society which tends to turn a blind eye to pain and suffering, internists make it their speciality. They do not run from or give up on the complexities brought on by ageing, chronic disease and pluripathology, or in caring for their patients.
In these times of cold technology, Internal medicine practices a global approach with a personal touch. This ensures that the needy and suffering are guaranteed continuity, integration and understanding of their care.
Sadly, one week ago, O Dr. Luís Manuel Monteiro Baptista passed away. He was a wonderful man, doctor and mentor. He personified what is to be an internist. He had a great influence on Portuguese Internal medicine and he touched the lives of many generations of Portuguese internists. Internal Medicine owes him a great deal. He knew more than anyone how to keep our speciality alive at a time when many shunned it and simultaneously, he showed us with his superior visionary intuition new fields for action.
Auto-immunity, auto-immunes diseases, is a filed in which Internal medicine works particularly hard and he was one of the pioneers in this close-knit relationship in Portugal.
Mr President
Ladies and gentlemen
Internal Medicine is practised in different ways in different parts of the world.
In the North of Europe it is a basic /common trunk speciality, necessary to allow access to other medical specialities. In these countries there are a lot of Internal Medicine specialists but very few presume themselves to be so, giving greater importance to their sub-speciality.
In the South of Europe, Internal Medicine is an autonomous speciality, based in the hospital with an integrating role not only of knowledge but also of the means made available by the hospital organization. Its influence is renowned, for there are autonomous internal medicine services in all hospitals which account for 15 to 20% of all hospital discharges, placing internal medicine as the speciality responsible for the treatment of more hospital patients than any other.
In the United States Internal Medicine is predominantly a speciality of primary and out-patient care and seen as a “Doctors for Adults” speciality. However, approximately 10 years ago, the hospitalist movement was created in the United States which later became the “Society of Hospital Medicine”.
This movement was established due to cost, efficiency and quality pressures originating from management care. Up until this time in the States, contrary to what takes place in Europe and Canada, there were no specialists dedicated solely to the treatment of in-patients, which for us Europeans is the principal role of internists.
In the United States “hospitalists” are, in 85% of cases, specialists in Internal Medicine who have decided to dedicate themselves to treating hospitalized patients.
This diversity in Internal Medicine shows its vitality and capacity to adapt to new needs as well as new models of organization in health care. Far from stagnating, Internal Medicine has looked for ways of being more effective and essential.
In Europe Internal medicine has learnt to transform its current diversity into a reciprocal enrichening factor. Through their Federation, European Internists have come together to work on projects and the European Congress expresses these most visibly. In addition, The European Scholl of Internal Medicine which will have its 10th (tenth) edition in Sintra, this year, the European Journal of Internal medicine and the website, are all examples of successful initiatives. Internists are thus determined to contribute to their specific area and the consolidation of Europe as a common social and political space.
In recent years, internists have taken a pro/active stance, demonstrating and proving their strategic importance in the health services to society, political decison-makers, health managers and administrators.
The edition in France of the “Livre Blanc – La Medicine Interne en France”, the publication in Spain of the “Estudio Socio-Professional de la Medicina Interna em Espana: prospectiva 2010”, and the studies carried out on the activity of internists in Portugal, are all clear indicators of how internists are determined to take a stance for the defense and affirmation of their speciality. The work which Professor Pitta Barros has already shown today, supports our conviction that it is essential for our health systems and for Internal Medicine that independent studies and an evaluation of the internists’ work in hospitals are carried out. This is something that the health authorities and hospital administrations should promote to support fundamental decisions regarding the future organization of hospitals. At a time when the construction of a significant number of new hospitals in Portugal is being planned, the decisions concerning the organizational model are crucial.
Internal Medicine is a speciality which is presently practised under arduous and sometimes distressing conditions, because it is impossible to refuse patients and there is no waiting list. In order to guarantee its future, to become more attractive in the eyes of young doctors, who are reluctant to dedicate themselves due to the additional effort expected from its training and practice.
In order to attract more young doctors we must emphasize what has always been the distinguishing factor of Internal Medicine: broad medical knowledge associated with the rigours of clinical practice, a high level of scientific and technical demand and high ethical and moral patterns and the social acknowledgement of its importance, thus creating conditions for its dignified practice.
In a society in which the technical side of medicine is overvalued it is necessary to find a way to value the management of medical knowledge which internists carry out at the bedside of each patient.
Internists are pluripotential doctors, who, just like stem cells, can easily adapt to and acquire new skills for the situation in which they find themselves. This skill is particularly important when advances in medicine happen so quickly that they become the obsolete truths of yesterday. This not only means having to be constantly up-to-date, but also being able to change habits and attitudes, something which internists with solid training and flexibility adopt naturally.
Internal Medicine is a speciality where innovation and its integration in clinical practice are permanent. Innovation is present hen we treat patients with new diseases which oblige us to investigate. We innovate when we use news methods of diagnosis, when we use news forms of treatment and when we create new models of hospital organization. Innovation is at the core of Internal medicine practise.
We are convinced of Internal Medicine’s ability to do more and better for society and the treatment of patients with available resources. Our tradition of ethical responsibility is unbiased and demands quality in the defense of greater and improved care for patients. The sustainability of the health system is, inevitably, in the hands of internists.
Mr President
Ladies and gentlemen
While preparing the programme for the Congress, we were careful to ensure that, from a scientific point of view, this would be a unique opportunity to bring our knowledge up to date, allowing all internists to share the best of what they have been doing with regard to scientific production. At the same time, it would also be an opportunity to meet and reflect upon the diverse practises of Internal Medicine in Europe and in the World and to assess the profound transformations which are taking place in our health systems, in terms of organizing the provision of health care, hospital organization and the training of doctors. The Congress will be an event where we may reflect upon new ethical dilemmas which new realities have thrust upon us. This discussion is only possible in an open forum and with society itself therefore, we have also opened the Congress to participants who are not doctors.
Over the last two years we have worked towards ensuring that this is a pleasant and valuable Congress for all internists, for Internal Medicine in Europe and for its Federation. The support we have received from the Executive Committee, the Administrative Council as well as National Societies, and the American College of Physicians has been tremendous and has contributed immensely towards what we foresee as being a very successful Congress.
I would like to take this opportunity to express our gratitude towards the pharmaceutical industry which, once again, has risen to the challenge of participating in this Congress of Internal Medicine.
The participation achieved both in numbers of those present, one thousand and eight hundred, and in the number of abstracts submitted indicates the current dynamism of our speciality. The presence of 45 countries from all continents has made us immensely proud.
We conceived the congress thinking of the future and that the future of Internal Medicine lies with young doctors who decide to become internists – the most complete way of being a doctor.
And so, confident in the future of Internal Medicine and in Europe which was its birthplace, I turn to these young doctors, to their enthusiasm and their determination.
Lisbon with its “blooming jacarandas” welcomes you.
Have a pleasant congress!
Lisboa, 23 de Maio de 2007
Dr. Faustino Ferreira
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