Post-Pandemic and Health in Brazil – Reflections on the new conscious and more collaborative patient

 “Humans tend not to look at a long distance. We are now required, in these generations, to have a broader view of what we have inflicted on the world and around us” Frank Herbert (Journalist and Science Fiction Writer).

I receive this honorable invitation after experiencing 50 days of quarantine, and now starting a lockdown, looking and reflecting on the current complexity of resource management and the suffering of the patient-team and family in the hospital environment. Although a little distant from the “front”, I try daily to collaborate in facing Covid-19 by participating in virtual meetings and, at the same time, studying, thinking, mentoring and writing about the effects of the different waves of the pandemic.

The challenge of pointing out the future about the post-pandemic in Brazilian health, which will occur, in a more optimistic interval, between 1.5 – 2 years, will require courage and creativity, considering that this new future will not be a repetition of the past (pre-pandemic period) and will depend on individual and collective choices.

My point of analysis will be the new patient, no longer the old paradigm, the already proclaimed Patient 4.0 (Dr. Google), sometimes with a trace of pride about his knowledge, rights and demands on health professionals and institutions. In my view, a consumer-citizen will emerge who will empathetically seek to understand and collaborate with his self-care and why to make appropriate choices in relation to his health and also the economic impacts that health promotes on the lives of individuals and the costs involved for the health system .

From the daily learning of information, which is exhaustively generated by the media and which enter the homes, certainly influence the daily lives of Brazilian families. The “pandemic crisis” is activating and redesigning a new citizen who uses health services based on a daily activity of modern health literacy. There will be a profound change in the real meaning of the role of true national heroes (health professionals who fight on the front lines), an understanding of the importance of science, the true function of the free press with real credible information and the profound disservice of the fake news. In addition, our indulgences and asymmetries in the quality of health services experienced in real time by the Brazilian population will be the pillars for this new awareness of the new Brazilian citizen in relation to aspects related to health and its social determinants. Our relationship with consumption, including those related to the areas of health and well-being, has undergone major changes in the face of isolation and reduced income, generating new desires, needs and priorities that fit the budget of families. Thus, after the end of this long journey, in which we participated in a prolonged social isolation and strong relationship with the old media and social media in which we were massively exposed to daily news about medicine, hospitals, epidemiological and clinical science, we learned the health-economy relationship is painful. Therefore, we will probably have developed a new mindset based on the collective human experience of the VUCA world (Volatile, Uncertain, Complex and Ambiguous), and the consequences and reflections that will be present in individuals, organizations, society, the Brazilian Government and State. In short, the construction of the new reality (new normality) will involve a spirit of citizenship with a greater sense of the collective and no longer tolerant of the immense inequalities.

The new humanism will be expressed by the attitudes of collaboration, solidarity, flexibility, self-awareness, and concern for the other and the appreciation of empathy, which will be more strongly present in people’s minds. The sum of all these elements will shape profound changes in the public and private sector, which will be charged for a greater degree of transparency, efficiency, and participation in citizen’s decision-making processes in relation to health issues. Alongside this, we will have to face major challenges in the areas of mental health and social assistance in the face of the large number of individuals with psycho-emotional disorders and the growth of the excluded and the “new vulnerable” in the post-pandemic period.

The confrontation of the prolonged economic crisis (second wave) will need to be analyzed and dealt with massive investments in the private and public sector to restructure the “Unified Health System” (SUS – Public Health System in Brazil). Discussions on the lack of inputs to face the pandemic in the country (China risk) will force the resumption of investments in the industrial health complex in Brazil. It will be essential to invest in biotechnology and biomedical research based on public-private partnerships and the connection and modernization of the Academy’s governance and financing. For the new era, citizens will be aware of the importance of modernizing the management and structure of hospitals and the quality of health service provision and will actively participate as protagonists and supporters of the digital transformation in health.

Digital medicine will be one of the priorities and will be present in homes and even in homes for the elderly, monitoring data in real time and transmitting information for maintaining the health of individuals and promoting integration of health care and social assistance. The need to generate short-term results and the sustainability of the private sector can lead to a sequence of bankruptcies of entrepreneurs. Doctor’s offices, diagnostic medicine clinics, popular clinics and more robust providers, such as hospitals, insurance companies, health insurance, assistance boxes and cooperatives, will need to be formatted based on the requirements and values of this new patient.

A new ecosystem will be formed from the iconic change of hospitals in the pre-pandemic as symbols of security and status. In the post-pandemic, they will be identified as places that should only be visited at special times and in strong need. In this way, family medicine and home care will be highlighted, employing technology with a strong participation of the multidisciplinary team. Physical and mental health, with a focus on primary prevention / health promotion, will be the real “passport of immunity” for the next pandemics and for an independent and full life.

Anyway, we started a new era with the participation of the individual with their self-care, greater understanding of health costs and the role of good management of resources in health and the great relevance of digital transformation in health. In short, alongside a new normality, a new, more rational health pro-consumer will be installed, progressively and definitively, with his choices and with a greater understanding of the complex functioning of the health system and the economic impacts.

Evandro Tinoco Mesquita

Teacher of Cardiology at UFF (Universidade Federal Fluminense)

President of the CBEXs RJ Chapter and Educator CTEB / UHG

Coordinator of the Universidade do Coração da Sociedade Brasileira de Cardiologia (Biennium 2020/2021)

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