Telemedicina | Precarización ad infinitum

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CFK ha señalado, en su última “carta”, dedicada a la Corte Suprema, que el Senado bajo su presidencia ha tenido más sesiones que cualquiera de los últimos 13 años, en los que evidentemente se incluyen los ocho de su propio mandato como Presidente de la Nación. Destaca la sanción o media sanción de toda una serie de iniciativas (desde el presupuesto de ajuste, con cero pesos para el combate del COVID, hasta el teletrabajo) y entre ellas incluye la regulación de la telemedicina. La telemedicina ya había inaugurado su propia secretaría de Estado en el Ministerio de Salud. Aunque se hizo masiva como alternativa a la atención presencial para evitar el contagio cruzado en los hospitales, la práctica de consultas médicas vía teleconferencia ya existía en algunas prepagas, las mismas que hoy quieren hacer masiva la consulta online.

La utilización de las TIC (tecnologías de información y la comunicación) en el ámbito médico no es una novedad. Desde hace veinte años que especialistas médicos de las grandes ciudades colaboran con sus pares del interior del país, ante la falta de centros y especialistas para atender diversas patologías. Es el caso modelo del Hospital Garrahan. La tecnología también hizo posible la visualización online y en tiempo real de estudios y bioimágenes. Es decir, la medicina ya utiliza hoy en día las nuevas tecnologías de la comunicación, incluso masivamente. La novedad en este caso es que se discute no ya la telemedicina en un sentido amplio, sino la teleconsulta: que el paciente realice sus consultas médicas y sea diagnosticado o derivado a través de una videollamada o videoconferencia. 

Así, lo que la OMS sugiere como alternativa para llegar a lugares geográficamente aislados, las empresas de salud quieren aplicarlo a escala urbana y masiva, apelando a la “comodidad”. El ministerio de salud no se queda atrás, sosteniendo que la consulta médica virtual dará más “equidad en el acceso” a la salud. Detrás de la novedad, sin embargo, se esconde un retroceso absoluto en la atención de los pacientes, en el acceso real a la salud y en las condiciones de trabajo de los médicos, todo esto en función de un nuevo negocio para las corporaciones de la salud privada, a la que también apuesta el Estado para bajar los costos de la salud pública.

Consultados por su opinión, los médicos son tajantes: “La telemedicina es incapaz de la observación clínica, el escuchar y el contacto físico con el paciente, bases no sólo del diagnóstico sino también de la relación “médico – paciente”, sostiene el Dr. Ricardo Iglesias, perteneciente al consejo asesor de la Sociedad Argentina de Cardiología. ¿Cómo diferenciar un ataque cardíaco de un dolor muscular desde la pantalla? ¿Una apendicitis de una gastroenteritis? Imposible sin las herramientas básicas de la semiología.

Con las nuevas tecnologías, no se busca acercar al paciente a la consulta, sino alejarlo de ella. Una especie de filtro a la llegada a la consulta presencial. Ya funcionan de esta manera las empresas de seguros de salud, primero la consulta por videollamada, luego, de no resolverse el problema específico por el que consultó el paciente, la visita al médico. En el medio, el malestar continúa y se agrava, sin supervisión. La teleconsulta ignora al paciente como sujeto, y se ocupa solamente del síntoma, ignorando no sólo cualquier condición subyacente, sino por sobre todo el carácter humano y holístico del sujeto-paciente.

Si la consulta a través de una app en el celular es equiparada a la consulta médica y traería “equidad en el acceso” ¿para qué construir nuevos hospitales y salas? ¿para qué sumar personal sanitario en todos los niveles? 

Por otro lado, la atención virtual cambia radicalmente las condiciones de trabajo del personal de salud. En primer lugar, si hoy la remuneración a los médicos por parte de obras sociales y prepagas, ¿cómo será el salario de aquellos que atiendan online?. En segundo lugar, la nueva prestación estaría necesariamente mediada por aplicaciones específicas (con la excusa de proteger los datos personales del paciente se trataría de programas específicamente diseñados, no plataformas como meet, zoom o whatsapp), monopolizando aún el negocio y subsumiendo a los médicos. Las propias empresas de medicina prepaga sostienen que uno de los beneficios de la atención a distancia es la reducción de los costos.

La Confederación Médica de la República Argentina denuncia el negociado de las prepagas en los siguientes términos: “Los argumentos esconden los verdaderos intereses: aprovechar la necesidad de atención médica durante la pandemia con el objeto de obtener un beneficio económico adicional y permanente para sus negocios. Las empresas comerciales de la salud promueven irresponsablemente la teleconsulta como una de las formas de atención médica a sus afiliados. Cuotas reales, servicios virtuales.” Poco para agregar.
La gestión de la pandemia por los gobiernos capitalistas ha acentuado los rasgos más parasitarios del capital y su Estado. Terminamos el año sin nuevos hospitales o centros de atención, con el mismo personal, ahora agotado, sin licencias, sin vacaciones y con salarios congelados durante todo el año (5% de aumento en CABA y 7% en nación). El presupuesto para el combate del coronavirus es de cero pesos en 2021. En ese contexto, la ley de telemedicina, lejos de buscar dar nuevas herramientas a través de las TICs para la atención de salud,devalúa por completo la atención de la población y las condiciones de trabajo de los médicos, en función de un nuevo negocio para la medicina prepaga y la reducción de los costos de la salud pública.

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