2009-The Physician of the Future English and Catalan

F UNDACIÓN E DUCACIÓN M ÉDICA (FEM) 38 1.5. !e Welfare State Over the last "%y years in most developed countries the so- called “Welfare State” has been successfully established. $e welfare state provides wide social coverage and support to society in health care services, education and social services. $e state "nances these services with resources obtained from taxation and assumes full responsibility for their provision to everybody. Health care coverage is seen as a fundamental right; an entitlement for the people that the state must provide. Physicians play a role of highly quali"ed technicians in the system providing health services with public funding in order to satisfy the ever growing demands of an (over)protected population. A trend, characterised by a steady increase of expectations and demands for more and better services and a decreasing tolerance to accept delays, failures or unsatisfactory outcomes, is becoming increasingly evident over time. Likewise, we notice that part of the demand for health care services falls into what some have called “ complacency medicine ”, composed of actions of insigni"cant health value but that represent a high cost for the system. In the U.S.A. it has been calculated that they represent nearly a third of medical interventions but contribute practically nothing to patient health. Additionally, through this emerges the so- called “ defensive medicine” , consisting of the physicians demanding unnecessary tests and explorations, sometimes with iatrogenic e'ects, accompanied by a condescending attitude by the doctor towards the patients to avoid their frustration at the denial of what it is considered an entitlement. $is combination of ever-growing public demand together with a permissive attitude by doctors goes a long way to explain some malfunctions in the Spanish and other health care systems, such as overuse of hospital emergency services or excessive appointments at primary care level.