Cruising between Scylla and Charybdis … Just a hope?

I have read with interest the recent paper written by Macchi and Pavan concerning the problems about the quality of medical care at the time of economic crisis. I acknowledge that the efforts for “cruising between Scylla and Charybdis” have been huge, but the meaning of this old Greek myth is hopeless (“having to choose between two evils”). Besides the present economic situation and the present tendency to have an increasing number of old or very old patients in the western countries, some problems that can jeopardize the quality of care within a research and teaching hospital cannot be solved on a local basis, but in my opinion, they can be efficiently managed only under a general health plan. Defensive medicine and the system of diagnosis-related groups (DRG) are not sustainable in the near future. It is always difficult to calculate the cost of defensive medicine, but in Italy, this has been estimated to be around 10–12 billion/euro/year. In time of shortage of money, this cost cannot be sustained by anyone, surely not in our country. Second, DRG have a small sense in the area of research and teaching hospitals that should not be judged on this base, as the case today. In addition, it is sure that when the financial resources are lacking, the staff turnover should be minimized. However, when the staff turnover is practically abolished, as Macchi and Pavan admit, the consequences for the quality of care can be more important than imagined. As a matter of fact, the education and training of a clinician require a long time spent with the master and the abolition of the regular staff turnover can determine a gap in the near future that could not be filled easily, even in the event of more favorable economic circumstances.