Oncology

Tumours: doctors and patients restricted to 20-minute minimum 'timetables'

The complaint of the Cipomo primars on a bureaucracy that occupies 40% of the professional commitment in the face of time cut to the bone for the relationship with the patient in many regions

by Barbara Gobbi

8 May 2025

3' min read

3' min read

"We talk a lot about communication, patient relations, reception. And then there is a 20-minute timetable for the oncology visit, which is totally inadequate'. "Too many times we have to become equilibrists between the patient in front of us and the PC screen where we have to be careful when entering data about him. Circumstances that are very poorly reconciled with the time for relationships and care, which is necessary because it has a bearing both on adherence to treatment and on the patient's quality of life and in some way on the evolution of the prognosis'.

No to diktats on visits

Turning the spotlight on the tight timeframe and bureaucratic burden that affect one of the most delicate steps when it comes to cancer, namely the care relationship, are the chief oncologists of Cipomo. They reject the 'diktats' on the minutes to be devoted to patients as well as proposing solutions to the increasing burden of bureaucracy. A commitment that robs them of 40% of their overall working time: if therefore therapeutic innovation proceeds at a brisk pace, the administrative burden is no less, and this is demonstrated by the national survey 'Oncology and Administrative Burden: an Italian Survey', promoted by Isheo, La Lampada di Aladino-Ets and by the College of Chief Oncologists itself, which has just presented and discussed it at the 29th elective congress in Florence.

Route on Appropriateness

"The lack of information systems and of the interoperability of systems does not help,' explains outgoing Cipomo president Luisa Fioretto, head of the Oncology Department of the Tuscany Centre Regional Health Authority: 'The survey that we conducted throughout Italy tells us that this time devoted to bureaucratic and administrative tasks must be reduced and that solutions must be found to delegate to other figures the activities that can be done: moreover, greater appropriateness must be found in the use of professional profiles, also with a view to costs. Just think of the cost of one hour of a first- or second-level doctor compared to that of an intermediate figure. The available resources must be used appropriately'.

Medics as Cup

'All too often,' explains Rosarita Silva, Cipomo treasurer and director of medical oncology at the Fabriano hospital, 'we are also reduced to carrying out the functions of the Cup: in the so-called 'taking charge' in the follow-up pathway, the patient leaves the outpatient clinic with the commitment, the instrumental investigations booked in the slots dedicated to oncology, and so on. All very well, but this takes away precious time that the doctors could usefully recover for that same patient as well as for others. This step could therefore be delegated to alternative figures. In short, in the face of an extraordinary administrative load, we are called upon to respect timetables and this is unacceptable'.

Region you go, time you find

Some regions have well-defined timetables: one 'model' is 30 minutes for the first visit and 20 minutes for follow-up visits, but it varies greatly from one region to another. "It depends on the sensitivity of the strategic directorates and the strength of the professionals to bring forward certain instances,' Fioretto reports. 'In Tuscany, we managed to obtain an hour for the first visit and 30 minutes for follow-ups'.
The minimum is reached in Lombardy and Liguria, where 20 minutes are set for the first visit. A 'roadmap' also linked to drg reimbursements and closely linked to the need to shorten waiting lists. Against which the regions have to 'ingenuise' themselves, if only one thinks that Lombardy has just signed a collaboration agreement with the Carabinieri of the Nas.

'Generally speaking, there is a tendency to compress and not to give the professional the opportunity to interact with the patient in the face of a tight schedule,' explains Cipomo president-elect Paolo Tralongo. 'The fact is that not all acts can be standardised and that there are necessary conditions that must be taken into account. Not everything can become an economic or exclusively technical element: there is a question of a cultural approach that must be defended and enhanced'.

Burnout risk

The other side of the problem is the psychological effects on doctors of the administrative burden. "There is a sense of frustration with respect to one's vocation, and a few years ago we had already noted this in an initial survey," Luisa Fioretto continued, "which showed a level of professional burnout that was less evident than in other northern European countries, but which had an impact on the personal lives of white-collar workers. Today this second survey shows a worsening: both burnout and personal dissatisfaction are increasing. Yet the well-being of patients also passes through that of professionals. Delegating, reorganising, and simplifying processes is today an unavoidable necessity to sustain the oncology of the future'.