by Maria Luisa Agneni
I have not heard a single comment on the total disconnect between what society expects and what we doctors are able to offer today. Not a comment on the deep crisis of medicine as if it didn’t exist or as if nobody perceived it and as if these atrocious accidents were only the manifestation of the inevitable isolated human folly.
05 MAG –
The brutal and tragic attack on our colleague Barbara Capovani has brought us back to reflect, saddened and indignant, on what happened and to imagine hypothetical solutions from many quarters such as greater vigilance in health centers, especially psychiatric ones or SERDs, or extending the treatment time to be able to establish a better doctor-patient relationship and much more; all hypotheses worthy of consideration but which, in my opinion, concern only the tip of the iceberg which, when it emerges, is always at our expense and at very high costs.
I have not heard a single comment on the total disconnect between what society expects and what we doctors are able to offer today. Not a comment on the deep crisis of medicine as if it didn’t exist or as if nobody perceived it and as if these atrocious accidents were only the manifestation of the inevitable isolated human folly.
Before analyzing the main reason for the aggressiveness towards us and which will presumably be expressed again, I would like to point out some rather unmentioned aspects.
1) The attacks by insane people against doctors is not just a problem for psychiatrists because these patients also turn to their GPs, children’s pls, emergency medical doctors and other specialists of any branch who often do not have the professional tools to relate well with them and therefore are potentially more exposed to being attacked.
2)Every day the patients (exhausted? arrogant?) raise their voices with us for alleged rights denied especially with the “doctors” who are still too often called ladies with an evident devaluing intent so much that any of our attempts at correction are taken with anger . In fact, if there had been a man in our place, no one would have called him sir. Speaking of denied rights, I recall the rather frequent demand that we pulmonologists maintain a long-term oxygen therapy life only because it was prescribed once after a hospital discharge after an exacerbation which after a few weeks in the stabilization phase would no longer be necessary, on the contrary, but which continued to be wanted with threats of various kinds. Or that of a patient who defined himself as asthmatic without producing any documentation but having the bronchodilator in his pocket and pretending to anticipate his anti-Covid vaccination in the group of frail patients in order to then be able to go on vacation more calmly threatening with screams and shouts to slam me on everyone the newspapers the next day. Or the one who, screaming and threatening, asked for a diagnosis of pulmonary fibrosis in order to be able to attribute responsibility to the hospital where he had been in intensive care for Covid and where they had saved his life by having only his chest with a negative Objective Examination.
These are just a few very frequent examples from which unreasonableness, lack of trust, cunning, dishonesty, madness emerge that each of us experiences very often and moreover in solitude. Those who work in the NHS know well how even the exasperation of queues, waiting lists or organizational problems, even the payment of blue lines, are downloaded with anger on the last link in a chain of which the health care provider is not only a stranger but in its own way it is also a victim.
3) And what about the warranty notices we receive? Aren’t those attacks too? How many colleagues and colleagues have permanently stopped their business and how many of them have died of a heart attack or stroke or have fallen ill after such an experience? Why is the average life span of a doctor shorter than that of the general population? Reporting an alleged manslaughter today is an act that costs nothing, it can only bring an economic advantage since the lawyers will be paid only if they obtain compensation but in the meantime an expensive machine of defenders, experts, etc. is started … and above all times of justice which for an innocent person who has to justify himself in the face of often artfully constructed lies takes an eternity. Yet if there was a law that automatically provided for the compensation of legal costs and moral damages against the doctor who was found innocent or whose proceedings were closed, these ignoble causes would be considerably reduced.
No one is taking care of this and the Gelli law, passed off as more guaranteeing towards health care, has proved to be an absurd trap in the name of compliance with guidelines that are too often not adequate for the individual and specific case and has meant that proceedings against doctors would increase exponentially. The thousands of attacks per year will lead doctors, in spite of themselves, to choose less demanding clinical cases despite their brilliant competence and towards a defensive medicine with an exorbitant public cost.
But do we really think we can reduce aggression by looking for protection in laws that also need to be improved? Could we ever regain credibility by better organizing our autonomy in the name of our authority? Or rather shouldn’t we work on authority and focus on knowing how to reason, think, interpret on becoming more and more a thinking subject?
For millennia, illness has been considered a fault and the term patient (one who has to suffer, endure) confirms this. But for some time now, patients in this society have disappeared to make way for individuals and citizens with rights who tend to contractualize every relationship even though they are still considered by medicine to be damaged objects to be repaired or talking diseases.
But those who have the right to health cannot be considered guilty of their illness and therefore the illness risks becoming the fault of the doctor or of those who, it is assumed due to incapacity, are unable to heal.
After all, every day the media offer us optimistic information on the giant steps taken by research that cures and heals more and more than yesterday, above all creating audiences and expectations, leading the public to believe that everything can now be cured and everything can be cured today more than ever … but reality often doesn’t match and then anger mounts towards those who wouldn’t know how to do their job well.
If we do not consider the patient alongside the disease and the relationship with their doctor at the center of our study, that is, if we do not rethink medicine and the way of being a doctor in a radical reform of medicine and the profession, the attacks will not decrease.
There is a need for a doctor who knows how to use the best evidence but who also knows how to choose the best for the singularity of his own patient, singularities and peculiarities that can only be satisfied with a careful recovery of the clinic and attention to the complexities.
To understand the great problems of the profession, those relating to social trust/distrust, or those relating to adequate care, analyzes on organization, management, financing, i.e. on the problems of services understood as containers, are also needed. on contents, methods, cultural approaches, training and therefore on practices as an expression of a certain medicine and a certain medical culture. We need a reform and a radical rethinking of medicine.
This is the way to recover the authority and trust of citizens, who will finally be treated not as priests / priestesses of science, which has become a kind of secular religion, but by doctors trained in complexity who know how to use discretionary thinking reasonably and responsibly.
The doctor who wants to be adequate to the specific needs of patients must be pragmatic, scientifically well trained, able to reason and use scientific evidence, his own and others’ clinical experiences and to interpret the numerous singularities of those who suffer then and only then it will mend the gap between what society expects from us and what we will be able to offer with the consequences of a recovery of our credibility and authority.
Maria Luisa AgneniOutpatient Pulmonologist ASL Rome 1
05 maggio 2023
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