28 FEB – I think I have good reasons to count myself among those who know very closely the thought of Ivan Cavicchi, his intellectual commitment and his obstinate and well-known passion for reform.
Since, in 2018, I was appointed president of the National Federation of Orders of Surgeons and Dentists (FNOMCeO) with Professor Cavicchi, an extraordinary cultural complicity has taken shape, thanks to which the “medical question” has been studied – perhaps as never done in the past – trying to analyze contradictions and problems.
It is no coincidence that FNOMCeO has entrusted the task of writing the 100 theses that are the basis of our project to redefine the medical profession to Professor Cavicchi.
So, for me, the Preface of this book is, at the same time, an honor and a pleasure, but also an opportunity to almost maieutically help the birth of a thought that could constitute a turning point.
And I consider this book, in all senses, a real turning point for several reasons – which I will enumerate below, first of all because, in my opinion, compared to the available literature and the analyzes carried out on medicine and its crisis, it has a value added and marks a real change of pace. In fact, the conceptual structure of medicine is reconstructed in its entirety and related complexity: from the paradigm we pass to the doctrine, then to the discipline and finally to the practices and a real system of rules is outlined.
The basic idea is enlightening: how can you say that medicine is in crisis if you don’t first define what medicine is? And Professor Cavicchi is right, in fact, because depending on how medicine is considered, there can be different kinds of seizures. If medicine were considered simply a scientific discipline, the crisis, in this case, would be limited to the problems of science, but if medicine is something else, that is, it is more than the scientific discipline and, for example, also concerns doctrine or paradigm, in this case, the crisis would inevitably be more extensive and more complex.
But also deeper and more difficult to resolve.
Personally I am grateful to Professor Cavicchi for this work of reconstructing the conceptual framework of medicine which allows us to better understand its complexity and “unparalleled” (to quote the title of this book).
In fact, there are too many proposals in circulation that trivialize or ignore the complexity of medicine, to the detriment of both the patient and the doctor.
Furthermore, I consider this book a turning point also for the analysis of the medical crisis and its dynamics that goes beyond commonplaces, reaching a realistic and extremely useful diagnosis for the profession, for the institutions of the order, for health professionals and for the actors of the system.
Personally I find myself fully, both as a doctor and as president of the FNOMCeO, in his basic theory and that is that most of the problems of medicine, and therefore of operators and patients, depend on the change in society and in its reality of today it questions the rules and criteria that guided medicine until yesterday.
In this book, Professor Cavicchi talks about an epochal crisis, that is, a crisis that could only happen today in our days. So of an unprecedented kind of crisis, which we are told to be made substantially by bias, by misalignments that have been created over time between medicine and society, therefore between the sick and reality, between us doctors and citizens.
The bias theory proposed by Professor Cavicchi has the merit not only of offering us + a concrete interpretation of the problems of medicine but of showing us the way to seek the solutions we need: the path of reform and re-contextualization, of rethinking with the strategic objective of creating new conditions of adequacy, trust, coherence between medicine and the world.
The world cannot be expected to adapt to our problems, we are at the service of the rights therefore of the Constitution, it is we who must adapt to the problems of the world and to do this, Professor Cavicchi argues, medicine must re-discuss itself and also deeply, a greater dose of amiability is not enough.
Today it is a question of rethinking our way of being doctors, our way of treating people, of being able to interpret both the singularities and the complexities that exist, of using relationships to get to know the patient and to decide together with him, that is, to choose by consensus, the necessary care.
The proposal inherent in this analysis, in a historical pandemic context that has forced everyone, political decision-makers and actors in the system, to re-discuss the evaluation and operational parameters that were considered immutable in health care, is a precious gift that can be accepted or put into practice. discussion, but which must be recognized at least for consistency and that honesty of purpose which has as its objective the right realignment between medicine and society.
In fact, Ivan Cavicchi insists precisely on solving the problems of internal coherence of the current conceptual apparatus, considering this the first condition that will allow to recover the bias between medicine and reality.
It is not coherent, on closer inspection, to consider the patient a priori as a complex person and to know him as a simple disease, just as it is not coherent to support an epistemology of complexity and to study him in a linear, deterministic and mechanical way.
Rebuilding the internal coherence of our conceptual system requires that there are no dissonances and that the values, rules, criteria, principles of the system do not conflict. Medicine without dissonance is the aim of this book’s proposal.
One last thing before leaving the reader the pleasure not only of reading but also of discovery.
As president of FNOMCeO, I was particularly struck by a strong thesis that is very dear to me and to Professor Cavicchi, on which we have
much beaten and that concerns the autonomy of the doctor and his practices.
He argues that for centuries, therefore up to the present day, the conceptual framework of medicine has “prescribed” the doctor what to do and how to do because he was able, in some way, to define a priori capable of governing the different degrees of complexity the doctor was dealing with.
While today the complexities involved are such that a priori alone are no longer enough. According to him, they must first be updated to have the guarantee of being able to count on truly adequate practices, then integrated by recognizing even legally to the doctor greater autonomy of judgment.
So, for the first time in the history of medicine, this society is forced, if it wants to be properly treated, to prescribe to the doctor how to behave but at the same time to leave him ample space for intellectual autonomy.
So for the first time it is a question of recognizing an important function to discretionary thought, thought, explains Professor Cavicchi, which in any case will have the obligation to be guaranteed in any case.
This greater intellectual autonomy of the doctor justified by greater complexity implies the need to initiate a reform of university education.
The thesis in my opinion, however demanding it is, is very suggestive and confirms the intuition that we as FNOMCeO had in 2018 and that is to redefine the autonomy of the doctor and consequently his professional training in order to better respond to new social needs. .
I close by congratulating Ivan Cavicchi, friend and accomplice, for the interesting work he has given us, hoping that it will have the success it deserves in the interest of medicine, the profession and the sick.
Bertolt Brecht said that ideas are like snowballs, they must be thrown before they melt in your hand. That’s what I hope will be in the general interest with this book.
Filippo Anelli
February 28, 2022
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