Għaliex it-tobba huma psikologi ħżiena daqshekk?

The assistant reports to the head of the department about the last appointment: “I measured the pulse, took blood and urine for analysis,” he lists on the machine. And the professor asks him: “And the hand? Did you take the patient’s hand? This is a favorite anecdote of the general practitioner Martin Winkler, author of the book Sachs Disease, which he himself heard from the famous French neurologist Jean Hamburger.

Similar stories occur in many hospitals and clinics. “Too many doctors treat patients as if they were only subjects of study, not human beings,” Winkler laments.

It is this “inhumanity” that 31-year-old Dmitry talks about when he talks about a serious accident he got into. He flew forward through the windshield, breaking his spine. “I couldn’t feel my legs anymore and didn’t know if I could even walk again,” he recalls. “I really needed my surgeon to support me.

Instead, the day after the operation, he came to my room with his residents. Without even saying hello, he lifted the blanket and said: «You have paraplegia in front of you.» I just wanted to shout in his face: “My name is Dima, not “paraplegia”!”, But I was confused, besides, I was completely naked, defenseless.

How could this happen? Winkler points to the French education system: “The faculty entrance examination does not evaluate human qualities, only the ability to devote oneself to work totally,” he explains. “Many of those who are selected are so dedicated to the idea that in front of the patient they tend to hide behind the technical aspects of the treatment in order to avoid the often disturbing contact with people. So, for example, do university assistant professors, the so-called barons: their strengths are scientific publications and hierarchical position. They offer students a model for success.”

This state of affairs is not shared by Professor Simonetta Betti, Associate Professor of Communication and Relations in Medicine at the University of Milan: “The new university education in Italy provides future doctors with 80 hours of communication and relationship classes. In addition, the ability to communicate with patients is one of the most important criteria in the state exam for professional qualifications, accounting for 60% of the final mark.”

“We, the younger generation, are all different,” says Professor Andrea Casasco, son of doctors, assistant professor at the University of Pavia and director of the Italian Diagnostic Center in Milan. “Less aloof and reserved, devoid of the magical, sacred aura that used to surround doctors. However, in particular due to the intensive regimen of hospitals and clinics, many people concentrate more on physical problems. In addition, there are «hot» specialties — gynecology, pediatrics — and «cold» ones — surgery, radiology: a radiologist, for example, does not even meet with patients.

Some patients feel like nothing more than a «case in practice», such as 48-year-old Lilia, who was operated on for a tumor in her chest two years ago. This is how she recalls her feelings from each visit to the doctor: “The first time the doctor studied my radiography, I was in the lobby. And in front of a bunch of strangers, she exclaimed: “Nothing good!” She talked about my body the way a mechanic talks about a car! It’s good that at least the nurses consoled me.”

The doctor-patient relationship can also heal

“The doctor-patient relationship is dominated by a patronizing style based on blind faith,” continues Simonetta Betty. — In our time, respect must be earned by scientific competence and the method of approach to the patient. The doctor must encourage patients to become self-reliant in treatment, help them adapt to the disease, manage disorders: this is the only way to deal with chronic ailments.

With the growth of diseases that you have to live with, medicine is also changing, argues Andrea Casasco: “Specialists are no longer those who see you just once. Bone and degenerative diseases, diabetes, circulatory problems — all this is treated for a long time, and therefore, it is necessary to build a relationship. I, as a doctor and leader, insist on detailed long-term appointments, because attention is also a clinical tool.”

However, doctors are increasingly faced with an exaggerated expectation that everything can be solved and cured, explains Mario Ancona, psychiatrist, psychotherapist and president of the Association for the Analysis of Relationship Dynamics, organizer of seminars and courses for personal doctors throughout Italy. “Once people were disposed to support, and now they claim to be treating. This creates anxiety, tension, dissatisfaction in the personal attending physician, up to burnout. This is hitting physicians and personal assistants in oncology, intensive care and psychiatric departments.

There are other reasons: “For someone who has chosen the path of helping others, it is very tiring to be blamed for mistakes or for not being able to calculate their strength,” Ancona explains.

As an illustration, he cites the story of a pediatrician friend as an example: “I discovered developmental defects in one infant and ordered him to be examined. My assistant, when the parents of the baby called, postponed their visit for several days without warning me. And they, having gone to my colleague, came to me to throw a new diagnosis in my face. Which I myself have already installed!”

Young doctors would be happy to ask for help, but from whom? There is no psychological support in hospitals, it is customary to talk about work in technical terms, everyone is afraid of receiving all the pain and fear of patients if they turn on sympathy a little. And frequent encounters with death will cause fear for anyone, including doctors.

Patients find it difficult to defend themselves

“Illness, anxiety in anticipation of results, all this makes patients and their families vulnerable. Every word, every gesture of the doctor resonates deeply,” Ancona explains, adding: “For someone who is sick, the disease is unique. Anyone who visits a sick person perceives his illness as something normal, ordinary. And this return of normality to the patient may seem like a cheapening.”

Relatives may be stronger. Here is what Tatyana, 36, (her 61-year-old father was diagnosed with a tumor in the liver) said: “When the doctors asked for a lot of tests, dad protested all the time, because it all seemed stupid to him. The doctors were losing patience, my mother was silent. I appealed to their humanity. I let the emotions I used to choke out come out. From that moment until the death of my father, they always asked how I was doing. Some nights, just a cup of coffee in silence was enough to say everything.

Should the patient understand everything?

The law obliges doctors to give complete information. It is believed that if the details of their illness and all possible treatments are not hidden from patients, they will be better able to fight their illness. But not every patient is able to understand everything that the law prescribes to explain.

For example, if a doctor says to a woman with an ovarian cyst: “It may be benign, but we will remove it just in case,” this will be true, but not all. He should have said this: “There is a three percent chance of a tumor. We’ll do an analysis to determine the nature of this cyst. At the same time, there is a risk of damage to the intestines, the aorta, as well as the danger of not waking up after anesthesia.

Information of this kind, although quite detailed, can push the patient to refuse treatment. Therefore, the obligation to inform the patient must be fulfilled, but not recklessly. In addition, this duty is not absolute: according to the Convention on Human Rights and Biomedicine (Oviedo, 1997), the patient has the right to refuse knowledge of the diagnosis, and in this case the relatives are informed.

4 Tips for Doctors: How to Build Relationships

Advice from psychiatrist Mario Ancona and professor Simonetta Betty.

1. In the new psychosocial and professional model, treating does not mean “forcing”, but means “negotiating”, understanding the expectations and mentality of the one in front of you. The one who suffers is able to resist the treatment. The physician must be able to overcome this resistance.

2. Having established contact, the doctor must be persuasive, create in patients confidence in the result and self-efficacy, stimulate them to become autonomous and adequately adapt to the disease. This is not like the behavior that usually occurs in diagnoses and prescribed treatments, where the patient follows the instructions «because the doctor knows what he is doing.»

3. It is important for doctors not to learn communication tricks (for example, a smile on duty), but to achieve emotional development, to understand that a visit to a doctor is a meeting with each other, which gives vent to emotions. And all of them are taken into account when making a diagnosis and choosing a therapy.

4. Often patients come with a heap of information from television programs, magazines, the Internet, which only increases anxiety. Physicians should at least be aware of these fears, which can turn the patient against the specialist. But most importantly, don’t pretend to be omnipotent.