SUBJECT 2017

FESTIVAL DELLA SCIENZA MEDICA
Innovation and Tradition

Bologna, 20-23 April 2017

Doctor-patient relationship: a path for change, between innovation and tradition

Between Innovation and Tradition is the third leg of the long journey undertaken by the Festival della Scienza Medica.
A long journey indeed, because the warm welcome we received and the great commitment by Scholars, Institutions, Companies, Teachers and Students allow us, I believe, to plan a long-term engagement.
Innovation goes fast while tradition, far from being merely outlined by time, is linked to our history: the history of mankind, of women and men who, since the dawn of civilization, and for their whole life, felt the need to believe that some people were able to work for the wellbeing of others, to ensure their health and keep them safe.
Tradition shaped the role of shamans, healers, and medicine men over many centuries. Then, at a quite faster pace, they all merged into the actual figure of the doctor. It all took place in an advanced environment where the selfless concern and the commitment on which the charisma of such figures was based within increasingly complex social groups, found its own definition, as it has been known and shared in the last few centuries, up to the latest advent of scientific medicine.
As it was highlighted by Eric Kandel in Bologna, the new biology science of mind is important not only because it gives a deeper comprehension of what makes us what we are, but also because it makes possible an important series of dialogues between brain science and other areas of knowledge.[1]
The process of development of medicine was long and discontinuous, it combined with an almost prodigious ability to gather pieces of knowledge and with the incessant evolution of its process of transformation into a proper science.
Within this framework, tradition was nevertheless respected and perhaps even enhanced, but the predominant (and I believe overwhelming) aim was to provide a meaning for the medicine of the future that may thus proceed in agreement with the medicine of today and tomorrow.
Medicine somewhat still feels like tradition. But, under many more aspects, it comes as innovation and technology and, at least in some branches, it widely conveys the need for a mutual understanding in the doctor-patient relationship. The latter is based today on the global nature of diagnoses and on the interaction between the doctor’s and the patient’s minds. Such an interaction seemed to be seen as obsolete, while now it is once again praised, almost paradoxically, as an innovative attitude.
Technological innovation makes it necessary to modify the once interpersonal relationships of the past that are now influenced by technology, which is invasive and powerful and can be transformed from a functional tool into a prevailing item.
However, the use of a tool, as complex as it may be, cannot be the final goal, either for the doctor or for the patient.
It is not only necessary to make a tool work, but it is important to heal and cure in order to achieve results denoting increased certainties, exactness, duration, naturalness, and the possibility to support the costs weighing on society as a benefit for society itself, so that it would be correct to foresee the need for an “extraordinary maintenance” for the National Health Service (Pelissero)[2].
Which major worries could be aroused by this scenario in the making? Doctors, being satisfied with the potential performance by the machines, and frequently rewarded by evident instant outcomes, might neglect the personal approach to patients taken as a whole, thus forgetting the still obvious limits to a full understanding of numerous problem issues that, despite all achievements, are far from being solved. Also, given the situation, patients might be tempted to adopt self-treatments.
At any rate, a full integration between medicine based on traditional principles and sophisticated and constantly evolving technologies would be so costly for society that unavoidable problems concerning the economic and social sustainability would arise.
The doctor-patient relationship is changing at a fast pace, as it is also a “product of the evolution of the behavioral nervous system that could be investigated through a scientific and evolutionistic approach” (Benedetti)[3].
Scientific medicine was considered at its onset and in its fast development, including many branches and many specialties of medicine. As renowned authors pointed out, the transition from shamans to modern doctors and from shamanism (based on a spiritual concept of diseases) to scientific medicine (where the anatomical-physiological outline of diseases prevail) was a centuries-old process that appears completed by now. (Benedetti)
However, the whole process was accompanied by a fragmentation of medicine that might hinder a medical activity meant for the individual as a whole, thus widening the gap between patients and doctors.
The recent developments in neurosciences could provide a sound support for improving knowledge on the behavior of patients and on the psychological and social factors affecting diseases, and would thus be extremely relevant for doctors to carry out their mission.
All this could possibly lead to a well-founded optimism, stemming from a more refined knowledge, on the part of doctors, of their own functions. A knowledge requiring a strong commitment in terms of skills as well as the adoption of behavioral modes fit to grant patients an overall situation of trust and confidence in their doctors, thus generating mutual positive results.
Today this confidence cannot just involve people. It must go hand in hand with an as trustful attitude towards the structures where doctors must work, in order to grant anyway a medical care that fully exploits the advancements of research.
Many think that the overall economic needs of a wider, albeit definitely hierarchical, Europe require a rigidity leaving no room for the flexibility and tolerance necessary to ensure the development of medicine.
The problems of public expenditure come to the fore and it becomes quite difficult to work constantly in view of a greater social justice and of the struggle against the increase in inequalities.
The development of innovation and, in spite of everything, the respect for tradition must face innumerable varieties of institutions and individuals, who cannot be denied a social response to diseases, based on hope, empathy, social trust and interpersonal doctor-patient confidence.

 

Fabio Roversi Monaco
President Genus Bononiae. Musei nella Città

 

[1] Lectio magistralis given during the Second Edition of the Festival della Scienza Medica: The Age of Insight: The Quest to Understand the Unconscious in Art, Mind, and Brain From Vienna 1900 to the Present (Bologna, May 19th, 2016).

[2] Gabriele Pelissero, 14° Rapporto annuale ‘Ospedali & Salute 2016’.

[3] Fabrizio Benedetti, Il cervello del paziente, Giovanni Fioriti Editore, 2016.