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The relationship with the doctor

foto di acquilone The WHO has established that health is not just absence of illness or disease, but identifies more broadly with a state of complete physical, mental and social. Quality of life is thus a multidimensional concept that includes functional status, psychological and social well-being, the perception of their health and disease-related symptoms and treatments.

To speak with the words of Luigi Frati: "The disease is not reducible to a purely biological phenomenon, but takes on psychological, sociological and ethical aspects of their own and give people seeking help. So in ancient medicine received a cosmological and anthropological basis, in the middle ages the disease and the relationship between doctor and patient were considered according to the Christological perspective, take the foreground in modern daily life and the individual as an individual with a history and a memory of itself aimed at productivity and therefore efficiency, rationality, normality.

The problem of disease is therefore also the problem of the image of the disease, when it attacks the self. Epidemics in ancient times were experienced by primitive societies as expiatory punishment and which are today remembered as the plagues of the past were characterized by a wound inflicted by the nature of divinity;'s disease belongs to the idea of a global relationship with the environment and with their ethical duties, the suffering is not absurd but in it no one is alone.

Syphilis, imported from the Americas in the sixteenth century, was already different aura. As taught in the style of the ancient medical Fracastoro, the secretion of tires Luetić bring out the moral rot of the patient.

Lost brotherhood in distress, the patient is not rejected now that the body (you must place himself in the mood to hear the primordial Catholicism brought guilt and shame associated with the disease who were experienced). In the last century tuberculosis was eventually to be one of the most serious endemic problems of mortality.

The agony for "ill-thin" as it was called tuberculosis, leading the patient to the physical destruction to the utmost respect but his awareness and his intellectual performances. In this lucid consummation of TB is so the image of post-Enlightenment, only with his intelligence, abandoned by the nature of "mother" who, with his pride, he tried to sway heretically.

Broadly speaking this corresponds to a change of internal images that, historically, the disease was experienced initially as a "sign of God." Then the idea was a "sign of the environment" (the environment that was felt at first as the natural then, after the industrial revolution, as the built environment and its productive activities).

Finally, in more recent times are characterized by the study of genes and molecular biology, the disease takes the form of a "sign code", a faulty transmission of information about cellular life. It is natural that the cancer should be considered in this frame of feeling, weaving what is the ideology of the disease.

The diagnosis of cancer causes more than any other disease, anxiety and fear: it imposes a dramatic implications not only on the physical condition of the patient but by procuring fractures, wounds and irreversible damage, with feelings of loss of stability, identity, relationality, generates a huge change in the emotional life of the patient. It bursts dramatically into a unitary system of existence that involves the body and psyche.

From the disease because there is defended fantastically comes from within and not from the outside. Cancer does not attack, Mina.

This ghost-miasmic cancer because the disease is real. It is interesting to note that the morbid picture which strictly speaking have a prognosis as serious, do not communicate the same horror. After all, neither the survival nor the quality of life of advanced cirrhosis, a serious kidney disease, a severe cardiac conditions are better.

Before we get started, the traditional discourse of pain is falsifying, because we now have medications and other therapeutic principals that control well this symptom. The truth is that a miocardiosclerosi a nephrosclerosis or cirrhosis are not intense images of death such as cancer, and that both the patient and the doctor.

Because the patient carries on his shoulders and this anxiety in institutions that accept it, and projects it on the doctors caring for him. We are not exaggerating. If the doctors casually accustomed to the daily presence of cancer in their surgeries, they will want to wonder so much drama, well, this is because the entire community, its organization, has put in place very effective defense mechanisms.

Let us begin with a culture of objectification and distance control. No theme is "exalted" as the problem-cancer. The health professional remains under his eyes distant and blurred image, conveyed in vague landscapes represented by mitotic cells and viral or immune phenomena in which the patient as the unit is no longer present.

But especially here is setting up a defense that is designed to fragment the report, defense that uses multiple scientific alibi. The multi-specialty approach, they say, requires different skills of the surgeon, the chemotherapy, the radiation oncologist, immunologist, and so on. The patient is no longer a unit, but a set of parts that will remain within separate.

The doctor has only one serious heart condition, his cardiologist, and he can feel like a father comforting, protective, ready Financo sudden and desperate needs of the night. The majority of patients with other diseases are also operated by a single specialist, regardless of the complexity of biological problems that arise related diseases.

Not so the patient with cancer. Already dismembered body, the tumor enters the Hall of Mirrors of his many kind players, which refer back to an identity fragmented.

He must resign immediately to the confusion on "what you know", "who you know" soon takes on that look painful to those who have unconsciously realized that all you can talk, but the only thing that really interests, namely his fear of dying.

The relationship between the doctor and the cancer is a fragile relationship in which carefully avoids the first to meet the anguish of a second, because the patient's death puts medical resonance in the image of his own death, after all, is not of the more distant.

Then the doctor's unconscious anxiety becomes persistent as a barrier even if unconscious. This is an important aspect of the problem of revealed truth or not the patient. Beyond the civil rights of the patient and medico-legal caution (see below), the substance of the matter show that the patient will not want to hear other truth than that which her doctor has decided to communicate in terms that he has chosen in order to orient in one direction or another.

But here it must be acknowledged clearly that this is not only of how much truth can receive the patient, rather than the doctor has courage in tackling this type of interview and, ultimately, how much truth to the report of these two specific individuals can live and endure.

Acutely observes that the ambiguity Scoppola within which the physician takes refuge with cancer, it prevents the patient to live in the most accomplished, the stretch of the existence of which he still possesses.

Whatever the length of this path, be it months or even weeks, the patient needs to take ownership until the end of what ultimately are his real chances of remaining life. At such a request, but basic human drama, too often the doctor responds by treating the patient suffering from cancer, "as if they were in fact already dead," to avoid contact with their own unresolved grief.

It is important to remember how this problem report is manifested from the beginning of the process of the disease. It is very common that the first diagnostic approach is made with your doctor (general practitioner or internist).

These, as we said, usually hiding behind a professional technical report, seconded by an ethically correct but emotionally. Or can participate actively in the experience of the patient and his need for clarity and reassurance.

But to best manage such a relationship the doctor specialist need adequate training and psychological support, unfortunately at the moment not easy to find. What about the patients? They must accept the rules of the game as they find them and in many cases come to be conniving with them.

The splitting of the self, to which the patient is moved from the environment and the institution, and thus represent the only niche defense at his disposal. So here it is, our average patient, to negotiate with the medical vocabulary of falsehoods and half truths which are conventionally woven their official communications.

There he will agree to be two people: one who listens patiently to all pseudogiustificazioni radiotherapy for certain applications that have been proposed and at the same time, those who anxiously inquiring with you about the last Congress on new cancer therapies.

Ask to be informed with euphemisms about your strategy but, if not helped, will sign the consent to engage in risky therapeutic solutions, looking good and thoroughly read the text too crude. Cancer patients sometimes become very good at driving themselves to the doctor on the thin ridge of those half-knowledge that they decided to formalize.

In most cases the patient is implicitly suggests that the doctor how you should express, and the doctor will usually be happy to accept that pact. Underground, in fact, weariness consumes mental energy in huge quantities: in malignant observed an inexplicable number of psychiatric disorders, including major ones such as delusions, certainly much more frequent than the organic causes (brain metastases, hypercalcaemia, paraneoplastic syndromes) can not justify.

Whatever the features of the patient, doctor's task is not only to write prescriptions and deliver medications more or less appropriate.

We must strive to understand the mysterious force field in which we introduced. Listening and communication are a vital aspect of our therapeutic potential.

Why is the health of the same doctor, in the broadest sense, which coincides with what the patient can receive from him.

Dr. Carlo Pastore