I believe that health care has undergone fundamental and often necessary changes throughout the world is a normal and well known fact. It is clear that the scientific developments that made it possible to achieve great goals in the field of medical and surgical treatment of various diseases represent the most positive, intelligent and striking aspect of this gradual and continuous development.
But, in parallel with the undeniable progress in medical “sciences”, which are often surrounded by other sciences and disciplines (biology, chemistry, genetics, engineering, physics, etc.), other aspects have developed in a profound, fundamentally modified way, In essence, it was called “ars medica”. I do not intend here to delve into this definition, that is, whether medicine is akin to art or science even if, like all activities involving man, it can never be framed entirely in the rigid dogmatism of science.
The first aspect that I intend to focus on is the institutionalization of health facilities. This phenomenon, which initially involved almost only private structures, including those operating in agreement with the NHS, obliged, since it is private, to necessarily make a profit from its activity, and then spread to public structures and in particular to hospitals. Nowadays, the hospital budget has in fact become the main criterion for assessing the task of general managers, who obviously require managers of operational units (once called “primary”) to account for it, moreover, for a five-year period to check their position. Well, this new standard for evaluating the work of healthcare professionals largely defines therapeutic options, directing them towards the most economically advantageous, but not for you, on the basis of an accurate and necessary cost/benefit ratio, but simply at the most profitable, often more cost to the state treasury.
The other side is the growing aura of demands on the part of patients towards healthcare facilities and doctors. The rate of conflict has reached levels that are no longer sustainable, neither economically nor socially. The number of legal actions for compensation is constantly increasing, not even by the so-called Geely Act that was initially hailed as the solution to the problem, but has instead exacerbated the situation. Even if the vast majority of causes were resolved into a stalemate, the impact of this new and much more dubious doctor-patient relationship has been and remains devastating to say the least, highlighting the use of so-called defensive medicine. The concept of defensive medicine is no longer merely a prescriptive abundance (demanding a large number of diagnostic investigations, often unnecessary and expensive) but also as a treatment option that may generally be less critical from a medical legal point of view, even if it is not always more effective in individual cases.
Without wanting to raise concern, but just to picture a case that we hospital doctors check daily, I feel I can safely say that the combination of these two elements (medical verb commodification, in fact often separated from real connotation/need, defensive medicine) leads to It is amplified by one effect: a citizen who turns to a hospital or other health facility today does not know whether what will be offered to him as a treatment is what he really needs or what those who need it suggest.
Without considering, then, that certain measures, which are likely to be very useful and effective, and which may seem to have been insufficiently exploited at the economic level, will no longer be carried out, with the consequent serious harm to patients, who could have Take advantage of it greatly.
For those who, like me, have studied other medicine, with a less technical but certainly more humanistic imprint, this is a bitter note which sadly bears witness to the affirmation of an Anglo-Saxon concept, more commercial and technocratic, over the purely clinical concept that, evidently, we Latins, heirs of classical culture and tradition, We could not adequately defend it, but, for the sake of humanity, we must hope that sooner or later it will prevail again.
Professor of Orthopedics and Traumatology at the University of La Sapienza
Director of the Department of Surgical Sciences, S. Andrea University Hospital, Rome
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