SCHIZOPHRENIA OF MODERN MEDICINE

SCHIZOPHRENIA OF MODERN MEDICINE

Every patient wishes to be treated by their doctor in a unique and personal way, taking into account their character, philosophy of life, and certainly not being treated like everyone else indiscriminately. A bit like how we were once treated by our old family doctor, who knew us all and took that into account.

Indeed, even today, university education emphasizes these aspects of doctor-patient communication. The physiological history is still collected with questions that may seem ridiculous. What use is it to ask an elderly person, afflicted by who knows what age-related ailments, if they've had childhood illnesses (measles, etc.) or if they were declared fit for military service? In semiotics texts, archaic terms like "dryness of the fauces" are still used, as if the patient were an animal and had fauces, along with terms like "bowel movements," "diuresis," "menarche," "pubarche," "adrenarche." Pubarche? Adrenarche? Can you imagine such terms?

Nevertheless, knowing how to listen, staying neutral, and communicating effectively are still emphasized.

This is because every patient is a UNIQUE individual with personal desires, needs, and values, meaning some patients may feel anxious or stressed by a series of repeated clinical tests, while others may feel more secure and comforted by regular monitoring.

It must be considered that frequent clinical tests can impact a patient's quality of life. Therefore, it is necessary to balance the need to monitor health with the effect this may have on the patient's daily life.

But after all these fine words and despite the training focused on personalized doctor-patient relationships, what does the doctor actually do today? What are they obliged to do?

They apply protocols, procedures, and guidelines. Procedures are detailed and logical sequences of technical and operational acts. Thanks to them, everything becomes objective, systematic, and verifiable. Yes, but to apply procedures, you don't need a doctor; an administrative employee of the local health authority would suffice.

Let's take an example of guidelines:

Guidelines

To diagnose diabetes, it is sufficient to perform fasting venous blood glucose tests twice. If it is higher than 126 mg/100 ml, the diagnosis of diabetes is made. If fasting blood glucose is above 110 mg, it is advisable to perform an oral glucose tolerance test, and if this is higher than 200 at the second hour, the diagnosis of impaired glucose tolerance is made. If it is normal, the diagnosis of impaired fasting glucose is made. Both of these situations require attention and further checks.

Unfortunately, at a recent conference, I heard that the threshold of 110 will certainly be lowered to 100 mg/100 ml.

The same goes for cholesterol, whose maximum limit was previously set at 250 mg/100 ml but has now been lowered to 220 mg/100 ml and is surely destined to drop further. I get the impression that those who draft these guidelines won't stop until there is not a single healthy person left. Everyone must have at least one disease, and everyone must feel guilty and afraid.

It's true that statistically, those with lower values live longer, but the values we've defined as normal, are they the values of the majority of people? Or are they the values that guarantee a longer life? If we starve a group of mice, we notice they live longer than other groups that eat freely; should we then conclude that it's in the nature of mice to eat so little?

And if we discovered that eating two celery stalks a day increases a human's life expectancy, what should we define as a "normal" diet for humans? The diet of the majority of people or that of those who live longer? The one based on the two celery stalks? These are questions we should start asking ourselves, given that for the first time, we risk defining normality not with criteria based on statistics (what the majority does) but with criteria based on life expectancy, a different approach from what has been done so far. It may be right to change our attitude towards "normality," but it doesn't seem to be discussed enough, and it doesn't seem like we are all aware of it.

Today's situation reminds me of a humorous play from the early 1900s written by Jules Romains titled "Knock, or the Triumph of Medicine." The plot is simple: the modern Dr. Knock takes over a remote practice in the mountains from the old Dr. Parpalaid, but he discovers with dismay that in St. Maurice, most people are in excellent health. He quickly realizes that this is due to the obsolete methods of old Dr. Parpalaid and gradually manages to make modern science triumph by convincing all the villagers that they are sick. Health doesn't exist; it's an abstraction, a thin imaginary line produced by ignorance and the incorrect practice of Medicine. Knock achieves his triumph when he finally convinces even the elderly colleague Parpalaid to don, at last, the garments of the sick.

Another good story that touches on the same topic is "The Psychiatrist" by Brazilian writer Machado De Assis. In this story, the protagonist, psychiatrist Simao Bacamarte, manages to convince all the inhabitants of a village that they are mentally ill and locks them all up in an asylum.

As you can see, many writers in the past also had these same impressions. From my perspective, I get the impression that today we are somewhat exaggerating. I see elderly people who line up every morning to get referrals, visits, and all kinds of medical services, and I often read a lot of fear in their eyes. It ends up that out of fear of dying, they die of fear, and I wonder if they are happy with this life filled with medical commitments. It's not that they have wonderful other choices, but this risks turning into a job, or worse, a nightmare. Is this the old age and life we hope for our elderly and ourselves? Alongside people who ask for nothing, there are others, "professional" patients, who navigate perfectly through all the bureaucratic obstacles and spend their entire day caring for themselves and requesting medical interventions. They are well-meaning, and everyone thinks they should care more and ask for more.

I know people who have quit their jobs to care for their mother and keep requesting, requesting continually. After a while, this becomes their profession and what they do best. Those who ask get everything, those who, perhaps out of modesty or lack of knowledge, do not ask, get nothing. There are individual people who demand as much energy and financial resources as are spent in Africa to support an entire village. And are they happier?

Sometimes, it takes courage to stop this race for medical services and put an end to the vicious cycle of fear. Fear helps no one; it only causes harm and suffering.