October 25, 2007

Paternalistic medicine

What happens when an Italian doctor becomes a patient? It happened to Gynecologist Carlo Flamigni in Bologna last year and now he knows both sides of the Italian health system. In an interview, he talks about the experience.

He passed from reanimation to long months of rehabilitation while knowing the mechanisms of the medical profession, the jargon and the tricks of the trade. He could see through the facade and, from a patient's point of view, he didn't like what he recognized. In particular, he found the very Italian tendency of not telling the patient the whole truth about his or her condition to be very annoying. He only found out that he had no sensibility in half of his body when he asked the nurses why they hadn't washed his left side -- but they had. He calls it the "Paternal model of assistance." He also noticed how doctors get easily bothered by patients' questions and brush them off with, "guardi che il medico sono io." (look, I am the doctor). What he wanted most was compassion and instead he found doctors that glanced at their watches while visiting his bedside.

It all sounds pretty familiar, except for the paternalism. We like "straight talking", directness, no "beating around the bush", to "tell it like it is". We do not believe that mentioning the possibility of bad things happening will attract the evil eye's attention and actually make them happen (like d..th, disa...l.ty, ca.c.r and t.m.r, those things that Italians never name directly and always speak of in a whisper). We "can take it." We are pragmatic. We make wills and take out life insurance.

Fifteen years ago, while spending nearly three weeks with my then three year old under observation in the pediatric neurosurgery unit of a large public hospital, the head neurosurgeon waltzed in one day with an entourage of foreign doctors at his heels to whom he spoke English. When he got to our bedside, he flipped out my son's various exams and proceeded to "tell it like it was" -- which, of course, I had not heard in quite such clear and direct terms. It never crossed his mind that I might understand English, but before I had absorbed what he had said and could manage a question, he had turned on his heels and left.

a domani,

p.s. no fear, it all worked out in the end.
p.p.s and with no hospital bill. Only about 10,000 lire (5 euros) for a copy of the "cartella clinica".


Anonymous said...

Dear Larc,

My Italian nepwhew is a doctor, a very good and responsible one, and yet I have noticed in him too a certain haughtiness linked to his "title" - DOTTORE, which clearly communcates as: Lei non sa chi sono io - You don't know who I am. Well!

But I do, sweetheart! I am your dear American aunt who changed your diapers so often that...

But he is a very good doctor, and very intelligent with a strong classical background, which means he knows a lot about FATE. And for this reason, speaks indirectly.

Thanks for the interesting thoughts, as always.


Anonymous said...

Hi Elizabeth,
Yes, the older Italians are like this. My mother's generation does not want their loved one to know what they are ill from or how bad it might be. When I had cancer, she wouldn't mention the word. I began to question myself if I really had it because no one would talk about it. They do not talk about bad things when they are happening, only good because it may bring the malocchio (sp).
Good post. I like your blog :)