The patient, and above all that a tumour has a clear path defined to be made…
A letter published in La Repubblica from Dr Alexander Bovicelli has given me something to reflect upon. He writes that it is necessary and urgent to institutionalise in any Oncology department, the role of psychologist-oncologist, which is something we can all agree upon.
But my attention is focused mainly on the following: “Now that surgery as well as complimentary therapies are able to make great efforts to try to achieve the best results. This, however, involves the patient being subjected to very long hospital stays, to physical mutilation which is important to try to reduce to zero the residual disease, and the psychological troubles too hard to bear for themselves.”
I’m trying to rewrite this sentence differently: “Now that surgery and subsequent therapies are able to achieve the best results. Physical mutilation, which is also important, reduces the residual disease to zero by ensuring healing. With these undeniable advantages, the patient will be able to overcome the psychological troubles.”
With these substantial changes to it, the sentence is undoubtedly more reassuring, but unfortunately it is false, the first is true. It is true, especially the uncertainty and discomfort that emerge from the original letter as it happens every time the doctor realizes that the disease is severe and the outcome of care, despite the best intentions, is uncertain. The psychologist, however, is not the solution to the problem, or rather, is not the only solution and perhaps even the most important.
The patient, and above all that a tumour has a clear path defined to be made: first meets the family doctor, then the clinician or surgeon or oncologist, not necessarily in that order, the study of diagnostic tests may lead to stressful and sometimes invasive procedures, should finally face a destabilizing truth for him and those close to him.
One who, among physicians who meet in a multidisciplinary environment, have been able to better understand its uncertainties and fears, will become your doctor. He who has been able to establish a long way to go together defining a relationship of care, will also become his psychologist, the point of reference to which contact at all times. The dialogue will be established between the two will be much longer and frankly the more severe was the diagnosis of disease. The patient must then be informed to the point to take a share of the responsibility for the care and however, decide what is best for him. The awareness of his condition make more responsible and able to fight actively participating in various stages of treatment. On a subject a real psychologist may have some chance of success, much more difficult it will be his task if the patient was treated with reticence and, ultimately, with little humanity. The psychologist shall not, in ultimately be the one to repair the damage caused by those who preceded him.