Rivista per le Medical Humanities

Claudia Zanini
rMH 24, 2013, 13-17

The legitimation of the patient's role (sick role) in the case of a chronic pain

In the case of chronic pain, a major problem in doctor-patient relationship is linked to the traditional definition of their respective roles. The patient, as a consequence of her sick-condition, should temporarily give up her social and working life and commit herself to the doctor. The doctor, repository of the medical science, is responsible for bringing the patient back to her active life. This model is appropriate in case of an acute illness, but it can become dysfunctional in case of a chronic condition and give rise to a problem of role-legitimation for the patient. For doctors and patients as well as for the society at large, the dominant representation of illness is the one of acute illness, and the role expectations reflect this traditional model. Therefore, people suffering from chronic pain often try to get a diagnosis that testifies a functional problem, in order to ensure social and institutional acknowledgment. Sometimes the doctor, once finished with the diagnostic tests, takes into consideration a psychological cause for the physical pain. However, a psychological diagnosis can be difficult to accept for the patient, because it is linked to a lack of social and institutional acknowledgment of what she has and feels. Doctor and patient should work hand in hand to define issues that often have blurred borders. This definition, far from being of secondary importance, is at the basis of an appropriate treatment plan as well as of patient-centeredness and the respect of patient’s need. Improving the quality of the doctor-patient communication can be helpful in this process. 

Paolo Maino
Claudia Zanini
rMH 24, 2013, 18-25

Communicating and under standing pain

Chronic pain is a spreading health condition in the current society: in Europe around one out five people suffers from it. Nowadays guidelines for the treatment of chronic pain and instruments for its measurement have been developed. However, for cultural and institutional reasons (e.g. religious views, prejudices against opioids), pain has often been undertreated. In the paper, we suggest a close examination to improve our understanding of the difficulties met by doctors and patients in the communication and measurement of pain. These difficulties are primarily linked to the subjectivity of pain and to the need of trusting the patient’s evaluation rather than the observation of physiological parameters. While defining the patient’s level of pain, the doctor cannot disregard the patient’s word. However, trusting the patient’s words moves the doctor away from the observation of objective data, typical of the biomedical model that often guides the medical practice. Communication and its tools become then an important source for the building of a dialectic linking the doctor’s and the patient’s world, searching for a compromise that takes into consideration both the patient’s feelings and the doctor’s need for medical evidence. 

Silvia Rinaldi
rMH 24, 2013, 26-29

Chronic pathology: psychological aspects of the doctor-patient relationship

In clinical practice, relational skills are considered to be a fundamental instrument for providing an adequate treatment. In the field of chronic health conditions, because of their incurability, the doctor’s involvement in listening to the patient and in understanding her personality, and the doctor’s ability to give a meaning to the illness, give even more value. In this paper, I focused on those aspects of the therapeutic interaction that, from a «prescriptive approach», develop into a «partnership approach» and become the means for collaboration between doctor and patient. This new interactional style frames both the doctor and the patient within a cooperative relation that highlights their respective skills and possibilities. Thanks to these skills, the patient will be able to better understand her health condition, and to desire reaching a satisfactory quality of life in accordance with her own needs. On the other hand, the doctor will reach high levels of professionalism, empathy and satisfaction. The outcome of such a relational therapeutic process can last longer, be more satisfactory for both parties involved and provide a better management of patient discouragement and stress.

Luca Camerini
rMH 24, 2013, 30-34

New communication technologies and chronic pain

As a consequence of the constant development and rapid diffusion of the new technologies of communication, a growing number of patients use instruments for the management of their chronic pain. At the beginning, such instruments – in particular websites and applications – were criticized because of lack of control over the quality of the content and services. Findings in the field of new technologies of communication and health (eHealth) lead to a better understanding of the role of these instruments for patients and health professionals. This paper presents a structured summary of these results and offers an update on the state of the art and future challenges in this important field of application. The summary, based on the new technologies for chronic pain, covers the main definitions and variables usually studied, the advantages as well as the limitations of their practical application. 

Anna Gioria
rMH 24, 2013, 35-38

Because of a doctor, thanks to the doctors

The present article discusses the topic of doctor-patient interaction from the point of view of the patient, through the story of a woman who, as a consequence of a medical mistake during labor, suffers from permanent damages: an error that made Anna dependent for life on a group of professionals responsible for her disability. The story of Anna shows how it has been possible, thanks to the support of her family, to put anger aside and build a therapeutic alliance with healthcare providers to go beyond the limits of a diagnosis that confined her to a restricted life on a wheelchair. By highlighting the importance of doctors' relational skills, this testimony is part of the literature that has developed over the last 40 years on the concept of patient-centeredness. Availability, commitment, empathy and listening skills are some of the features that contribute to the building of a lasting relationship based on trust and collaboration. Anna's story is an example of how the management of the patient's person is a key ingredient in defining a shared care pathway that may be satisfactory for both the doctor and the patient.

Sebastiano Martinoli
rMH 24, 2013, 73-75

In support of informed consent

Canton Ticino’s 1989 Healthcare Law states the duty, on the part of the caregivers, to conctact the patient’s relatives in case the patient passes away without leaving clear indications about organ donations. In case the preferences of the deceased are not clear even to his/her relatives, then it is the latter’s decision which is decisive. The experience of the past years has demonstrated that informed consent does not hinder the increase of organ donations. Statistics demonstrate that Ticino, despite the early choice for informed consent, actually shows donation figures two or three times higher than the rest of Switzerland (between 28 and 42 cases of donations per million of inhabitants). Informed consent in Ticino has favoured, in the critical area of hospitals care, the development of a culture of communication of death, and of assistance in mourning.

Marco Borghi
rMH 24, 2013, 76-79

In support of presumed consent

Essentially, the model of presumed consent does not present any disadvantage as compared to the opposed system. Moreover, it is the only system that really fulfills, in all conceivable circumstances, the juridical requirements for the validity of informed consent. Among other things, presumed consent promotes the need for every citizen to acquire information on transplantation, given the legal obligation it entails of necessarily taking an active stand, adequate to the ethical deed of human solidarity. 

Alberto Bondolfi
rMH 24, 2013, 80-84

Incentives to organ donation: pecuniary and gratuitous models

This article firstly presents some critical distinctions between incentives and compensation in the case of organ donation. The author details his own objections to the system of incentives (pecuniary or otherwise), as a measure against the so called scarcity of organs. The causes of the latter are not to be sought for in the subjective attitudes of a population regard a possible explant, but rather in factors within the organisation of transplantation medicine. Once we accept that the causes of scarcity are not in a direct relation to the potential donors, then the need for incentives falls. The autor argues that incentives deny the pertinence of the «gift» metaphor and, therefore, yield results contrary to the desired end.

Nathalie Maillard Romagnoli
rMH 24, 2013, 85-90

Organ commerce and the commodification of the human person

Ethical problems raised by the possible commodification of organs for transplantation are of three types, concerning the issues of altruism, commodification of persons and exploitation. I will focus here on the second issue: the commodification of persons. The moral condemnation of organ sale in the name of the argument of commodification implies that, by selling organs, we don’t show due respect to persons and their dignity. My aim is to show how the commodification argument is constructed and to assert that it lacks soundness. I will also oppose this type of argument – which is linked to what I call «the Kantian strategy» – to the liberal position about the question of organ sale. We will see that none of these two strategies gives us good reasons to morally condemn organ commodification.