Pediatrician at the Sant Joan de Déu hospital in Lleida, Montserrat Left is director of Borja Institute of Bioethics– Ramon Llull University and is president of the deontological commission of the Consell de Col.legis de Doctors of Catalonia. In the week in which Caregiver’s Day is celebrated (November 5), Esquerda values palliative care and defends that medicine should provide good care for all patients.
-Does medicine heal and care in equal parts?
-There is no line that separates healing from caring. We have wanted to separate it, but they are intrinsically linked. Care is curative and to heal in a certain way, it cares. Caring is the core of medicine. A little over 20 years ago, a group of experts led by Daniel Callaghan defined the four objectives of medicine in the 21st century: prevention and health promotion; relief from pain and suffering; cure within the means and care for all patients; and attempt a peaceful death. Medicine should pivot around these four priorities, but there is a clear bias towards curative.
-During the toughest months of the pandemic, it was not always possible to care.
-We had to give a very immediate response, without time to think, and this was focused on the biomedical field and little attention was paid to the elements of care. Now we must incorporate the reflective part, what we could have improved and how we can guarantee a good cure to all of us who can cure and good care to all patients.
-We are in the middle of the second wave. Have we learned anything?
There is a positive part and that is that we are more prepared, we have epis, ICU bed planning and devices so that patients can connect with their families, but there is a lot of exhaustion. In the toilets there was a physical, cognitive, emotional and ethical overload.
-Does it touch to humanize medicine?
-We should guarantee that all health professions acquire the three forgotten competencies: emotional, relational and ethical. Before the covid, there were already beginning to be humanization strategies, but it is a huge contradiction, because if medicine is not human, what is it? One of the fathers of cybermedicine says that if a computer can replace a doctor, that doctor deserves to be replaced by the computer. We had entered such technical territory that we had forgotten that medicine is human.
-We thought that medicine could do everything.
-We still have this idea, that we will find a solution even in the most extreme cases. A techno-scientific illusion that has made it difficult for us to accept and recognize the end. Series like ‘House’ or ‘The good doctor’ support this idea, they present us with desperate cases with almost miraculous cures. A separate chapter deserves one of the phrases of ‘House’: “What do you prefer, a doctor who shakes your hand while you die or another who does not look at your face while he heals you?” It is a fallacy.
-Curing and caring implies more economic resources?
-In the book ‘Compassionomics’, the authors show that care improves health and is curative, but also that dedicating yourself more to people saves processes. Another study says that more compassionate surgeons have shorter hospital stays and fewer readmissions. And then there are programs, such as the Fundación «La Caixa» to care for people with advanced diseases, which show that in this comprehensive care we can find the union between healing and care.
-Do we hide death?
-A century ago death was feared and painful, but also known and domestic. With medical progress we end up medicalizing death. What is an existential, vital issue, we turn into a medical problem. Palliative care is a game changer. But until the emergence of palliative, death mostly occurred in hospitals and associated with medical decisions.
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