“The doctor told me.” Gone are the times when trust in one’s referring doctor justified the unequivocal goodness of the therapy to be followed. We have been in full pandemic since Covid-19 and what a slice of the population claims is that a “safe and effective” vaccine is al 100%, not a percentage point less. The case Astrazeneca it has now expanded a dangerous skepticism. Sometimes dictated by fear, others, and in an even more hostile way, driven by a total lack of knowledge of the subject. And if on the one hand the virus positives continue to enter the intensive care units of hospitals across the country, on the other hand there is someone who chooses to cancel their vaccination appointment, because they no longer trust the anti Covid drug. The biggest discovery he made is that right to zero risk, which until now he was convinced he enjoyed, perhaps does not exist.
Doctor Maurizio Turturo, cardiologist at the Di Venere Hospital in Bari, is one of the leading exponents of Narrative Medicine in Italy. Explaining and talking to patients through a language designed for each of them is the only way to get out of the impasse. “Trust as an essential method of care», This second Turturo is the starting point for an effective anti Covid strategy.
Doctor, let’s clarify one thing immediately: is medicine able to give certainties or not?
“No. Or rather, it is unable to give absolute certainties. This needs to be said and explained clearly. Scientific research does not tell us that a drug works but that a drug responds positively to safety and efficacy criteria. These criteria are not close to 100%. The effectiveness is such in a statistical way, that is on a number of cases examined, and not in an absolute way. Vaccines are more than ever part of this discussion. We are pretending to forget that, like all medicines, they have side effects ».
First the race for the “Serie A” vaccines, now the claim of zero risk, in fact impossible in medicine. Just a pandemic effect or the deepest expression of an unprepared society?
«The sense of collectivity in this field is fundamental: if this is not the case, our entire educational effort towards patients collapses in the face of the first complication. I believe there is a cultural block. Thinking about the continuous conspiracies and the possible interests behind the reasons for a stop or an encouraged cure means that the level of credibility of what we transfer to the population gradually decreases. Zero risk does not exist and this is an aspect that encompasses all fields of medicine, not just research. Not even in the practical application of medicine, not even in the surgical gesture. Aspirin can cause far more deaths than hypothetically can happen with vaccines, and people don’t know that. Basically there is a difficulty in recognizing skills, pretending to know more than others without an adequate course of study. On the other hand, there is the desire or the illusion of thinking that medicine is perfect ».
“Safe and effective”, since the first vaccine these two words have resonated in the authorizations of the regulatory bodies. Perhaps it should have been better explained what they really meant?
“In hindsight, yes. On the other hand, it surprises me that we are only noticing this aspect now. There have been medicines on the market for years, the leaflets exist precisely for this purpose. Why not make the same considerations for vaccines? This is probably where the effect of the pandemic we were talking about comes into play ».
The case numbers of adverse events are statistically negligible compared to the large number of people vaccinated. The figures define the danger and in this case are very low. Should we all take statistics lessons as someone has suggested?
“People saw the speed with which vaccines were offered without waiting for phase 4, the post-sales study. Hence the common perception was that of being put more at risk. I believe there was no medical intermediation. Generally, when the patient learns some news or approaches new medicines, he calls his trusted doctor. Just as it is happening with my heart patients who in these hours call me worried to understand what they risk in getting vaccinated. Now doctors must make a very important communication effort: it will be good for them to get off the pedestal, to avoid necessarily speaking with statistics, choosing the language that best suits the background culture of the patient in front of him. The way is not to impose anything, let alone the vaccine, by working on sharing care. The “I do it because the doctor told me” no longer works ».
Trust is an integral part of the anti Covid strategy. Today an absence that can cost us dearly.
«In medicine I would define trust as an essential method of care. For things I don’t know I must have the wisdom to turn to reliable people. For the doctors I must have the availability to explain and re-explain in the right language. The effort must now be made by everyone, to understand and be understood. The paternalistic relationship with the doctor, “I do what he tells me without asking anything else”, cannot work especially in a pandemic situation in which the awareness of what is happening around us is fundamental ».
In this regard, there is narrative medicine, can you explain what it is?
“If we continue to consider only the infection and not the patient we will remain in the technique. Health is not only avoiding the virus but also having the perception of one’s health condition. Listening in this moment is fundamental and narrative medicine, the dialogue between patient and doctors, is an integral part of the anti Covid strategy. In the clinics, in the hub as far as possible in pharmacies. A patient listened to is a person who feels that he is being treated in the best possible way regardless of the technical quality of the therapy chosen for him. One study found that an average doctor interrupts their speaking patient after about 19 seconds.
And then the shared therapy. Most of the patients who come to my office for the first time and to whom I ask why they take a certain drug cannot answer me. That “you know doctor why I take it” is the most wrong thing we can afford as health workers. “
What is the negative feeling that everyone is now called to fight in order to get out of this tunnel?
“Fear. I have different patients, with different opinions on vaccines. What unites them is the sense of fear. And it also applies to people who believe in the good faith of researchers and science. The fear of getting sick, however, can lead to denying the evidence, to putting up a wall that is difficult to cross. This must be a commitment to be made personally. A no vax, after all, it is only a man or a woman who is overwhelmed by fear ».
