Author + information
- Daniele Rovai, MD∗ ( and )
- Franco Bonaguidi, DPsych
- ↵∗National Research Council, Institute of Clinical Physiology, Via Moruzzi, 1, 56124, Pisa, Italy
We were truly enthusiastic to read the Editor's page by Dr. Fuster (1), which emphasizes that technological advances are replacing medicine at the patient's bedside, instead of complementing it.
In 1964, Herbert Marcuse published a book that became famous in the student movement of the 1960s: One-Dimensional Man (2). According to the author, modern society tends to control, suppress, or even eliminate many aspects of human existence, such as nature, art, or sexuality. In our technological civilization man lives predominantly in 1 dimension, based on production and consumption of waste, without the possibility of resistance. The current diagnostic and therapeutic approach, based largely on technology at the expense of the enormous amount of information and its effects that can result from personal interaction between doctor and patient, leads us to believe that patients are currently confined to a single dimension—that of medicine itself. Other dimensions that play a significant role in the pathogenesis and prognosis of diseases, such as the psychological, social, economic, or spiritual, are in fact ignored.
It is clear that patients with myocardial infarction show an increased prevalence of stress at work, in the family, financial stress, and stressful life events compared with healthy controls (3). It is also clear that depression increases the risk of developing ischemic heart disease in previously healthy persons and is associated with increased mortality after myocardial infarction, although this relationship is attenuated—but remains significant—after adjusting for the severity of the heart disease and other variables. Anxiety in young people predicts subsequent cardiovascular events and worsens the prognosis in patients with ischemic heart disease. More recently it has been shown that acute emotional triggers, such as anger attacks, can precipitate a myocardial infarction, an ischemic or hemorrhagic stroke, or a ventricular arrhythmia (4). Social factors such as isolation and lack of human support also affect the incidence of cardiovascular disease. The economically less well-off classes are at a disadvantage regarding many diseases, including cancer and cardiovascular disease. And finally, it has been proved that even spiritual factors, such as religiosity, not only are able to influence how the patient faces and tolerates the disease, but also are associated with prolonged survival (5).
A medicine that is essentially technological fails to take into consideration the personal aspect, namely how the patient lives with his or her illness. The impact of a disease on family, work, sexual, and emotional life as well as the patient’s self-image is not explored in present-day medicine, and doctors often totally ignore the personal dimension of their patients. Medicine is certainly very complex, and technology helps us shed light into this abyss for better patient care, but the patient is even more complex. However, we should consider many more variables than we usually do. Finally, the integration of medicine at the bedside and technology could reduce the number of inappropriate examinations, and thus healthcare costs.
For Marcuse, man had to break free from the constraints of a technological civilization to achieve freedom, and this freedom would have to be achieved mostly through the imagination (l’imagination au pouvoir). Unfortunately, the patient cannot free himself or herself alone from the dimension to which he or she has been relegated; this is the duty of physicians. As suggested by Dr. Fuster, without sacrificing our technological progress, physicians must rediscover the human dimension of patients, their fragility faced with the disease and their anxieties; they should spend more time communicating with their patients, resume the habit of performing a physical examination as complete as possible, better understand nonverbal body language, and, finally, consider themselves an integral part of the cure.
- American College of Cardiology Foundation
- Fuster V.
- Marcuse H.
- Rosengren A.,
- Hawken S.,
- Ounpuu S.,
- et al.,
- for the INTERHEART investigators
- Chida Y.,
- Steptoe A.
- Bonaguidi F.,
- Michelassi C.,
- Filipponi F.,
- Rovai D.