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Follow in the footsteps of parents in choosing a job? No way. Six out of ten American doctors would not recommend young people to pursue their own careers. It is the result of a survey conducted by the Physiciam' Foundation, which brings together twenty North American medical associations, on twelve thousand general practitioners in the United States. The main complaint of family doctors concerns the overload of work due to the lack of colleagues. More than 90 percent of doctors complain about excessive time spent doing paperwork, which in 63 percent of cases translates into less time dedicated to their clients. For these reasons, one in five US physicians consider reducing the number of their patients, one in four aim for part-time or other measures to reduce the workload and one in ten even consider leaving medicine. In the United States, where the problem of accessibility to medical care for people with limited financial means was denounced, with a bitter and at the same time moving humor, by the director Michael Moore (Sicko, 2006), associations of " general practitioners of luxury" (Luxury Primary Care Medicine or LPCM), which can be enrolled, paying several thousand dollars a year, only the wealthiest patients. If this guarantees doctors a better quality of work, and their patients greater attention from the doctors, there is no shortage of those, like Troyen Brennan, professor of health policy at the Harvard School of Public Health in Boston (Massachusetts), who underlined that discarding less well-off patients in a commercial logic represents a behavior contrary to the ethical principles of medicine. In Italy, as in France or Great Britain, the National Health Service is inspired by the principle of equity, thus guaranteeing a level of health care for all citizens that the World Health Organization has judged to be among the first in the world; even in our country, however, there is no shortage of situations in which the doctor's attitude towards the patient can vary depending on whether he is a paying patient or not. Furthermore, the increase in the number of analyzes and technological examinations, if it has brought significant progress to medicine from the diagnostic and therapeutic point of view, has reduced the space dedicated to the conversation and meeting between doctor and patient. The emphasis placed on the biological aspects of the medical profession has partially diminished the importance of respect and empathy, indispensable in the relationship with a sick person, especially if the disease is serious. The training of doctors presents significant shortcomings in this respect, as he wrote already in 1972. Giulio Maccacaro, pioneer of epidemiology in Italy, stigmatizing the habit, rooted in university clinics, of always delegating "to the specialist, to the internal student, to the 'latest arrival' the collection of clinical history from the patient's live voice (anamnesis). And if Bruce Newton, professor of neurobiology at the University of Arkansas for Medical Sciences in Little Rock (Arkansas), spoke of a "hardening of the heart during medical studies". Duncan Geddes, of the Royal Brompton Hospital in London, wrote that "while adverse events to a drug are usually transient. a poorly conducted consultation can do lasting damage. * Psychiatrist, Psychiatric Service Diagnosis and Treatment, Viterbo 

La Repubblica Salute of 03/19/2009, article by Francesco Cro* N.615 – 19 MARCH 2009 p. 40 


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