If you cure a disease you win or lose, if you cure a person you always win
(Quote from Patch Adams)
I'm an enthusiast.
I often find myself reflecting on how fortunate those are, like myself, who practise a profession every day with passion, love, joy and, I hope on many occasions, while at the same time bringing real benefit to another person.
The first rule
“You’re not your job, you’re not how much money you have in the bank, you’re not the car you drive, nor the contents of your wallet, you’re not your designer clothes, you are the singing, dancing shit of the world!” recites Brad Pitt as Tyler Durden in the cult movie Fight Club. Well, it would be nice if, singing and dancing every day, our work could also be that. I was born as a general dentist, with the proud awareness that many of medicine's innovations are inextricably linked to this scientific branch. Among my colleagues are some of the most brilliant, creative, sensitive, and detail-oriented people I know.
Among the first to use modern anaesthetic techniques, growth factors derived from autologous blood platelets, osseointegration, minimally invasive and digital and 3D imaging methods. If you think about it, it's incredible how this medical field, almost entirely private practice, with public funding or private insurance coverage close to zero, has managed to have such a significant impact on public health. What do we do to have such a huge impact on people's sense of well-being? I've come to the conclusion that the single most important thing my profession relies on is, without a doubt, prevention.
Medicine or Commodity
Whilst health policies were undermining the fundamental role of general practitioners as “family doctors” – who know everything about you and your medical history, and who help you to prevent illness in the first place and then treat it – dentists recognised that “prevention is better than cure”.
All that hard work has paid off: nowadays, people come to my clinic at least twice a year; if they have any concerns or want me to check something, they ring me, send me photos on WhatsApp, or come in for a check-up – all to prevent a minor issue, if left unchecked, from turning into a major problem. We all – myself included – have a certain ‘Marvel superhero’ image of the doctor in our minds, no doubt fuelled by TV series like ER and House.
In a beautiful article in The New Yorker, The origins of the myth of medicine as an interventionist and life-saving force can be traced back to the end of the Second World War, with a generation of people who, for the first time in their lifetimes, witnessed the introduction of antibiotics, the discovery of vaccines, organ transplants and open-heart surgery. The healthcare systems of many Western countries have been built upon this myth of the doctor’s decisive intervention. From there, it was a short step to medicine as a ’commodity“.
It is only now that people are beginning to realise that a drug can also have side effects, and that the replacement of a heart valve must be followed by regular check-ups and additional treatments that will need to be continually adjusted throughout the patient’s life; there are medical conditions for which, unfortunately, there is no complete and lasting cure, or even an immediate cure, through Dr Miracle’s life-changing procedure.
Modern medicine and society are facing a challenge for which they are not yet prepared: chronic illness.
Incremental vs Episodic
Years ago, I began to focus on all aspects of aging, obtaining postgraduate specialisation and a second-level university master's in aesthetic medicine and therapy. I never thought it was anything different from my clinical practice up to that point. There is nothing that falls under the definition of chronicity like ageing; in dealing with it as a doctor, I realised I hadn't done anything else throughout my more than twenty years of practice, and I had always employed the most effective strategy: prevention.
Prevention, and what is called incremental medicine. Who wouldn't want to see an imperfection disappear overnight? That's why in my clinic we are fortunate to have the advice of a plastic surgeon Dr Maurizio Gravili. Patients love him; the results of his treatments are brilliant and obvious. I must admit, I’m a bit jealous of this approach to patients’ needs. It’s not always the case that people who ask me to treat them go home with a solution to their problem on the very same day they consult me.
It is sometimes difficult to convey the value of my long-term vision, which is based on incremental treatments leading to gradual results, as well as the importance of prevention. Yet, incrementally, step by step, things are changing: we are seeing more or less regular check-ups combined with daily monitoring via the ’Internet of Things“; simple objects such as scales and blood pressure monitors automatically compile, without any effort on our part, a digital health record within the Health app on our iPhone, where we can find a log of our physical activity, steps taken and distance covered; shoes are connected; there are wearable devices that track our strokes and laps in the pool, help us with aerobic exercise, tell us if we’re sleeping well, and how many calories we consume and burn. The value of this information, of prevention and of a step-by-step approach, is beginning to gain traction. We now have scientific evidence of how high levels of blood sugar, blood pressure, cholesterol and weight affect our health and quality of life in the long term.
The heart surgeon who saves lives with a stent, a heart valve replacement or even a transplant is a superhero to us all; they resolve emergencies and problems that can no longer be put off. The hand of God on earth. With prevention and an incremental medical strategy, we could postpone or avoid such surgical procedures for many years; certainly, in 100% of cases, both will be indispensable immediately following what I might call episodic medicine. The short- and long-term outcomes of surgery are directly proportional to the quality of the incremental medicine that follows.
Everything flows
You know that friend of yours who, every now and then whilst chatting about this and that, says that one thing – those two seemingly off-the-cuff remarks that you then find yourself mulling over and over again? One of my friends who fits this description is called Massimo Mastacchini. Massimo has many interests and a wide range of skills; he could do many different kinds of work, but – fortunately for us passengers – he has chosen to be a civil aviation captain. Do you think that airlines (the reputable ones) base the safety of their crew and passengers – and therefore their business – on a short-term, ad-hoc strategy whereby, for example, they wait for an engine to break down before replacing it?
“Massimo, is it true that your airline fleet has a very high average age compared to your competitors?”
“Did you know that…“ he replies in a calm tone, “…after a certain number of years, an aeroplane has almost none of the components it was originally built with?”
I thought he wanted to avoid the question. I only realised afterwards that we were on the same plane. An aeroplane has a very strict maintenance schedule.
stringent: scheduled checks, sensors that flag anomalies, hour-logs for various systems, scheduled component replacements. Just as one can never step into the same river twice, one never flies on the same aeroplane twice. Prevention and incremental maintenance allow me to take off and then land safely without leaving it to chance. Is this a system that guarantees us 100% safety on our journeys? No, sometimes the intervention of the super
hero: the captain. Like all superheroes, the pilot also has a secret identity. His superpowers are undoubtedly mysterious, but they are sustained by checks – including medical ones – updates, simulators, and continuous, or rather incremental, training.
The heroism of incremental care
The author of the New Yorker article titled ’The Heroism of Incremental Care“, the Dr Atul Gawande, surgeon specialist, professor at Harvard, reminds us that there are scientific studies demonstrating that:
- In countries with a greater presence of GPs, general mortality rates, infant mortality, and mortality from heart disease or heart attacks are lower.;
- regardless of their initial state of health, people who regularly consult their GP have a lower five-year mortality rate;
- facilitating access to the GP, hospital admissions decrease;
- In the UK, it has been estimated that increasing the availability of primary care by 10% has led to an improvement in public health comparable to a 10-year increase in life expectancy.
We see it in everyday life: a politician gains immediate approval if they commission a public work (can a football stadium be considered one?), but a discerning administrator knows that for the common good, one must plan for the maintenance and incremental improvement of the cycle path, the road, the park.
Prevention Correction Protection
In my clinical practice, I specialise in smile design, creating functional and aesthetically pleasing smiles, much like an architect. I could not do this if I did not know the history of the person I am treating, if I could not bring them to the ideal conditions that allow for this improvement, or if I did not have the assurance that what we have designed and achieved is constantly monitored and progressively maintained and improved. Can there be a beautiful smile, with bright, well-aligned teeth, but with lips that are too thin, constantly parched, surrounded by fine lines, and with facial skin that is thickened, dull and grey? Skin quality – the appearance and health of the skin – is of the utmost importance; no amount of make-up can replace it. Smoking, the sun and air pollution also damage the skin, affecting both its health and appearance. Aesthetic medicine, with its many corrective methods, is also preventative and protective. When do we achieve the best results in combating ageing and promoting health and physical appearance? By focusing on general health, lifestyle habits and the quality of treatments, whilst striving to build a relationship in which everyone feels at ease whilst waiting for the effects of those small, incremental, minimally invasive treatments to become apparent in the short, medium and long term. What really “works” against ageing? None of the things I have listed. Only ALL of them TOGETHER. Waiting and being patient seems at odds with the idea of combating ageing – a chronic “disease” that can only get worse as time goes on. That is indeed the case; I do not want to sit idly by, waiting until there is nothing left to do but resort to something highly invasive with a long recovery time. I would like the graph showing my patient’s beauty and health to have no positive (short-lived) peaks, nor any negative ones. Preventing the problem (antioxidants, neuromodulators, microneedlingThrough incremental medicine, correct any damage that may have occurred.Peeling, Filler), Protect from further aggression (sunscreen).
This allows me to say, most of the time, that I have a plan in mind and am ready to adapt it as I live.
