Translator: Theresa Ranft Reviewer: David DeRuwe
I've got some bad news for you:
medicine is sick.
But I've got some good news, too:
we can heal it.
The art of healing well, the art of healing and being a doctor
rests on a cornerstone:
the doctor-patient relationship.
This is a very delicate relationship where I need to spiritually engage myself
in such a way that I understand the suffering of the individual,
that I have compassion, that I have empathy.
But at the same time, I have to maintain a certain distance
to allow me to have technical rigor and technical judgment,
so I can offer the best treatment for the individual.
It's a very delicate balance.
These days, human relationships are shallower and more superficial,
so this balance is off course.
Over the last 10 years,
I've been to the Amazon more than 25 times as a surgeon.
During those trips,
I accompanied many doctors who had also been there several times before.
When we arrived there,
with our elite white arrogance,
I thought I'd be the one bringing something to them,
but I didn't clothe the Indian;
the Indian unclothed me.
When I got there,
I rediscovered a feeling I had nurtured since childhood,
of relating to someone who needed my expertise,
and being able to offer my time and love to that person.
The medical assistance we gave
surpassed all the days of health plans,
examination requests, patient scheduling, medical fees ...
All the doctors that accompany us return exhilarated,
and what we bring back to São Paulo, to our daily practice,
is the realization that the simplification we experience there
can be replicated here, as well.
Of course, I don't need to go to the middle of the Amazon
to discover this,
but that was my way of discovering.
There's a study that shows that at the beginning of medical school,
if you ask students to make a list of their primary goals,
their main ones are altruism and doing good.
These same students,
at the end of their course and with the same survey,
list their primary goals as success, recognition, and curing.
Something went wrong down the line,
where we took someone with a brilliant and poetic spirit,
and turned them into a technician,
who knows a lot about medicine but nothing about people.
Concern over doctor-patient relationships dates back to the remote past,
to Greece, the cradle of medicine,
and where Hippocrates, the father of medicine, was from.
This doesn't mean that medicine wasn't practiced before.
When Adam choked on the apple, Eve cleared his air passage.
It's the same thing we do today in the emergency room.
(Laughter)
So why is Greece considered the cradle of medicine
and Hippocrates the father of medicine?
Because for the first time, he introduced a method
and transformed the art of healing
into something which can be taught, learned, reproduced, and replicated,
in a logical way for the people involved.
At that time, too, the Hippocratic Oath was created,
and it is still used today by medical graduates around the world.
It was created in the fifth century BC.
I brought a copy along, folks - they're rather complex words.
I picked out three phrases:
"Into every house that I may enter, I will go for the benefit of the ill,
while being far from all voluntary and destructive injustice,
especially the seduction of women, of men, children, and servants.
And whatsoever I shall see or hear in the course of my profession,
in the exercise of my profession or outside it,
and that should not be disclosed, I will never divulge,
holding such things to be holy secrets.
If I respect this oath and do not violate it,
I will be worthy of reputation among men at all times;
but if I break or violate it, may the opposite befall me."
Why were they concerned with this at that time
and why is the oath still made today?
We take an oath about transgressions
because there are those who transgress,
because the doctor-patient relationship is essential for good healing.
Today, few things are ruled by an oath of honor,
so I have the honor to be in a profession
that is ruled by an oath of honor.
With medical knowledge in Greece, an individual produced science
in order for the next one to go even further.
What's happened to that?
Medical knowledge has proliferated in such a way
that a person is no longer capable of absorbing all this knowledge.
Today, therefore, a patient has a team of doctors who take care of him.
Each member of the team takes care of a little part.
In this way, we're specializing a lot in curing the disease,
but not in curing the patient.
There's a current theory that says:
"The exam can speak for the patient."
No, it can't!
Once I was in a small group in medical school,
and I joked with the professor,
"Look, this patient has a CT, MRI, endoscopy,
colonoscopy, ultrasound ...
I'm going to place my hand on his stomach, just for peace of mind."
I received a scolding.
The guy took me aside, called the whole group and said,
"Let's look at the patient's belly."
He saw that there was tobacco on the patient's fingers
that showed he was smoking when he said he'd quit.
The hole in his belt showed that he'd lost weight.
Blemishes on his skin.
In an elderly person, you can tell if they're taking care of their clothes.
A dirty navel can say a lot.
When you're touching the patient, there's a moment of intimacy.
They may remember something they didn't say beforehand.
And the professor said, "If all this hasn't convinced you -
in addition, when you're examining the patient,
they're exposing their vulnerability to you,
they're letting you do things with them.
This is the moment when you have the opportunity
to communicate non-verbally that you're taking care of them,
that you're examining them for their own good,
that you're asking them permission for you to take care of them."
This relationship, this magic, isn't only beautiful to hear,
but it's replicated in science.
Children in neonatal ICU who are placed on the lap and caressed
improve faster and are discharged earlier.
The number of functional diseases among us is increasing.
We don't know why functional diseases appear.
There's no change in the tests, blood, X-rays ... there's nothing.
They're diseases that have symptoms.
Does this happen because our society is a little sick?
Some of you might say,
"This doctor-patient relationship you talk about is very interesting,
but if I'm the patient, and the patient is the passive one,
why are you telling this to me?
Why not tell this to a group of doctors?
After all, they're the active ones."
It's time for us to stop thinking that there are two sides:
doctors against patients.
It's time for us to stop thinking about being passive,
that we're passive patients.
We have to take it into our hands and be active in our healing process,
and it's not just through healthy living,
but also getting involved in our healing process,
in the decisions of our healing process.
To do this, the first and most important thing is information.
It's no use talking about Dr. Google as being trendy. It's not trendy!
As a child, we had an encyclopedia "Medicine and Health" at home.
We had "The Book of Health."
This has always existed.
The difference is that at that time,
for you to convince someone to publish something, to have an editor,
you needed to have content to talk about.
Nowadays, with Google, you have an infinite amount of information,
much of which is very good and very important,
but there's also a lot of trash,
and we need to know how to filter it.
The ability to generate information is greater than the ability to filter.
We need to think about some things when reading this information.
First,
good information is usually from an authoritative source.
I have a blog
where only 1.3% of people check my resume to know who I am.
This upsets me
because people use my blog to hear what I have to say,
but they don't know who I am, what I did, studied.
They believe in me blindly.
This really bothers me because it puts me on the same standing
as those who only want to defend their personal interests,
make money, sell medication, or things like that.
So, authorized.
A second very important thing:
don't believe bombastic declarations like
"Medicine has changed! Now your problems are over!"
This is usually nonsense.
Very rarely would a laboratory or scientist
make a resounding and urgent discovery
that hasn't been advanced for some time by the scientific community.
Information spreads everywhere; nobody does anything alone.
Nothing is discovered today and on the internet tomorrow
that my doctor wouldn't know about.
Nonsense.
Third, if there is anything paranoid like
"The industry has no interest in you knowing this,"
it is ridiculous; no one dominates information.
It's highly unlikely that there's an ulterior motive behind it.
So, we don't believe in these paranoid things.
Finally, take the information and discuss it with your doctors.
That's what they're there for.
Information is not the same as knowledge.
Information is information; knowledge is knowledge.
Take the information, participate actively in your cure,
but discuss it with your doctor.
Another very important thing to be active in your healing process
is to ask, demand, and know.
When you talk to your doctor,
you have the right to know what that medication is for.
You have the right to know the risk of that surgery.
It's no use saying,
"It's a public hospital, the doctor has no time for this."
I've worked 20 years in a public hospital; I know there's little time,
but this won't change overnight.
We need to have a culture of change, a culture of demanding,
but demanding isn't arguing with everyone in the emergency department.
It's slowly recognizing how to demand and position yourself.
Over time, changes will be made to healthcare services.
Doctors want this; they want to do a good job.
They don't want to treat 100 patients an hour;
they want to give their time to each one.
I was once in the Amazon, near Venezuela,
in a mountainous area, in the Yanomami area,
and we had a patient there who had penile cancer.
He had a tumor on his penis.
Because we didn't have a urologist with us,
we brought him back to São Paulo
to be treated at the Institute of Cancer of São Paulo.
After all the tests,
I had the opportunity to be present at his appointment.
He was a native Indian, didn't speak Portuguese,
and the doctor obviously didn't speak Yanomami.
The translator, son of this Indian, spoke very little Portuguese.
He spoke very poorly and was obviously scared.
I witnessed an appointment which would make a good movie scene.
The Indian turned to the doctor and went like this,
"Uh or uh?"
And the doctor said, "Uh!"
And the Indian said, "Uh."
(Laughter)
What I'm trying to say with this
is that the magic happened at that moment.
That patient, not speaking the language
and coming from a totally different culture,
gave his soul to that other individual
who had every interest in taking care of him.
This magic is the art of healing well.
So, it can be very simple.
It just happens.
Right now, as we're speaking, I'm very proud to think
that there are doctors attending in emergency rooms,
outpatient clinics, in their offices,
and who are anonymous,
fighting the good fight,
healing, attending.
So, as doctors, we should try to put more humanity and more compassion
into our treatment,
and all patients should try to be more active in their healing process.
This will create a connection,
the world will be a better place,
and, as a result, you'll have better treatment.
Thank you.
(Applause)