In recent months, events that have touched people close to me and some of my patients have made me reflect on the role of the doctor, and it has been a bitter reflection.

The figure of the "doctor" used to be able to know the person, to take an interest beyond the time of the visit, to study the case taking into account the context of life, his relationships, his work, his life, to be able to give advice beyond the illness and often to comfort you and pat you on the back. This "my doctor" is now threatened with extinction (as Giorgio Cosmacini writes in his latest book).

Knowledge, the development of pharmacology and technology have given us a really powerful weapon to fight diseases and often win, but the lengthening of life expectancy together with a series of habits that are too often unhealthy and unbalanced have favoured the appearance of chronic diseases that often need to be carried out more than cured. Under this magnifying glass, we can understand how the doctor in the modern age should ensure that he has a strong technical and scientific knowledge by constantly updating himself, but he must also regain his human side, the pat on the back, the care of the complex cases, the smile, the accessibility beyond the end of the visit or the “time” of the phone calls, in short, to "be there for the sick person" again.

ùIf it is a simple problem, for which there are specific diagnostic and treatment protocols, then a simple visit is enough to make a diagnosis and initiate an effective cure. But when the cases are complex, when one cannot clearly understand the nature of the problem, when time passes and the body and mind gradually adapt to the unpleasant, unresolved situation, then the modern pilgrimage of one expert to another, the reception of diagnostic hypotheses, therapeutic options, requests for instrumental examinations and, what is worse, the constant referral to other specialists, becomes a source of deep discouragement.

In the field of mental health, the situation is even more delicate, because the decision is almost always based on a discussion with the patient, as there are no laboratory tests or imaging examinations that allow us to make a diagnosis. The diagnosis and treatment of people suffering from a mental disorder depends both on diagnostic and therapeutic skills and on the human alliance capable of helping the person concerned to continue treatment despite initial lack of success, to believe despite treatment failures, not to be discouraged even if other professionals make different diagnoses, to accept the risk of relapse and sometimes, unfortunately, to accept improvement without complete restoration of well-being.

If it is true that we often win and diagnosis and therapy are a simple and clear process with predictable results (for example, in many cases of panic disorder), it is also true that in other cases, where many complaints seem to overlap in an incomprehensible tangle, where the expected effect of a medication does not materialise, in which we have the feeling that the spectre of the disease will never leave us, in which we have to suffer side effects without it doing us any good, in these cases we are not dealing with a blitzkrieg against the disease, but the war turns into a guerrilla war, hope into resignation, life into an ordeal. In these cases, clinical and scientific expertise is not enough, but the "M.D." must transform himself into a "doctor", into "my doctor", whether he is a specialist or not, who cares about me and my suffering, who is able to examine my illness during a visit, who takes responsibility for decisions and sometimes takes us by the hand and encourages us.

When I think about my work with patients, I realize that I feel a great need to be their doctor, being fully available by phone and email, for example, but too often acting as a simple doctor.

The real problem today is to combine the enormous amount of new information from neuroscience (to think that I would have to read 34 scientific articles every day on the subject of anxiety alone!) with the increasingly pressing requests to see large numbers of people who are suffering with attention to the individual case, to the individual person who is suffering, and to their world. While it is true that diagnosis can often be made quickly and treatment initiated immediately, there are many cases whose complexity would merit an in-depth examination of the case and special attention to the individual: Time management and the demands of modern society prevent this possibility, perhaps also our weakness as human beings to impose what is right on what is appropriate.

Perhaps the solution of the future, combining high technical skills with the awareness that each patient is a person and not a disease, could emerge from the push towards so-called "personalized medicine", i.e. medicine (and psychiatry) that seeks to create tailored diagnoses and specific therapies for each individual person as a whole, with their genetic, environmental, symptomatic, medical, relational and, why not, spiritual characteristics. In this regard, research is progressing.

“Work in progress......" - that's the sign I would hang on the door of my profession. I will continue to work on becoming your doctor and not just a doctor...