2024-04-11 13:34:57
BOLZANO. «I don’t know where these forty years have ended, it seems to me that I started yesterday. The hospital? For me it has always been home.” Michele Comberlato, 67 years old, twice president of the Medical Associationon March 31st he left the leadership of the Gastroenterology department of San Maurizio, today in the hands of Piercarlo Farris.
Could he stay if he wanted?
«Yes, up to 70, but the communication on the matter was late, I had already reorganized my life and built an exit path».
Painful detachment?
«Yes, it will take some time, I’m there with my head and my heart».
And now?
«I’ll do something. I have spent a lifetime learning to do important things for patients, I will put them at someone’s service. In the meantime I’m taking a long holiday.”
Medicine, your always passion?
«No, reasoned choice. Of course my wife Cristina, also a doctor, gave me a good push. Once I finished the classics, I did the first two years of medicine in Padua and then in Verona. Thesis with professor Giorgio Dobrilla. He had great skills, leadership and leadership skills, he was respectful of the roles, I owe him a lot. He stimulated us, he wasn’t jealous. Did we want to go around learning new techniques, new therapies? He sent us. But when we came back he would tell us “you’ve learned, now show me”. We also had clashes. He told me “when you leave, turn off the light. The hospital is like your home”. He taught me the sense of participation in the common management of an important space. “Your job here? You have to do it well.” From the thesis with him the transition to “gastro” was automatic. I entered the hospital at the age of 25, as a student, I worked for free in the ward. Then the specialty, another 4 years in Verona.”
How has Medicine changed?
«I witnessed a total revolution. Today we do unimaginable things. I am thinking of the management of complex pathologies with biotechnological drugs. Ulcerative colitis, Crohn’s disease, they are my passion… and when I started there was only cortisone, now we have various molecules with which we change patients’ lives.”
And the diagnostics?
«I started working with fiber optic endoscopic instruments. You looked inside it and the fibers broke, now it’s all on video, high definition, you see much better and you recognize much better. In addition to diagnostic capabilities, endoscopic therapeutic modalities have appeared that were not there before. As far as instrumentation is concerned, we are in good shape both from an endoscopic and ultrasound point of view. In Bolzano we do what is done in all the most qualified hospitals internationally. Our diagnostics are advanced. We have two endoscopy rooms that have the module to apply artificial intelligence to endoscopy.”
And how does artificial intelligence work?
«The machine knows thousands and thousands of images of polyps. Accumulate data and keep learning. While you are doing the endoscopy and moving along the very long curves of the colon, when it recognizes a small protuberance on the mucosa it puts a bright square on it. You see the flash and you look closer and you see an octopus that perhaps you would have missed. Wonderful technology. We participated in an important international study with six centres, four European, one “extra-EU” and we… they needed numbers and we carry out many high-quality tests. So, based on this experience, the second one started after the first study.”
There is more?
«Yes, it was once unimaginable to remove a 4/5 centimeter colon polyp, now we remove them endoscopically. We used to send the patient to the operating room. All hepatic, biliary and pancreatic endoscopy has also been revolutionized. The treatment of hepatitis, cirrhosis, etc. has transformed. Thanks to advanced drugs and targeted treatments, patients have a previously unthinkable quality of life. Today you cure viral hepatitis. In the hospital, a portion of our activity is dedicated to the liver, then there are specialist clinics on the pancreas, small intestine, etc. And these are just a few examples. Medicine never stops. If that treatment doesn’t work for your patient you have a second, a third choice.”
How many are there in the department?
«Twelve, plus two tough interns. There is a lack of nurses, we are constantly understaffed.”
Performance, what numbers do you have?
«We do around a thousand hospitalizations a year, 950 day hospital admissions and we travel with around 9,000 endoscopic and ultrasound tests a year. We only have three endoscopy rooms – one has been closed since Covid – but the new endoscopy service is being completed in the spaces of the former emergency room.”
Are tumors on the rise?
«They increase because we make more diagnoses. When people have something they go to be seen and between laboratory diagnostics, heavy radiological machines (CT scan, MRI, PET) and ultrasound endoscopy, which we perform, we are able to identify the disease early. And intervene immediately.”
Colon screening remains low, with just over 30% of citizens responding to invitation letters from the local health authority. Why does this happen?
«We are a land that is not very inclined towards health prevention, I am also thinking of vaccinations. I have had three colonoscopies in my life. Resistance to screening is the fear of being told something is wrong. But if the unpleasantness can be faced and managed, there is no need to be afraid. Colon cancer often starts from a polyp which on histological examination turns out to be malignant. If we remove it, the problem is solved. Then of course his life will be divided in two. First the person lived peacefully, then he will live with controls. But if this will allow you to lead a normal life and age well, then there is no problem.”
Healthcare is navigating troubled waters…
«It’s never an easy game. Councilor Hubert Messner lived in the hospital and knows the situation very well. We have great resources, the great opportunity to be able to manage ourselves independently and structures spread across the territory but we struggle to implement concrete projects in the medium or long term and to do this they should trust us doctors a little more”.
For example, waiting lists?
«The ASL approach is obsolete and unscientific. It is not by increasing the supply that you solve the problem. You need to check the question. You have to perform the right service, to the right patient, at the right time. We have criteria for which the patient goes to the specialist with variable priority depending on the importance of the problem. And a solid collaboration must be built between family doctors and hospital doctors. Because a large part of what is sent as specialists to the hospital today should not get there.”
Is there collaboration between doctors?
«There are no structured meetings, except on an individual level. I had proposed periodic meetings. Colleagues in general medicine have tools and skills, but a shared path must be established. Otherwise we send all the patients to the CT scan.”
What remains for you after 40 years in contact with patients?
«What remains is the richness of human relationships, the most difficult cases, the ones I’m still thinking about now. The difficult decisions. There is a beautiful phrase by Umberto Veronesi, who, speaking of medical decisions, spoke of the “painful loneliness of the doctor”. And that’s how it is. Every patient has his own story. They all hit you. I have always told young people “never forget that those who come to you are afraid”. You have to manage the clinical and human sides. Today, young doctors are very well trained. They go online and find the world, at their age I traveled on books and photocopies. Leave my hospital? Very hard. The heart still beats there.”
2024-04-11 13:34:57