The future lies in preventive medicine: lessons from a good GP

“I wouldn’t go back even a single day.” Lorenza says this without a second thought, as she comes to greet me on the beach in Giulianova, where our family has always gathered in August. I’ve come from Rome; she’s come from Bologna. She’s thirty-two years old and a general practitioner, with five hundred patients in the heart of the city. I am almost twice her age and have spent my life between hospital wards, university and research. I used to be Dean of a Faculty of Medicine and now I head up scientific research at a large university hospital.

I ask her a question almost out of habit, perhaps as an old examiner: don’t you miss the hospital? For me, and for many doctors of my generation, that was the natural path, almost the only one imaginable: specialisation, a ward, a hospital career and, for some, academia. Her answer takes me aback more than some ministerial hearings. Lorenza first talks to me about the practicalities: autonomy, how work is organised, and the chance to build a professional life different from that of hospital work. She also reminds me that, financially speaking, general practice can now compete with many hospital careers. But when I ask her what she really likes about her job, her tone changes. She talks to me about her patients. About the home visits she continues to make regularly. About the fact that she enters their homes, gets to know the families, knows who has lost their husband, which child has moved back in with their parents, who is looking after an elderly mother, who has suddenly stopped going out. “They’re not just case numbers, mate. They’re people I know by name.” It’s a simple sentence, but it sticks with me. Because in large teaching hospitals — in mine as in many others — this kind of personal connection is gradually at risk of disappearing. The patient arrives, is examined, diagnosed and treated. We often treat them with a precision and effectiveness that we could not even have imagined forty years ago. We have genomics, advanced imaging, biologic drugs, robotic surgery, transplants and artificial intelligence applied to everything. But we only see that patient for days or weeks, rarely for years. We do not always know what home awaits them when they are discharged, who they live with, what they eat, who makes sure they take their medication, or what had changed in their life in the months leading up to the onset of their illness. We have achieved extraordinary diagnostic precision. But we risk losing, almost without realising it, that slow and continuous understanding of the person which, for centuries, has been one of the very essence of medicine.

And it is precisely here that my conversation with Lorenza intersects with a topic I have been working on for some time: anticipatory medicine. The medicine of the future will have to be capable not only of treating disease, but of recognising its early signs: in metabolism, in the microbiota, in the genetic makeup, in the environment, and in lifestyles. We discuss this at conferences. We develop biomarkers, predictive algorithms and large-scale data platforms. But many of those signs, even before they appear in a laboratory test, are already embedded in people’s life stories. An elderly person who starts walking more slowly. A patient who stops going out. A bereavement that alters sleep, weight and habits. A family in which obesity, diabetes and certain behaviours span three generations. A carer who can no longer cope with the burden of care. For those who meet a patient just once, these are mere details. For those who have known them for ten years, they may be the first signs of a diagnosis. This is why we should start to view general practice differently. The GP is not merely the gateway to the National Health Service. They are the custodian of a person’s longitudinal history. And perhaps it is precisely there, in that knowledge built up day by day, that one of the most authentic forms of anticipatory medicine is to be found. Lorenza doesn’t call it that. She simply says she wants to get to know her patients, she wants to follow them over time, not just see them when the illness has already set in. She wants to be able to tell if an elderly person is deteriorating before they fall. If a young mother is slipping into depression before anyone writes it down in a diagnosis. Whether a man she has known for years has lost weight, become withdrawn, or changed the way he speaks or walks. In short, she has chosen to stay close enough to people to notice when something changes. It is a professional choice, but also a medical one. And it strikes me that it is a young doctor, aged thirty-two, who reminds me of this.

At the Higher Health Council, we often discuss the crisis in general practice. There is a shortage of doctors; many retirements are not being replaced; and entire regions of the country are struggling to provide adequate local healthcare. But Lorenza draws my attention to a deeper issue. The problem is not merely economic or organisational. It is also a question of prestige. Throughout our university years, we continue, implicitly, to construct a hierarchy of medical professions. Certain specialisms – major surgery, high-tech disciplines and academic careers – are perceived as the natural pinnacle of the career path. General practice too often remains in the background.

And this is something the university must also reflect on. Even I, during the years when I was responsible for training doctors, probably did not emphasise strongly enough to my students that caring for a person and their family for thirty years is just as much medicine as performing a transplant. It is simply a different kind of medicine. Perhaps even more difficult to teach. For Lorenza, however, it was not a fallback option. It was a choice. She chose a form of medicine that does not begin when the patient is admitted to hospital, but long before that. A form of medicine built on closeness, continuity and memory.