Phlebosophy is a newborn concept and a European registered trademark in the field of Phlebology. The word Phlebosophy has a greek etymology that indicates love of wisdom in venous disease: Phlebo (Venous) – Philosophy (φιλοσοφία, philosophia, literally “love of wisdom “.
Phlebosophy is the study of general and fundamental problems of venous disease concerning matters such as existence, knowledge, values, reason, mind, and terminology. Phlebosophical methods include questioning, critical review and discussion of literature, rational argument and systematic presentation. Classic phlebosophical questions include: Is it possible to know anything and to prove it? Absence of evidence is also an evidence? What is most real? However, phlebosophist might also pose more practical and concrete questions such as: Is there a best way to treat venous disease? Is it better to be just or unjust? Do humans have free will?
Why we built Phlebosophy?
The main reason we built Phlebosophy is to try to improve and uniform the daily clinical and scientific work among doctors who are dealing with venous disease, and share this knowledge among them; in other words to create a functional network and a smart web platform, able to interact 24 hours daily with doctors and patients.
Before analyzing the ID of Phlebosophy we have to understand first who is the modern phlebologist and which are the current standards of education.
Without any doubt, in the last 5000 years venous disease was well known and many pioneer doctors created incredible methods to resolve venous problems and complications in the past; the real phlebosophists. Nowadays, despite worldwide recognized scientific organizations that are dealing with this items, guidelines are often misunderstood in current practice, and an international school in training phlebologists is still lacking. Many university master classes or private training courses have been offered in order to teach doctors, but probably the “à la carte” theoretical school is going on.
A doctor, “Twitted” recently that doctors are strongly and continuously recommended to use guidelines; with all guidelines available by the moment and often in conflict among them, we really need some more guidelines to understand and use guidelines.
Guidelines are a good instrument to transfer to the current clinical practice the evidence from reliable scientific studies but regularly they do not consider the reality of multiple and individual variabilities of every single patient.
The accelerated progress of science in the last years, rapid and free access to international libraries of medicine, and diffusion of knowledge by internet, lead to a globalization of information.
Contrary, reduction of human resources, economic crisis, lack of vein clinics and vein specialists and other multiple factors, do not allow the spread of knowledge widely in the current practice. In many countries the different health systems (private, public or mixed) offer alternatives that are not well accepted from patients.
The main problem that we want to evidence is that frequently vein specialists have different background and professional training: there are general practitioners, angiologist, internal Medicine practitioners, General Surgeons, Vascular Surgeons, Dermatologist, ecc. Training is more or less complete and in most cases the dedication in this discipline is not total but only occasional. You can notice at a glance in the abstract book of an international meeting how uniformity of terminology, anatomy, standard clinical evaluation, quality of life tables, are different from author to author and in different countries all over the world.
Another major problem is the difference between different cultures and different treatment approaches, often based on different economic healthcare systems. A significant example is the different reality between the public and private healthcare in Italy, and among Anglo-Saxon and Mediterranean countries. There are incredible cultural differences between doctors that developed personal guidelines and myopic thoughts proposing strategies according personal experience and probably economic interest. They treat everything with schlerotherapy, or conservative surgery, or stripping, or mini-invasive endovascular ablation techniques, and sometimes you can visit websites recommending that varicose veins should never be treated.
In Phlebosophy we believe that a doctor must be familiar and able to perform all the different treatments that have scientific validity, and try to give always to the right patient, the right treatment, at the right time.
During the various UIP consensus regarding training in Phlebology, some milestones had been discussed, such as basic knowledge in venous anatomy, pharmacology, clinical examination and evaluation of the patient, diagnostic tools, ultrasound, different treatment modalities, additional education, critical reading and writing of scientific publications. In other words a complete management of phlebologic activities before starting venous treatment. But how many specialists enrolled in medical scientific societies complete these requirements? Very few. In Italy the medical schools of Angiology have disappeared over 10 years ago, in some European countries they have never existed; in more than 70% of cases, phlebology is performed not by vascular surgeons, but by other specialists, and even by non-specialists and paramedics. Management of phlebologic problems will become truly complex in the future unless we will offer new instruments to create a functional network that will enhance collaboration and will improve skill of training doctors.
Milestones of Phlebosophy
Varicose vein disease is an incurable disease, regardless of the method used to cure it. We believe that at the basis of this disease there is an hemodynamic dysfunction that creates a superficial venous hypertension. The purpose of the patient’s initial evaluation should aim at identifying the most evident causes that lead to venous hypertension, the main condition for development and progression of varicose disease; in particular we have to understand etiology and distinguish it in primary, secondary or both.
The ultrasound examination must be performed as the first step of the examination in order to perform a correct identification and extension of venous reflux, which can be distinguished in superficial, deep, communicating or a combination between them; extension can have a distribution at thigh level, calf or both. The study should be performed in supine and orthostatic position, in a static and dynamic position, even if the latter is difficult. From these early concepts, we can also say that the diagnostic ultrasound examination requires a hard and good training, since this kind of evaluation is operator-dependent, is not only a technical evaluation but requires a medical and phlebosophic approach.
Many times it happens that you have to visit patients who had performed a limited ultrasound examination, disassociated from the current knowledge in Phlebology, which really gives no useful information to perform a surgical treatment or to compare a result after a conservative treatment. It ‘s absurd to know that every day millions of patients are treated, and only a fraction of them are recorded to evaluate the “out come” in the follow-up. The vast majority of the specialists are not able to document the success or failure of their work; today we speak more about healers using natural methods that regenerate veins rather than by the results of vein surgery and guidelines.
It appears that everyone creates his own guidelines by modifying guidelines and many specialists take inspiration from guidelines to perform treatments that do not follow the guidelines, because the their hospital cannot provide technology, or because they do not have an ultrasound device in the operating room, or because they do not trust endovascular procedures without performing a high ligation. Then there are aficionados of the old disappeared schools, who support experiences made decades ago and which are often handed down as a case of knowledge from one operator to another because the “master” had said that it was necessary to do so!
New instruments to create network
- E-learning in Phlebology
- E-library in Phlebology
- E-training in Phlebology
- E-photogallery in Phlebology