Paolo Banfi is Manager of Neuromuscular Disorders Ward at Don Carlo Gnocchi Foundation Onlus. Expert in the field of Narrative Medicine, he is member of the Committee of the Project “The words of breathing”: the aim is the collection of Parallel Charts – the narratives of patients’ experiences – by doctors, in order to make life of people facing chronic obstructive bronchopneumopathy in the global context, between care, family, home, relationships, emotions, thoughts, activities.
Q. Which effects did Narrative Medicine have for patient’s life, in your experience?
PB. In my experience, Narrative Medicine has been extremely important: it put a real “milestone” on my behavior respect to my patients. The fact of listening more carefully, of positively interacting, of trying to get those implications not considered before, totally changed my approach to the patient. And I think that the same thing happened inversely. For example, in my ward, we had several controversies related to a lack of empathy and conversation with patients: the introduction of systematic conversations with them ensured that controversies were impressively reduced. Finally patient is seen as a person, not as a pathology.
Q. Parallel chart, that is the written narrative of doctor-patient relationship, is one of the used tools. Did you try to use it, and if so, with which results?
PB. We don’t have a real parallel chart, but we use a similar system. There is a case manager – a professional specifically trained and hired – that follows all the patient’s path. In the case of the so called “fragile patients” (for example, COBP, ALS, and decision-making problems), at least one a week we meet the patient and his or her caregivers, and from this meeting emerge criticalities. We need this because we write down and put in the chart emerged dimensions, and from here comes the doctor’s and case manager’s role: understanding how we can follow the patient without feeling alone, but without influence him or her in his or her choices, and ensuring that the patient will not perceive only the negative aspect of the recovery, but also that one of personal benefit.
Q. Even so, we can consider it a type of application of Parallel Chart. Which are the main problems you find in your patients, and how Narrative Medicine can help?
PB. Essentially, the main problem is solitude. Narrative Medicine helps because allows us to sustain patient during decision-making process.
Q. How much time is needed to use a narrative approach? Can we say that time invested in patient comprehension is a time saved after?
PB. This question is very important. Doctor works with time limits: visits must last few minutes, conversations with patients too – we are regulated by not an ethics, but a clock. Letting the patient talk is extremely important, because emerges half of diagnosis. Thank to this, we do less exams, less defensive medicine, and there is a therapeutic alliance, a paths sharing. Obviously, we can also save costs. Patient does not do exams that will be revealed as not necessary. Let’s say that initially “we lose time”, but this time is absolutely regained in diagnosis. We found that we can do a diagnosis in short times, and this is all in advantage to doctor and patient.
Q. Some considers Narrative Medicine as preventive medicine. What do you think about it?
PB. I consider Narrative Medicine as preventive medicine, but also as “medicine of the person”: finally we highlight the concept of taking care of people and not of pathologies.