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NARRATIVE SKILLS IN MEDICAL TRAINING: INTERVIEW WITH DR. GRAZIA CHIARINI

This month we are pleased to host in our journal an interview with Dr. Grazia Chiarini, General Practitioner from the province of Pisa. The doctor not only offers us her valuable testimony as a former participant in the Master of Applied Narrative Medicine, but also tells us about her dream of spreading narrative medicine through the creation of a  network among professionals who apply the narrative approach, and her projects for the inclusion of transversal skills courses within the education in health care.

1) As a first question: briefly, tell us about your professional life as a general practitioner and your experience with narrative medicine, from the Master of Applied Narrative Medicine, up to the courses you are involved as a teacher for colleagues and students? 

After graduating in Medicine and Surgery at the University of Pisa, at the end of 1978, in 1982 I signed an agreement with the S.S. in general medicine, at the Asl 11 of Empoli, in Santa Croce sull’Arno, a town famous for its leather tanning, in the province of Pisa. During my university career, I had already realized that the study of the human body and pathologies was enough to train a good technical operator of the body-machine, but not for a doctor who would have to take care of the sick person in their entirety. The imploring eyes of the patient resigned in their beds of the hospital, told, in fact, much more of other things. They often talked to us about their doubts, expectations, fears, and hopes. I became more and more aware of those bodies, that need to be repaired, were people to listen to and understand. Being a general practitioner is not easy. So many problems every day, more and more demanding people, stimulated also by the mass media, so much bureaucracy that takes a lot of time, serious pathologies that lurk behind apparently trivial symptoms, chronic diseases that are increasing, psychological and social problems to be faced, together with the periodic reports required by the Health Authority for the containment of costs in healthcare. All these become a burden on the daily work but also on the private life of the doctor and can lead to stress, intolerance, increased conflicts with patients and, sometimes, with their families. I have had to face this reality every day too, which is tiring but enriching a lot both from a professional and a human point of view. One aspect, in particular, is the most important for me: the ongoing and trusty relationship that is established with the people who choose you as their doctor. A relationship based on acceptance, listening and sharing. I have had the opportunity to listen to many stories of illness, suffering, joy, stories of different people, even from other countries, with whom you can only speak with gestures, dusting off the English or French studied at school. Taking care of the person considering not only the clinical and diagnostic aspects, but also the environment in which he lives, the family, their experiences with the disease, becoming aware of the therapeutic role of himself as a first medicine,  are the heart of the work of general practitioner, defined as the specialist of the person not only of one part. My introduction at the Narrative Medicine world was natural, I would say inevitable, that followed a path of autobiographical writing, and was where I had the opportunity to learn more about the therapeutic potential of writing. However, the Master of Applied Narrative Medicine, attended in 2015, was what gives me the tools, but also the necessary preparation to be able to use these tools in various contexts: with the young doctors of the Training Course in General Medicine in Pisa, participating in my project work for the master (subsequently students at my lessons); with the nurses of IPASVI in Florence; with the Doctors of General Medicine, as part of a cycle of groups Balint, which I proposed to write, two metaphors about their profession, at the beginning and end of the path, to assess the possible changes correlated with the participation in the group over time. Finally, thanks to the training course at the ASL Toscana Centro and the training course for animators, I was able to organize, a course in Narrative Medicine in San Miniato, in the period September-December 2018, as part of the ongoing training of GPs.

2) From your experience, what are the major difficulties and benefits that narrative medicine has brought to your clinical practice, as a general practitioner?

The main difficulty that I perceived, as well as other colleagues who have participated in the courses, is the time to dedicate to the narrative medicine. The general practitioner takes care of the health of their patients in their totality, and visits many patients both in their clinic and during various home visits, especially for whom suffering from chronically ill, not walking, having not only health problems but also feeling loneliness and need to talk. In addition, we take much time making certificates, disability applications, recipes but we need some time also for our personal family. I have learned, however, from my experience, that time is relative and can increase if you listen better to what the person means behind the symptoms brought if we try to understand his experience and his expectations. “Listen to the patient, he’s telling you the diagnosis!”, as Osler and Balint suggested: it is very very useful advice in daily practice, helping you to improve the relationship because enriched with new contents. Writing down my impressions of some patients and inviting them to tell or write about their experiences has helped me to take better care of them, to establish a better shared therapeutic path.

 3) By virtue of your experience, what strategies would you recommend to implement the communication and dissemination of the narrative approach, especially in those realities where the culture of this approach still struggles to emerge?  

We need to proceed in small steps but continue to propose initiatives, conferences, narrative groups with health professionals and patients in order to grasp the needs and proposals. It could be carried out also involving business managers, training centers and training leaders. However, it may seem an extra effort to general practitioners, who are already overburdened with a lot of work,, but when they realize that this approach allows them to become aware of their actual daily basis, improving the quality of their professional and personal lives, they will be more willing to use it. This happened in the last course of narrative medicine with family doctors. After initial skepticism, the majority asked to be able to continue with an in-depth course, also in order to create an ad hoc space, a parallel folder, to be included in the computer programs most used by GPs in their daily practice.

4) As a teacher, what is your opinion on the introduction of the narrative approach in the curriculum of young students in the health field?

This is very important. The university course of Medicine and Surgery, even more so than other courses in the health field, is based on the study of the human body and not of the sick person. This is an approach that is well observed in students attending the last years of the faculty and in young doctors, who do not feel prepared to take care of a person from a biopsychosocial point of view. As a teacher, as part of the Training Course in General Medicine, I am continuing to bring my experience and my thoughts on medical practice that is “an art”, which, as Hippocrates said in the fourth century BC,.  Taking into account the clinical, diagnostic and therapeutic aspects is fundamental, in parallel with the relational aspects. Today we talk a lot about “Precision medicine” or “Personalized medicine”, which more personalized is a medicine that deals with the experience of a person and not only with his DNA?

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Written by

Researcher at Healthcare Area of ISTUD Foundation. Master degree in Industrial Biotechnology at University of Milano-Bicocca, Post-graduate ‘Scienziati in Azienda’ at ISTUD Foundation. Expert in Medical Writing, especially in areas as the qualitative research and Narrative Medicine. She contributes to research and educational projects with the aim of improving the quality of life and quality of care of patients with chronicle or genetic diseases.

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