How to really listen in 20 minutes – and change care.
Andrea is 32 years old and newly diagnosed with HIV. He entered hospital for an opportunistic infection and, during his admission, received the news. After discharge, he presents himself at the infectious diseases outpatient clinic. The doctor welcomes him and immediately starts explaining:
“Andrea, your HIV is in an early stage. With treatment we can keep it under control. The viral load is high, but we can make it undetectable. You have to follow the therapy every day. If you do that, your life expectancy will be normal.”
Andrea listens, but something breaks. He feels paralysed. He cannot even speak. Then, in a hushed voice, he says:
“Doctor, I don’t even know where to start. I am afraid to tell anyone. I am afraid of losing my job, of being judged. I feel dirty. It’s like everything has changed in an instant.”
The doctor said it all correctly, clinically speaking. But Andrea is somewhere else: he experiences Illness (the subjective dimension of the disease), not just Disease (the medical diagnosis). And in between, there is the burden of Sickness, the social stigma, the judgement of others, the sense of isolation.
What would have happened if the doctor had had more time?
The truth is that the visit lasts, on average, 15-20 minutes. And that will not change. But what may change is how we use that time.
Although this is an illustrative case study, constructed for educational purposes, similar interactions really do happen every day in the wards and outpatient clinics. And they can make the difference between a patient who feels lost and one who begins to see a way forward.
In Andrea’s case, this is how the dialogue continues, when the doctor adopts an integrated narrative approach:
“Andrea, I understand that this diagnosis was a hard blow. It is normal to feel scared and confused. Many people with HIV tell of experiencing a similar feeling at first. But today, HIV is a manageable chronic condition. And above all: you are not alone. We are here to help you not only with the treatment, but also to guide you through what you are experiencing.”
Andrea looks up. He finally feels recognised. And he opens a new door:
“It scares me how others will see me. I read stories of people who have lost their jobs. And even in relationships… who will want to be with me now?”
The doctor listens, without interrupting. Then he replies:
“There are still prejudices, unfortunately. But there are resources. We can get you talking to a counsellor or put you in touch with a support group. There are also laws that protect your work. We can deal with it together.”
Andrea is no longer alone. And he starts to think differently:
“Maybe I could talk to someone who has been through it. I hadn’t thought that there might also be help for the… social part of the disease.”
You don’t need many minutes. It takes a fresh look.
In 20 minutes, we cannot do everything. But we can change the way we are in those 20 minutes.
Narrative medicine does not lengthen time but teaches how to manage time in a more human, effective and transformative way. Integrating listening, empathy and attention to the personal dimension of illness is not a luxury: it is an integral part of care.
The ISTUD Sanità e Salute Master’s Course in Narrative Medicine was created for this.
To provide professionals with concrete tools to better inhabit the time of the visit, to welcome the patient’s story, to direct care towards what really matters to those in front of us.
You can learn to change your gaze, to stay in time, to align your language to really meet the other person, even in the most delicate moments of care. It is not a matter of adding to the daily load, but of rediscovering how time, however brief, can become a space of trust, recognition and orientation.
Master in Medicina Narrativa Applicata – MedicinaNarrativa.eu