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Catch the moment. The secret for a good Narrative Medicine

Persistence of memory - Salvador Dalì

Persistence of memory – Salvador Dalì

Time looks always finite: no matter what a healthcare team does, there are always 24 hours a day. Time is the constant mantra brought by healthcare professionals, physicians, nurses, psychotherapists, when a narrative approach is proposed in the carer-cured relationship. Or better, shortage of time, lack of time.

Indeed, in this world seeking a struggle for better efficiency, time is gold. Shorter are visits, bigger is production. For a first visit, the physician must take maximum 20 or 30 minutes to take care of the patient. In the practice, visits might last up to 15 minutes. And if Narrative Medicine proposes the art of listening, the tools of reflective writing, the moving forward from disease to illness, giving each patient a central role and so right time, where to find this proper time?

Is time finite? To answer this, we can go back to mythology, which might help us to find a possible way out from this dilemma. Ancient Greeks had two deities to define time: one was Chronos, an old man, who was eating his offspring: the past was eating the future, in a terrible sequential manner, and the way he was acting was absolutely linear. Time eats everything. We are finite. Time of visit between a physician and a patient is finite. However, there was a young deity, a little boy with wing at his ankles, called Kairos, the little God of the opportunity. With this word, ancient Greeks considered the suspension of time, or better the right time in which good choices were picked up. In physics we might call it the quantum leap, the instantaneous infinitesimal time to get to a higher energetic level. In healthcare practice we might call it as another way which intuitively pops up in mind to establish a successful relationship with patients. It requires not extra time, but a different energetic level, it demands for a different perception, it looks for different questions and different answers.

To have good conversations inviting change, John Launer teaches us that 10 minutes could be enough if we know how to handle them, if we know the right questions to ask, and if we follow the path of the carer, without invading the field with our egos already filled in with the judgement and a priori diagnosis. Kairos is an invite to change perspective, not a request for an extra time for implementing Narrative Medicine: a part from the due time of education and training which was to be acknowledged, since only in few universities Medical Humanities and Narrative Medicine are fundamental and not complementary subjects (New York, London, Milan, Rome, Paris, and probably some other few academies). Time is lost in the university where too much technology is taught, and therefore it must be invested after in regaining these competences before is too late to prevent the risk for de-humanising the medical and nursing practice.

However, once we have invested the adequate time to empower narrative practice, it’s quite simple to act it in each practice or hospital and it does not require the Chronos time, the tyrannus. Is it a tyrannus a five minutes of time spent to write a parallel chart, the written room of thoughts of doctor-patient encounter? And what about the wasted time in a waiting room where patients could write, if they wish, their narratives about their disease? And if we consider a time span of eight hours per day, why should we dedicate the same amount of time to each patient? Some may require 20 minutes, some 5 minutes, some 45 minutes, some 10 minutes: it depends from each individual, and “right time” is not based on an objective perception, but on a subjective perception.

However, we are yet in the Chronos sphere, accounting for wastes of time and time saving: here we are time keepers with a chronometer. No, Kairos, the little God with winged ankles, is able to fly, to be light in the sky and takes our hands so that we can learn to fly over time: if we listen carefully to some doctor-patient encounters, the “context” is stuffed by tests, investigations, remedies and drugs. “How do you feel?” is a tricky question, which can allow the expression of a qualitative adjective “bad”, “better”, “good” or the spreading out of the inner realmWith fear”, “anger”, “pain”, or “joyfully”. The first kind of answer brings back to physicians, in a sort of Pavlovian’s reflex, to change therapy, prescribe new test, comment of the Haemoglobin level: no Kairos at all, Chronos is the winner with the productivity of investigations and therapies. Kairos would like that we, as free children could express out emotions so that an authentic doctors-patient relationship can start. Kairos brings us to another way to practice our professions, of counselors, psychotherapists, nurses and doctors.

Of course, Kairos is not replacing Chronos, but if we don’t do anything to block our behavioural stereotype with patients, as defensive medicine, the defensive wall of Chronos will be reinforced, and daring new changes in healthcare context won’t be possible. Kairos is an act of bright courage. It is picking up from patients’ words, that sometimes are worried – for example – about losing their job. A Kairos approach wouldn’t continue in talking about the disease but may ask: “What can I do in helping you to overcome the fear to lose your job?”.

Defensive medicine is paralyzing the development of fresh and genuine doctor-patient relationship: it is an old conservative approach, like the old God with the beard eating his offspring – in this cases, eating thoughts and feelings of physicians, nurses and patients.

Therefore, when we are questioned about how long does it require to do Narrative Medicine in practice, we answer quite in a provocative way: no more time. It’s another way to take care of the people. Without allowing the phantoms of the terrible failure overwhelming the building of a positive encounters saving drugs, and tests and procedures.

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Epidemiologist and counselor – 30 years of professional life in health care. Classic humanistic background, including the study of Latin and ancient Greek, followed by scientific academic studies, chemistry and pharmacology. First years of career, in private international environment. I worked in medical research, moved to health care organization, getting academic specialization in Epidemiology. Later, in consultancy and health care education. Counselor with transactional analysis orientation. Currently, director of Innovation in Health Care Area of Fondazione ISTUD, an independent not for profit Italian Business School with an humanistic approach acknowledged by the Italian Ministry of Researech.. Active member of the board of Italian Society of Narrative Medicine, tenured professor of Narrative Medicine at Hunimed, Milan, and in 2016, referee for World Health Organization for “Narrative Method in Public Health.” Writer of the book; “Narrative medicine: Bridging the gap between Evidence Based care and Medical Humanities,” edited with Springer and of international publications on narrative medicine in scientific journals. Last book “The Languages of care in narrative medicine: words, space and sounds in the healthcare ecosystem”. Lecturer in different international contexts from Academy to Public and Private Foundations.

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