The concreteness of Narrative Medicine in the everyday practice of care
The Workshop “Science and Technology of Narrative Medicine” of ISTUD Foundation was characterized as an advanced laboratory. Professionals who participated brought their own projects, already active in their working context, to increase and further enhance them through the more refined and advanced tools of storytelling and semantic analysis of stories, under direct supervision and counseling, and with lessons and follow-up by national and international experts.
Among the discussed themes, that have seen in comparison the experiences of three different countries (Italy, Portugal, Israel) on the effectiveness of Narrative Medicine practice, there were the resilience condition, the decision-making process linked to the ethical aspects of the end-of-life and the sustainability of the NHS, and the narrative tools in the context of professionals’ training in healthcare settings.
Resilience is one of the answers a person can express after trauma (considered in its more comprehensive meaning, in a physical and psychic sense): a high level of resilience could increase the post-traumatic reintegration capability, and this process can be fostered precisely in the doctor-patient relationship, through the practice of Narrative Medicine tools. In particular, the integration of the autobiographical memory through narrative positively influences self-awareness, increasing resilience.
Narrative Medicine offers the opportunity to act also in the decision-making process in the end-of-life care context. In medical training, even if there are courses on Bioethics, teaching and acquisition of narrative skills are usually set aside, with the risk of distancing more and more healthcare professionals from patients. The end-of-life care context is particularly delicate: the difficulty of decision-making, in respect of patient’s and professionals’ dignity, can bring to situations of burn-out and non-sustainability. The contribute from Portugal underlines how the use of narrative tools could improve the communication abilities between professionals, patients, and caregivers, and wants to analyze how the improvement in decision-making can have a positive impact on NHS costs.
Furthermore, the use of narrative tools turned out to be of great importance in the field of professionals’ training in healthcare settings (hospitals, and so on): the acquisition of narrative skills, the social and linguistic comprehension of the territory, and the use of narrative in clinical and welfare practice allow a better and more adequate understanding of care and illness context, getting the patient’s story beyond the clinical date.
The training of ISTUD Foundation and the professionals’ experiences exchange demonstrated how Narrative Medicine could enter the everyday clinical and care practice, preventing non-sustainability, improving doctor-patient communication, helping in warning carers’ burn-out situations.
The Workshop represented a considerable evolution in its path: the proposal of the more advanced and practical tools of this discipline was connected with lessons, discussions and laboratories, without taking anything for granted – just as group and mutual listening experience. If the mere update can be done in several contexts, ISTUD teaching team allowed reality of relationship, listening, regard of resources, and collective reflection to emerge: a fundamental step to make Narrative Medicine become practice.
Practical and theoretical tools and subjects, the invitation to a qualitatively different act of listening, to the rediscovering reciprocal resources: all united to the searching for strategies to link Narrative Medicine worlds with the “scientific request” by medical and clinical research.
At first, it could be complex to “close” the richness that narratives offer us into the firm schemes of quantitative research and scientific publications. But if we want to approach more people, we have to learn this communication scheme too. Furthermore, let’s ask ourselves: only we have to adapt to a scheme? Or can we enrich this scheme, giving importance and dignity to stories, and not only to numbers?
It is difficult to subvert the “evidence pyramid”, in research as in publications. It’s not only a matter of methodology and of “homogeneity” of scientific communication, but also a philosophical problem of priorities: the patient is in the background. “Honoring” patients’ stories, respecting them, are beautiful and important words, and they take us back to the fundamental point of Narrative Medicine and Medical Humanities: people who live, think, reflect and act in the complex arena of care.
A first step, a way to continue this respect could be recognizing the richness of multiplicity, in and out our research field: this means that there is no “one” Narrative Medicine, and that the changing perspective is given by the comparison of experiences in an autonomous and critical context.