RAFFAELLA PAJALICH is an endocrinologist and board member of SIMEN and has just completed the 10th edition of Fondazione ISTUD’s Master in Applied Narrative Medicine.
How did the decision to train you in medical humanities and narrative medicine mature and with what expectations?
I run into narrative medicine by chance in 2015, coming across a book by Rita Charon and I became interested in it. I wanted to give a structured look and method to something I was already doing in my clinical practice in some way and in which I mirrored myself, such as attentive listening, or the use of the parallel medical records. I am a curious person and when I realised there was a cross-sectional science called narrative medicine, I wanted to learn about it and study it. I wanted both to improve my clinical practice and to understand how to involve other doctors, who unfortunately still often seem to me to be distant from a narrative approach to the profession. Certainly through my training I have learned a lot about the method and theory of narrative medicine, and I have combined it with a basis in humanities that I already had for my own interest.
What do the humanities and narrative medicine represent today in your work as an endocrinologist?
They represent a great deal: I have learnt to listen even more to people, to pay attention to what patients say but also to what I say, to place great value on words, to foster mutual empathy, which must always be present in a treatment relationship. Narrative medicine has helped me to work better, I think I am a better practitioner now, and I get this from patients who tell me they appreciate our relationship from a human point of view. I have also learned that keeping in mind the emotional and narrative aspect of the doctor is fundamental for the prevention of burn out, a danger that is very high, especially in this historical moment. This is an aspect that I did not consider at the beginning, but it is clear that it is necessary to preserve the other subject of the relationship as well, besides the patient to listen also to the health worker. The emotional baggage of the doctor and the nurse, their response to the pain of the other is something that is rarely considered, but it is a huge shortcoming not to consider it. I remember when I was studying, when I arrived at the fourth year, when you start to have practical and clinical experience, at the first visits to the bed of the patient I thought I could not do this job and I wanted to leave, I was not emotionally ready to face the suffering of the patient. Then, over time, I prepared myself, but on my own. There is a moment when the doctor is faced with a flesh and blood human being, and theory has to be transformed into practice, not only in terms of diagnosis and drug therapy, but also in terms of human relations, which is itself a therapy. Many doctors react to the difficulty of encountering pain by closing themselves off and deciding to eliminate the emotional part, but in the long run this does not favour the therapeutic relationship and leads to burn out, because the suffering of the other person filters through anyway. The beauty of the arts supports the doctor, it feeds his mind and spirit, and this is what I have personally experienced with music and literature, for example, which are my great passions. Over the years, I have tried to nurture this inner part of myself, which would otherwise have been crushed, and which I now also use in clinical practice. I therefore believe that narrative medicine is a way for doctors to reflect on their relationship with the patient, on their work as carers and, I repeat, to prevent burn out.
As a member of the SIMEN board, what role does networking among other experienced healthcare professionals play in the use of narrative medicine?
In the last few years there has been a boom in enrolment in SIMEN which I think is a sign of strong interest. I am really happy to have had a wonderful and comprehensive training course because I have met so many extraordinary people, who are very knowledgeable, and I am learning so much from this network. Many initiatives are organised, there is a swarm of events that clearly respond to a strong need, the need to reflect on health work and complete it with a humanistic dimension. The request is precisely to humanise healthcare relationships, to go beyond a purely technical-scientific approach, which was necessary in the past because of the technological leap that has taken place over the last few decades, but as I repeat, we now need to reflect on the one hand on the increasingly sophisticated technical data, while at the same time recovering the human relationship and the narrative dimension of the healthcare worker-patient relationship. It is a great challenge because it is like asking the professional to do a double somersault, to hold together the scientific competences reconciling them with a narrative posture, but it is the way that can lead to a medicine more and more complete and worthy of this name. The network is fundamental to make this path in a capillary way, one could not do otherwise, to share, to know, to be enriched. In the lockdown, the exchange that was created was extraordinary, it was an additional strength, that of being together in a moment of great difficulty. In addition, humanly speaking it is a wonderful experience, also to break the sense of loneliness and have a group that supports you in the relational experiences of the profession, which in my case are solitary because I work most of the time in an outpatient clinic and relate to individuals.
What is your next project related to narrative medicine?
My basic project is to involve doctors, which is not easy. I would like to disseminate narrative medicine among doctors, to understand what they feel, also with the help of literature, because I read and have always read a lot, so I consider literature one of the most important tools for me in training, which I would like to do especially in hospitals. And then it is important to start with medical students, there is a great demand for access to the faculty, the degree courses are full. Obviously there is a great ideal drive, which must be safeguarded and nurtured throughout the degree course. In the past, this ideal drive was not taken into account, in fact it was almost annulled, the human factor and the doctor’s emotionality were considered an obstacle to the diagnostic and therapeutic process. Instead, starting from the motivations is a fundamental step, in order to always leave the students open to reflection and avoid them arriving at the meeting with the patient emotionally unprepared, as happened to me. Today I am satisfied with myself and my work, but I had the doubt that I was not suitable to be a doctor, I had to find my own way to the profession. If I had encountered narrative medicine then, I would have had many answers sooner and I would have felt less alone. I believe very much in this training project and I think there is room for listening to this need, both at institutional and university level. A few years ago, at an endocrinology congress, the opening lecture was dedicated to narrative medicine, and this seemed to me to be a strong first sign, as there was an audience of hundreds of people, confirming the deep interest in the subject. This is certainly the way forward for medicine to finally embrace the whole human being.