Marco Testa is a cardiologist at the Sant’Andrea University Hospital in Rome, specialising in clinical and molecular cardiology. A lecturer at the Sapienza University of Rome, he integrates clinical teaching with the Medical Humanities, promoting a person-centred approach.
President of the Italian Society of Narrative Medicine (SIMeN), he is dedicated to the dissemination of Narrative Medicine as an integrated clinical practice, enhancing active listening, reflective writing and humanities training. With her commitment, she contributes to innovating the care relationship, making it more participatory and attentive to individual experience.
- What does narrative medicine represent for you as a physician?
Thank you for this question. It allows me to retrace what I consider my path of personal and professional growth, which starts from the first years of my degree course and leads me to my position today as president of the Italian Society of Narrative Medicine (SIMeN).
For me, Narrative Medicine represents above all a return to the most authentic origins of the medical profession. As Karl Jaspers already told us several decades ago, and ever since, the medical profession has been going in a hyper-technological direction that risks leading us to repair the body, or rather often only isolated organs, rather than to fully cure a person.
Narrative Medicine has allowed me, as I hope it will for many others, to rediscover that relational dimension that I had already learned during my university years. During this time, I followed a medical anthropology and bioethics course by Professor Sandro Spinsanti, a true pioneer for Italy, and beyond, in the necessary reacquisition of medicine’s soul. It was a true Copernican revolution, putting the person back at the centre gave me new motivation for my profession.
For me, Narrative Medicine is first and foremost a ‘posture’ – as Paolo Trenta masterfully explains – a way of being in the care relationship that recognizes in the other not an object of study, but a bearer of meaning, a person whose disease carries all its existential baggage.
It is not a matter of simply being kind or human, that is essential for anyone. It is, in accordance with the Consensus Conference of the Istituto Superiore di Sanità of 2015, having specific skills to use narration to ‘acquire, understand and integrate’ the perspective of everyone involved in the care process, with the aim of therapeutic projects increasingly tailored to the person.
- Why does it serve the carer?
Narrative Medicine serves the carer because it enables him/her to offer better, more comprehensive, and more effective medicine. When we integrate narrative listening with clinical interview and diagnostics, we achieve a bio-psycho-social personalisation of the care pathway that goes far beyond what we can achieve with Evidence-Based Medicine alone.
In my work as a cardiologist, I have found that when a patient with heart failure tells me that his heart is “like an engine that runs on hiccups,” he is not just describing a symptom, he is offering me access to the world of his experience. The metaphors that patients use in my studies allow us to adapt our communication and support patients from an existential point of view as well. For example, I have seen how those who accept a defibrillator describe it as a ‘parachute’ or ‘safety net,’ while those who do not accept them view a defibrillator as an ‘intruder.’
But Narrative Medicine also serves the practitioner, as it protects him from burnout. As Anatole Broyard says, ‘giving up some of the authoritativeness of the doctor in exchange for more humanity is not a bad deal, because by learning to relate more with his patients, the doctor can learn to love his work better’. Shifting from a performance logic to a relational logic also has huge advantages for us practitioners: being recognised as people, with our skills but also our weaknesses, helps us to prevent emotional exhaustion.
- Let’s talk about the Italian Society of Narrative Medicine – SIMeN: what do you propose?
SIMeN is a unique experience on the international scene. Our fundamental mission is to promote and spread narrative medicine in Italy. Our goal is to strengthen the link between patients, caregivers, healthcare professionals, researchers, and associations.
In our policy document 2024-2027, which we approved as a new Board of Directors, we set very ambitious goals for ourselves. First of all, we want to make a meaningful impact on the daily clinical practice of every healthcare professional. Data from a recent MioDottore survey reveals that almost all patients (97%) and about half of the doctors (57%) in Italy still do not know what Narrative Medicine is, so there is a lot of work to be done.
We have three pillars: training, research and dissemination. In terms of training, we continue with the courses for facilitators of Narrative Medicine Workshops. In the past five editions of the basic course and five editions of the advanced course, about two hundred and fifty facilitators have been trained to date. Additionally, the sixth edition of the basic course is currently being held with twenty-six participants. The task of the facilitator is to lead narrative-experiential workshops and build Narrative Medicine projects, applying the tools and methods of Narrative Medicine in health care and educational practices.
We are also working on the development of a more clinically oriented training course. Its aim is to train health workers, who already acquire narrative skills, how to make the most of those skills with their patients and with caregivers as well.
On the research front, the CESIMeN Study Centre is active and we are working on becoming an increasingly recognised Scientific Society. We collaborate with the Istituto Superiore di Sanità and we want to increase scientific production in the field of Narrative Medicine.
But what is most important to us is to create an awareness that will lead patients and operators to increasingly demand a ‘claim to more participatory care,’ as I often say. We want to influence healthcare culture and institutions to move from a performance logic to a relational logic.
- What can be done to see the Medical Humanities, and in particular Narrative Medicine, more widely integrated into the training paths of future doctors?
This is one of the most important challenges we face. For eight years now, as Professor Marini, who has been our guest lecturer so many times, knows, I have been coordinating a course on Narrative Medicine for students on the degree course in Medicine and Surgery at the Faculty of Medicine and Psychology of ‘Sapienza’ (University of Rome). I can say that the interest and response of the students is always very positive.
This year, for example, we hosted over one hundred students simultaneously in the classroom for two ADEs. For these, I had involved Paolo Trenta and Antonia Chiara Scardicchio, respectively. However, only a portion of the students attended the entire course, which consists of thirty-six hours of lectures and is currently optional. Those who completed the full course clearly come out with a much deeper awareness and commitment to live their profession according to the teachings of Narrative Medicine! What can be done to engage others? I never wanted to make the course mandatory, but perhaps that was a mistake.
While several faculties nationwide have long provided Narrative Medicine courses, organized with diverse methodologies and durations, this training is still far from being a widespread component of Medicine and Health Professions degree curricula. This is a systemic problem that requires a profound cultural change in the academic world.
The Medical Humanities are taught, often episodically and in the context of non-dedicated courses, in several universities. While this is a good start, I believe we should aim for dedicated Narrative Medicine instruction stricto sensu within the academic pathways of not only Medicine, but all Health Professions faculties.
I believe that what is needed, first of all, is a greater awareness among academic decision-makers of the concrete benefits of Narrative Medicine. The data from the scientific literature – such as those analysed by Palla, Turchetti and Polvani in their article of 2024 – clearly show the benefits. Some of these benefits include improved care relationships, greater therapeutic adherence, and better quality of life perceived by patients. We need to work at an institutional level to make people understand that Narrative Medicine is not simply a luxury or an accessory, but an integral part of a modern, comprehensive, person-centred medicine.
Narrative skills training should be considered in the same regard as training in areas like pharmacology or diagnostics. We are in the era of precision medicine, of omics, and Narrative Medicine should be considered in the same regard as omics. Narration allows us to be “precise” in treating that specific person who experiences his or her illness in his or her own individualized way.
It is also essential that Narrative Medicine training is repeated beyond basic academic training. At SIMeN, we are developing partnerships with universities that both desire and can offer advanced courses in Medical Humanities and Narrative Medicine. Additionally, we have also been proposing CME courses for all healthcare professions, for years, which can be implemented within healthcare facilities or externally.
The ultimate goal is for Narrative Medicine to become the modus operandi of an ever-increasing number of health professionals. This can only happen if we start from basic training, from the university benches, and if we then accompany professionals throughout their professional lives.