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Narrative approach in care relationships in Neurology: interview with Professor Eleonora Cocco

We host an interview with Eleonora Cocco, Associate Professor of Neurology at the University of Cagliari and supervisor of the Multiple Sclerosis Centre of Cagliari. She collaborated with the Health Area of ISTUD Foundation within the SMART – Multiple Sclerosis: listening to the multi-professional realities of neurological teams, sponsored by the Italian Society of Neurology (SIN) and conducted in partnership with Biogen Italy, and which involved thirty centres for MS treatment.

Q. What has Narrative Medicine meant for you, within the SMART project? 

EC. Surely the narrative approach is an important aspect of this project. As doctors, we have always been used to think about numbers, and often in research we lose the qualitative aspect, which is essential in the medical profession. Remembering the importance of this aspect is particularly urgent, especially in the field of chronic diseases, such as multiple sclerosis.

Not only, therefore, we risk losing the most intimate and relational aspect of the person with MS, but we forget that we are personally involved in the care relationship. The narrative approach allows to bridge those gaps that leave us with a more classical quantitative approach.

Q. What emerges about professionals from a generational point of view?

EC. I belong to a generation that we could define as “intermediate”, at least for now, that of the Seventies. As for my experience – my colleagues and those who work with me, who are partly even younger – and for the contacts I have with colleagues from other structures, I must say that the commitment of the “younger” colleagues and the the quality of the relationship that they try to establish with people with MS are not inferior to those implemented by other colleagues, structured and with a longer experience.

On the contrary, sometimes I see in structured professionals, with more years of work behind them, a greater risk of going away. Of course, precariousness remains a fundamental problem, but I don’t see it as a “relational” problem: the problem, in this case, arises when a contractually precarious professional has installed a good relationship with people he/she has taken in charge, and has to leave because he/she found a job somewhere else. Precariousness does not necessarily imply a lack of attention in the treatment, or an emotional detachment: I believe that these are more a matter of sensitivity and of the environment in which physicians professionally grow.

Q. The burn-out issue emerged from the project as a transversal element for professionals. What are your reflections about it?

EC. Considering that I carried out my professional activity in a center of this type, that is dedicated to people with multiple sclerosis, I saw people who had great difficulties, for personal questions but also for the professional and emotional burden. Generally speaking, our health system allows us to manage human suffering all-around, but it does not prepare us to manage our suffering: we operators are at risk precisely on this.

Our training often does not give value to the human sciences: it puts us in front of the technical aspects, and not the more personal and human aspects of managing what could be our emotions and our role in the care process. A narrative approach could help in avoiding a whole series of heavy situations: when you are in contact with suffering and with pathologies in which you cannot help from a “technical” point of view, this leads you to a crisis also from a personal point of view. Burn-out is a problem, but it is also linked to the fact that culturally we are not ready to face chronicity and our own presence in the care pathways.

 

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