Alessandro Gringeri is a physician, haematologist, senior medical advisor for the Charta Foundation. His experience, gained in the international clinical and pharmaceutical fields, is characterised by a particular focus on the relational dimension of care, which he has deepened by attending the ISTUD Master’s Course in Applied Narrative Medicine. Today she dedicates part of her commitment to promoting this approach as a concrete and transformative tool. Combining scientific rigour and listening, she reflects on how speech – when truly embraced – can become an integral part of clinical practice.
- Let’s start with your personal journey: how was the experience of the Master in Applied Narrative Medicine for you? What has it left you, professionally and humanly? How did it change – if at all – your view of care and the role of the physician?
Participating in the Master’s course not only gave me a concrete insight into how to apply Narrative Medicine in my clinical practice and the tools for narrative-based research, but also allowed me to come into contact with national and international experts, to be able to ask them questions (also very practical ones), and to get advice from them on a well-structured methodological approach.
Moreover, perhaps even more importantly, the master’s degree opened up a new horizon, a new perspective, or rather, a new depth to the empathic approach I already felt I had in my relationship with the patient and his illness, with a different way of listening.
- When a doctor takes the time to really listen to a patient’s story, what happens?
Dedicating, from the very beginning of the encounter with the patient, time – and it does not take hours, but a few quality minutes – to listen attentively, to look him in the eye, to understand his deep needs, which go beyond wishing to be cured or to improve living with the disease, the difficulties, resistances and fears towards the therapy (and often also towards diagnostic methods), transforms the relationship, deepens it. From a purely clinical point of view, it makes it possible to better understand the symptomatology, to avoid dangerous underestimations or hasty diagnoses and, finally, to achieve greater adherence and concordance to the therapeutic choices.
- Integrating storytelling into clinical practice also means finding a balance between scientific rigour, protocols and empathic listening. In your experience, what difficulties or resistance – whether cultural, personal or organisation-related – emerge in trying to combine these aspects? Do you think that narrative medicine remains a challenge or is it becoming an increasingly natural component of care?
Medicine is not an exact science and is based on statistical frequencies sometimes calculated from tens of thousands of observations. This evidence allows us to understand the ‘prevailing’ response of the disease to certain drugs. But each individual is different, and the same therapy may have different efficacy: medicine is gradually moving towards so-called Precision medicine, tailored to the individual and the characteristics of his or her DNA, physical body and disease. The person, his feelings, his relationship with his family and society, and his spirit remain absent. Talking about this today in Italy is difficult, it is sometimes scoffed at, often regarded as superfluous and superficial. Talking about it at conferences, however, one discovers that these topics manage to open a breach, for now in a minority, but which cannot fail to progressively infect more and more health workers. Narrative-based research itself is often considered second-class, because it is qualitative rather than quantitative research. But this too will progressively win over more and more practitioners, with the example of how much knowledge it can bring.
- Narrative medicine is not only about the individual personal story, but also about the cultural and social context in which the patient lives. In your work with haematological diseases, how do you use the tools of narrative medicine to gather this information? Do you think this perspective can bring concrete advantages in the management of care?
In my opinion, the individual, understood as a single, self-contained entity, does not exist: we are indeed like cells, but they are nothing on their own, whereas together with other cells they make up a tissue, which together with other tissues forms an organ, which in turn is part of a set of interconnected organs. The individual, even against his will, is embedded in family or acquaintance groups, which in turn form part of a certain social environment (school, work, friendship, neighbourhood, etc.). Analysing the sick individual as a single entity is like studying a single cell without knowing how it interacts with, influences and is influenced by the tissue it is part of and how this relates to the whole organ and thus to the whole body.
Chronic diseases, such as haematological diseases for example, need – and this is not an optional extra – to know what support the patient might receive from his family or from the social sphere in which he is embedded, or vice versa, what obstacles to treatment and in general to life and its quality may be posed by the social sphere. This would make it possible to better modulate therapy and care, truly taking care of the patient and not only of the disease.
- Looking back on your experience with narrative medicine, is there a project that has involved you in a special way – or one that you would like to see come to life?
It is difficult to choose between one of the many projects presented during the Master’s lectures and directly by the other participants with their theses. In addition to the enormous interest of the ‘evidence’ they gathered through their projects, these stimulated my desire to conceive of others that could gather what I call ‘evidence’ from the narratives and their analysis, also to spread the practice of Narrative Medicine and the great possibilities it has.
- What, for you, is the most profound potential of narrative medicine? What real impact can it have on the quality of care, on the patient experience, on the role and training of the physician and on the very vision of health?
The Narrative Medicine approach to the sick person, in short, allows for a true caregiver-patient relationship, the establishment and strengthening of empathy, reciprocally (the caregiver also needs to be ‘understood’, often, for example, in his or her frustration and helplessness in providing a more effective and/or tolerable therapy), in obtaining a better adherence to treatment (concordance) and thus better results or in any case a better health-related quality of life, in decreasing the recourse, also reciprocal, to defensive medicine or, worse, to violent reactions towards health professionals or the use of ‘violent’ language in communicating with the patient and his family members.
Furthermore, Narrative Medicine teaches health professionals that the sick person is not his or her disease, that making the right diagnosis is a lot, but it is not enough, that the therapy must be individualised not only on the individual characteristics of the disease and the specific pharmacogenomics of the patient, but also on the person who is sick.
There would still be so much more to say, but there are many books and articles today that describe the benefits of Narrative Medicine much better. What I suggest is to enrol in the ISTUD Master’s Course, to visit the medicinanarrativa.eu website and all the material it offers, and last but not least to participate in the very interesting “readings” of the European Narrative Medicine Society.