Narrative Medicine goes into the quality plan of Poliambulanza Foundation: interview to Elena Vavassori

Dr. Elena Vavassori
Dr. Elena Vavassori

Whe host the interview with the Dr. Elena Vavassori, that tells us her encounter with Narrative Medicine and the way that brings this practice into the quality plan of the Poliambulanza Foundation of Brescia.

How was embraced the Narrative Medicine project in your facility by your colleagues?

After the organization on the basic lines, the project was showed at the dr. Bernardini, responsible of the Urgency and Emergency and Intensive Therapies Department (my head physician) and at the Healthcare Director  of the Poliambulanza Foundation, dr. Zacchi. Both reveal themselves like open and learned people facing this new project and showed early on interest for my proposal of Applied Narrative Medicine and they didn’t obstruct the realisation. I could say that the Healthcare Directorate (with the Legal Office) took part actively to the realisation of the project formulating the Informed Agreement for the patient that decided to write their living with the disease. All my colleagues focused in the Clinic of Pain Therapy, informed about what does it means Narrative Medicine, showed interest about the chance of utilise his “instruments” in their clinical practice.  Not everybody choose to write down the thoughts and the feelings produced by the encounter with the patient, but during the equìpe reunions also who didn’t write had a chance to tell us their reflections and at the end of this encounters there was the need and the will of making another one in few time, to make possible to read all the narrations, of physicians and of patients, and with those make a comparison.

 

 

And in the end of the project, which were the reactions of your colleagues and of the Healthcare direction?

In the last phases of the project, a colleague, spontaneously, wrote his reflections underlining from one side his surprise for the beauty and the intensity of the stories he read and at the same time their absolute utility for his clinical practice, because they showed a point of view of the patient (for example the shame for his condition) that cannot be observed by the time and the modalities of the visit in the first-aid station. I put the words of this colleague in the results of the project for their sound effective and truthful. Colleagueas that have wrote the work judge it “a good job” and they have been surprised both from the analysis and the narrations throughout the classifications, in specific the Translational Analysis. These, have permitted a further reflection about yourself and the ways of meeting with the patient. The healthcare directorate embrace with pleasure and satisfaction the results of which the project is arrived and has herself presented the possibility of the beginning of another one project with the oncological patients.

 

 

How it’s born the proposal of including Narrative Medicine in the quality plan of your structure?

 The Poliambulanza Foundation it’s been accredited again for the next three years like Hospital of Excellence by the Joint Commission International. The judgement of the JCI was conducted last December, so in the previous months there was an intense activity to improve the quality standards of the hospital. In this context, my attention was focused on the standards for the improvement of quality and safe of the patient, particularly on the QPS 3 standard, that claims: “The quality and safe of the patient program utilise updated scientific information and others information to support the healthcare assistance, the professional healthcare formation, the clinical research and the management”. The Joint says that the knowledge that the healthcare professional base his responsibility in a relation of care could have many sources, all equal and all measurable in their efficacy. The Project Work it’s perfectly inserted in this standard, having amply showed through the patient’s diary, how the scientific world it’s only one of the many different possible worlds where we live and it’s not in conflict with the world of life, the world of our commune and immediate experiences lived. The disease first of all it’s a human experience, and it’s charged with meanings bonded to the context, to the experience and to the personal history of patient. It’s not possible to understand an individual without understand the worlds of that human-being and the network of meanings where this human-being lives. The human-being afflicted by chronical pain, narrating his living with the disease narrate and describe a part of his vision of the world and in this context the narration have a meaning of knowledge. The Project Work showed how the narration of the infirm about what he lives everyday disclose unexpected knowledges with whom the medical knowledge had to talk to understand better the infirm. Those were the premises that persuaded me to propose the Narrative Medicine project to the dr. Gomarasca, responsible of the Risk Management and Quality of the Poliambulanza Foundation. In our short talk he agrees the idea that the patient’s stories were the “others information” touched upon by the Standards of JCI and that the project deserved to be enhanced inserting it in the Quality Program of our Department like a reached target for the 2016, with the proposal of increase it for the 2017.

 

 

Which you think that will be the practical consequences of this result on your working reality?

 The Project Work showed through the patient’s narrations the chance to measure the pain with a different method, qualitative, from the evaluation scale (NRS) utilised by the physician; moreover, already during the team reunions, colleagues realised that from patient’s diaries emerged the need to modify the therapeutic plan followed up until now for some of they and also the need of utilising a clearer language and less technical in the explanation why were necessary the consumption of the prescribed drugs. In the history of people afflicted by chronical pain physicians reads in which reflections and in which daily context “felt” their therapeutic provision and how was more clear understand why some patients had interrupted the drugs. The therapeutic adherence in effect it’s one of the biggest problem in the doctor-patient relation in the Clinic of Pain Therapy and source of a conflict that makes the doctor defines the patient like a difficult patient. In the practical relapses of the job I put without a doubt the chance to improve the therapeutic adherence of patients and, not less important like I said before, the chance for the healthcare personnel to express their feelings. In the targets of the Project Work there was the chance to apply Narrative Medicine also in others clinical environments, beyond the one of the therapy of chronical pain. I believe that, beyond the results reached in So far, so close, the chance to continue the talk with so sincere and learned people like the one that I met in the realisation of the project makes absolutely workable to apply the instruments that Narrative Medicine offer also in other contexts.

Matteo Nunner

Graduated in Literature at the University of Eastern Piedmont, he's now studying anthropological and ethnological science at the University of Milano-Bicocca. Journalist and writer, he collaborated with many local newspapers and in the 2015 he published his first book "Qui non arriva la pioggia". In the 2017 published "Il peccato armeno, ovvero la binarietà del male".

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