In order to better understand the structure and the use of parallel chart, we decided to interview an expert in this field: Paola Chesi, coordinator of the Master in Applied Narrative Medicine and researcher at ISTUD Foundation, who since years – together with ISTUD team – collects and analyses healthcare professionals’ parallel charts.
Q. Could you tell us how the Health Area of ISTUD Foundation decided to start collecting parallel charts?
PC. The first experiences with parallel chart started contextually with the first ISTUD training courses in Narrative Medicine. Since the first edition parallel chart has represented one of the more interesting and educational narrative tools for healthcare professionals participating to the Master. Every year several project works has provided for the collection of narratives of entire care teams, and these are extraordinary experiences of application of Narrative Medicine in daily practice. Furthermore, progressively the use of this tool reveals its potentialities both as a space of individual reflection and as a tool for discussion and awareness between healthcare operators.
Q. How do involved physicians react?
PC. The reaction of healthcare professionals using this tool usually evolves in time, mostly for who doesn’t easily write. Initially they can be uncertain or embarrassed for using a tool so different from the clinical chart, that in some ways “lays bare” working experiences. But writing is a real experience: narratives open up, become more fluid, free thoughts. So, doctors can move from diffidence to curiosity, until gratitude for a tool able to “listening”.
Q. Which kinds of information do you collect?
PC. Often in parallel charts doctors talk about patients and relationships: impressions, reflections, reactions. Mostly when there are communicative and relational difficulties, parallel charts become the tool that collects the story of care relationships, meeting after meeting, giving more space for reflection on these relationships and on the possibilities to improve them. Sometimes doctors, from an episode, can enlarge their reflection on professional motivations and their daily experience – hasty days, relationships with colleagues, expectations then and now. Narratives can become a broader tool of awareness to recover motivation often absorbed and hidden by daily frenzy.
Q. Which were doctors’ reactions after reading parallel charts?
PC. Usually we ask them to write how they felt at the end of the narrative experience. I let them answer through some of the many stories collected in time:
It’s very interesting writing about what we don’t address together with patients, and mostly with colleagues… And maybe even ourselves; [I feel] Lighter, as if I had loaded on me a bit of the patient’s concerns, and writing I had in turn partially free myself from this burden; [I’m] pleasantly surprised… I felt closer to my patient; For the first time I faced my work with another perspective; It helped me to cheer up the relationship with a patient I’ve always considered difficult to manage; Writing this chart helped me to remember little, big details we often forget, but that can be fundamental for diagnosis and therapy; It’s wonderful the creation of a parallel chart: it’s like to have the possibilities to write “margin notes” reminding us that “under the shirts” there’s a man!
Q. Which are the more interesting information emerged for the education of healthcare professionals?
PC. As early said, parallel chart gradually reveals its potentialities: more we use it, more aspects can emerge, from those more contextualized to a specific care relationship, elements of reflection and awareness relatives to our own behaviours. Who uses parallel charts, sooner or later, starts to see him-herself “from outside”. We can get many points of view: patient, relatives, colleagues, professionals. I think that this is what narrative let them, the knowledge of a practical help.
Q. Do you think that this system could be effectively used also in Italy on a large scale?
PC. Parallel chart is already used in several Italian contexts, on the model of some US or UK hospitals that have legitimated this tool earlier than us. During the last years, also in our country there have been experiences of less or more structured use of parallel chart in the hospitals. There are some professionals – and I think about some of our participants – that go on to individually write parallel charts, as a necessary space. It’s possible to use this tool in a structured way into care team; where this tool was experimented, it represented a unique occasion of discussion and reflection to improve healthcare. Yet discipline, organization, and perseverance are needed, and this could seem an additional burden, if we consider the increasing of the requests of “services” and the reduction of time and resources. On the contrary, writing parallel charts is really an additional resource for better looking to ourselves and clearly see all the rest.