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Reflections on the Master in Narrative Medicine of ISTUD Foundation

Master in Narrative Medicineby Valerio Miselli

Among the several possible uses of Narrative Medicine, John Launer taught us a practice to reflect on our work, on the intrinsic motivations, on the sense of belonging, on planning, on the meaning of working together.

In our country, we often use the concept of “team working”, with meanings very different from the original ones. Moving patients from a professional to another, exchanging opinions, maintaining a pyramidal organization of work, does not mean “team working”. In their educational path, physicians hardly learn the real meaning of this concept, and often they confuse it with the concept of shared performance – that is, when they need other professionals to carry out a work.

These are the steps that lead to team working: the common feeling, the peer sharing, the emerging of a professionality different from the typical one, the searching for sharing of experiences and – why not – narratives. A Narrative Supervision implies a discipline not taught in medical courses, implies rules finding their application in the work of little groups – another missing link in the medical training.

In this top-down and pyramidal deployment for the conquest of power, also other professionals (nurses, dieticians, technicians, psychologists), instead of fostering the searching for team working, in some way tried to imitate the medical training, creating many little “spaces of power”, looking for an identity often in contrast with the medical one. In our country, there are many responsibilities, and physicians surely have a big one. The constructions of bridges implies an initial risk of loss of power, but we can gain the beauty of working together, of sharing patients’ narratives in the search for solutions that have to be multidisciplinar (at least in the chronic diseases field).

The “narrative feeling” is not a practice to say someone what to do, but it is a discipline which starts from listening, does not search for easy solutions, faces risks, carefully acts in a difficult context, but has the “good care” as objective. The “narrative feeling” implies a change in organizational processes and the desire of reorganize work considering records, context and career necessities that could illuminate the several professionals involved. For example, inserting an organized room for reflection involving all professionals to discuss about an organizational problem or about a patient’s story, is seen as an useless fallout, as a distraction, and not as a fundamental component of the working process to better face the multiplicity of needs (that will be never solved, if everyone works incoherently). I would like to mention another example: the overwhelming amount of work of a crowded day hospital; the single professional, who cannot find an adequate organization or a debate with other professionals involved, risks to face an irreversible burn-out.

Competence, motivation, curiosity, sense of duty: these are the most precious values that must be preserved in a healthcare context. If a healthcare organization is not able to do it, loses all, day after day, in an irreversible way; there is no “healthcare budget” able to value this kind of failure. Not necessarily the use of Narrative Medicine succeeds in preventing the disaster of the loss of professionalism, but this must be sufficient to insert Narrative Medicine in medical training: the fact that several examples and researches demonstrate that it can improve the doctor-patient and the doctor-healthcare professional relationships, as it is going on in another countries (United States, for example).

John Launer invited us to reflect on the difference between “talk about cases and patients” – methodology that brings to behaviors based on anecdotes, and these have nothing in common with equity and research of evidences – and the “narrative” communication, that automatically improves also the doctor-patient relationship, modifying the relationship quality through little changes, using the so-called “supervision” between professionals. This is a new way to listen to the natural flow of patients’ narratives, generated in every healthcare organization or even in simple and informal conversations between professionals; it’s a new way to “move stories” and to go on searching for the best way to guarantee cares, assistance, and support to people facing the disease that broke their life story.

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