Stefania Mattioli is head of the UOS Communication at the ASST of Cremona and participated in the Master in Applied Narrative Medicine of Fondazione ISTUD a few years ago.
How did the decision to train in medical humanities and narrative medicine come about and what were your expectations?
The desire was born out of a passion and curiosity for humanity and humanism: those who (like me) deal with communication in a health care environment always have to deal with people’s lives. This cannot be ignored. Instinctively, I have always understood the relationship, the attention to words, as an integral part of care. I am convinced that within the organisation, health and non-health roles are complementary. Whoever works in a hospital, including switchboard operators, always encounters the suffering of potentially vulnerable interlocutors. We must pay attention to the feelings of patients and their families at all times. Not only that. For me, it is essential to intercept the sentiment of doctors, nurses, OSS, etc., as well. It’s by meeting and analysing the different perceptions that you can understand what works and what doesn’t. In this sense, communication and public relations play an important role.
Certainly my humanistic education (literature and philosophy) has been decisive in my approach to work, it is the origin of my interest in medical humanities. Narrative medicine was a dazzling encounter, discovered in a subtle way, through the stories of Oliver Sacks, Sandro Spinsanti; reading Notes of a Young Doctor by Bulgakov, The Death of Ivanil’ic by Tolstoy and many other enlightening texts. Then came the Istud Master’s course, which I found while surfing the net. From the very first lesson, I felt at home. I was struck by the concordance of language and intentions between lecturers and participants, and by the depth and beauty of the presentations. In short, I learned a lot. The expectation fulfilled was that of learning about structured experiences and acquiring a method for giving substance to the ideas and disordered thoughts that crowded my mind.
What do the humanities and narrative medicine represent today in your work as head of the Communication and PR Office?
A treasure trove to draw on at all times and an oxygen tank to breathe deeply when faced with difficulties. They have become a kind of mindset, even if the work is in progress.
Apart from structured projects – two examples for all: Parkinson’s is not a hat (2018), Stroke in my own words (2019) – every report, complaint, telephone conversation is experienced as a story (never as an annoyance or an expression of judgement). I try to highlight and keep in mind key words, those that in jargon I might classify and bundle (nodes). It helps me get to the essence, facilitates understanding and the search for the authenticity of the facts. This often leads to the solution of the problem. Declining the narrative approach also in communication activities (events, open days, media relations) means trying to match organisational needs and the expectations of citizens, patients, journalists (etc.), but also nurturing creativity. In my work, moreover, all the arts (painting, photography, literature, cinema, etc.) are essential tools for facilitating encounters with others and the construction of “therapeutic relationships” and training.
The Cremona Hospital, like many others in Lombardy, was particularly in the front line during the health emergency. What role have humanities and narrative medicine played in this time?
I would say essential. One example for all was the activation of the URP-on line, through Facebook chat. In the hardest months of the emergency, we immediately realised that fear, the impossibility of attending services and assisting loved ones could not be left unresolved. Paradoxically, social media became a (very human) office open almost 24 hours, out of a passionate desire to be useful. My colleague (Maria Grazia Tozzi) and I started to talk to people online: those who were only at home in quarantine, those who were sick and had no reference points, anxious relatives, mourners who wanted to recover personal effects and last memories of their loved ones. There were lots of requests for information, children sending us drawings, messages to be delivered to the patients. And a mountain of words of gratitude for the work the health workers were doing. We experimented with a really smart and narrative PA model that we are trying to nurture and structure. For this the collaboration with all the other figures, in particular with the nursing coordinators, has been crucial.
Without narrative medicine, all this would not have happened with the same intensity and the same results (compared to 2019, the increase in requests via chat was 100%). The approach was to listen, reformulate, understand the meaning of each question and word we were asked, even of the silences; to look for common denominators between the requests and situations intercepted, to identify the actions to be taken in such a difficult context.
Narrative medicine (philosophy and approach) was also very useful in managing relations with the press, in constructing the story together with the journalists. I mean that it gave us the tools to respect the right to report without overstepping the mark, it allowed us to stay on the facts without invading and violating the dignity of sick bodies and instrumentalising the fatigue and suffering of all.
What is your next project related to narrative medicine?
The intention is to develop a workshop with emergency room operators, now more than ever a frontier place. After almost two years of great effort and wear and tear (also emotional), the need to work on the patient/person and not body/thing has emerged, especially for minor codes and the elderly. One of the problems detected is that the absence of family mediation (because of Covid-19) complicates things, and this is true for all departments, but is prevalent in the emergency department. The unexplained waits, the lack of words accompanying the stay in observation, the fear that something serious will happen and not understanding what, exacerbate the sense of anxiety, the perception of lack of attention, diagnostic superficiality and incompetence. Even when, from a clinical point of view, the pathway is flawless and the doctors have made the best choices for the patient’s health. This will be one of the commitments next autumn.