Narrative Medicine: What It's For and How It Works

Narrative medicine is a form of therapy that isn't an exact science, much less an alternative to evidence-based medicine. Rather, it's a complementary method to medical treatment, yet crucial for both the doctor and the patient. The doctor can better connect with the person they're treating, and the results are likely to be better; the patient, if listened to, responds better to treatment, feels more accepted and cared for, and generally feels better.

The scientific definition of Narrative Medicine in Italy dates back to 2014 and is written verbatim by the Istituto Superiore della Sanità: “The narrative of the patient and of those who take care of him. people, through their stories, they become protagonist of the treatment process. And therefore of its results. Already twenty years ago, a very good American internist, Rita Charon, of Columbia University's School of Medicine in New York, began, using a therapeutic model, to establish the principles of narrative medicine. Working in the field, he managed to convince doctors, healthcare workers, patients, and students to use the resource of literature, and therefore narrative, in the treatment of patients. Not only that, he encouraged patients themselves to write stories, narratives, and autobiographical pieces to create a better relationship with their patients. doctors, to allow oneself to be discovered and better understood. And to create a full integration between the patient's clinical aspects, starting with their pathology, and the more specifically human aspects, their history, their life. Their narrative.

Rita Charon is considered a true personality in the American medical world, and directs an entire Narrative Medicine Program at Columbia University, with a master's degree that has enrolled over 200 graduates. Her most famous book, Narrative Medicine: Honoring Patients' Stories, has been translated into several countries around the world, including Italy, thanks to the publisher Raffaele Cortina. If we delve into Charon's work, and in general into the therapeutic framework of narrative medicine, we discover some concepts that we can even trace back to ancient Salerno Medical School (that of the Middle Ages, in fact the first medical university in the world). For example: a good doctor needs narration, storytelling, history and stories, to enter into empathy with the patient. And where the relationship is good, the chances of successful treatment become much higher. Why waste them? There is a humanistic sensitivity, a concept of medicine that always places the human person at the center, which should not be overlooked but rather should serve as a guiding light for doctors and all healthcare professionals. Medicine, in this sense, is a purely humanistic science.

Narrative Medicine is not, simply, telling stories in a cross-cutting way, nor can it be reduced to a empathic relationship between doctor and patient that should always exist. Narrative medicine is a method of clinical-care intervention, based on storytelling that integrates evidence-based medical decisions. Narrative medicine allows the doctor and patient to share and build together the treatment pathway, also involving family members and healthcare personnel, and to personalize the intervention based on how the patient experiences his or her illness.

The usefulness of narrative medicine can be measured using several parameters. The most significant are:

• Improve adherence to treatments and their effectiveness by considering storytelling as an integral part of the treatment pathway
• Give a non-secondary value to the patients' experiences, to their history as individuals and not so much as patients
• Improve the functioning of the medical teams
• Reducing emotional stress in healthcare workers and caregivers
• Optimizing healthcare resources

Benefits

Another fundamental aspect of narrative medicine, already known in its essence to ancient medical schools and then evaporated under the blows of treatments reduced to "assembly lines" and patients considered as "numbers," is the fact that those who treat (the doctor) and those who are treated (the patient) are able, through narrative, to connect facts , places , and people , which can then become essential to understanding the troubles and problems that need to be overcome through clinical therapy. And when we talk about narrative, it is clear that, even with narrative medicine, we see two, both extremely powerful. Narration understood as novels, especially the classics: which is why texts such as the works of Dostoevsky, Balzac, Borges, and the list is truly endless, are "curative." And narrative understood as one's own story, one's own experience. Equally essential.

If we've managed to clarify the potential of narrative medicine, without charging it with any miraculous virtues but simply considering it as an opportunity not to be wasted , you won't fail to notice that there's a crucial factor underlying its proper functioning: time . That is, the rarest resource in a society of the here and now, of perpetual haste, and of presentism with all the problems that entails.

Many doctors, even those not opposed to narrative medicine in principle, say: We don't have the time to apply it. True, up to a point. Learning to listen to a patient, creating a relationship , a direct line, and therefore a bond with them, certainly means dedicating time to the person, but then saving it. One fact demonstrates this unequivocally: doctors who fail to listen to their patients are at great risk. Even losing them. And this is one of the reasons why alternative treatments often become fashionable, but they lack great scientific value and actually lead to the derailment of treatment.

Methods

The methods of Narrative Medicine can be different, and among these the most significant are those linked to these forms of narration:

• Interview conducted with narrative skills
• Narrative interviews semi-structured (to build the narrative sheet, the shared illness story)
• Parallel medical record
• Video Interviews
• Creative writing and writing reflective
• Vicarious narrator (for example, if the patient has communication disabilities)

Where it is practiced in Italy

Narrative medicine has come a long way in Italy since 2009, when the Italian Society of Narrative Medicine was founded. Today, it has its own website where different experiences are shared. According to the Italian National Institute of Health (ISS), more than 70 organizations in Italy, including various institutes, local health authorities (ASL), hospitals, scientific societies, and patient associations, promote and practice narrative medicine. A narrative medicine clinic has been opened in Rieti, and other important projects have been implemented at the San Raffaele Hospital in Milan, the Sant'Andrea Hospital in Rome, and various healthcare facilities throughout Tuscany . Narrative medicine is widely used in the care of VIDAS, the association that cares for terminally ill patients. The NAME Piemonte project, led by the Italian Society of Narrative Medicine and the Sant'Anna School of Advanced Studies in Pisa, is attempting to objectively evaluate and measure the impact of narrative medicine on clinical practice.