Giovanni Pizza, in his manual “Medical Anthropology” (Pizza 2005), speaks to us at the end of a “human method”, or a criticism of the biomedical model of care, with the aim of highlighting the necessary and inevitable humanization of the patient. The author tells us about the intellectual movements that have arisen in the world, defined as belonging to a “medical humanism“, which have given rise to the discipline of medical humanities.
According to Pizza, the importance of being “human” does not lie in the biological dimension and this is why it is necessary, if we really want to discuss a human method, to rethink the very concept of human nature. Interesting, at the end of the chapter dedicated to this topic, is the Gramscian quotation:
Let us say therefore that man is a process and precisely it is the process of his acts […] that “human nature” is the “complex of social relations” is the most satisfactory answer, because it includes the idea of becoming. (Gramsci 1975, p.1343, 885; in Pizza op. cit.)
I believe that the discipline developed under the name of Narrative Medicine falls right under this definition of human method, moreover, I believe it falls under its most sincere, active and critical side. Just think that the World Health Organization (WHO) in 2016 released a report entirely dedicated to narrative medicine and its guidelines, entitled Cultural contexts of health: the use of narrative research in the health sector. The document was produced by Trisha Greenhalgh, professor of Primary Care Health Sciences at Oxford University, in collaboration with Brian Hurwitz of King’s College London and Maria Giulia Marini, director of innovation in her area of Health and Safety at the ISTUD Foundation. The abstract of the document can help us to better enlighten the skills and objectives of this clinical practice:
Storytelling is an essential tool to tell and enlighten the cultural contexts of health – the practices and behaviours that groups of people share and are defined by customs, language and geography. […] Storytelling (and interpretation of history) belongs to the humanities and is not a pure science, although established social science techniques can be applied to ensure rigour in data sampling and analysis. Case studies illustrate how narrative research can convey individual experience of disease and well-being, thereby integrating […] epidemiological and public health data. (Greenhalgh 2016, p.ii)
The monthly theme of our magazine is this time linked to statistical results and measurements that can account for how much the discipline of narrative medicine can actually bring benefits to patients, health professionals, caregivers and the medical system in general. Unfortunately, to date, there are still too few articles that go into this direction in depth, but on several fronts the need for more attention and more analysis in this direction is now being called for. To better exemplify this purpose we have reviewed and reported some very evocative studies:
– In serious hospitalized patients, for example, a 30-60 minute conversation with a doctor or nurse in the treatment protocol has generated a significant reduction in the periods of hospitalization and an increase in the number of patients returned to their homes. (Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733-42)
– In nephrology, on the other hand, clinicians often do not take the time to inform and motivate patients about the advantages of having an arteriovenous fistula surgery before starting haemodialysis. This results in high rates of infection and complications related to the use of a catheter. Failure to communicate (cost of time spent $200) can result in a worsening of the patient’s condition and an increase in expenses of up to $20,000 in the six months following the start of therapy. Haas DA, Krosner YC, Mukerji N, Kaplan RS. (Delivering higher value care means spending more time with patients. Harvard Business Review. December 26, 2014)
– Another study compared six possible treatment alternatives and showed that among them, the only therapeutic proposal that provided for a doctor-patient relationship (investment of 100-200 dollars) generated a reduction of 5% of the associated costs and 12% of hospital admissions. (James J. Health policy brief: patient engagement. Health Affairs. February 14, 2013)
– Finally, we need only think of the study conducted in collaboration with the ISTUD Foundation (Paolo Banfi, Antonietta Cappuccio, Maura E Latella, Luigi Reale, Elisa Muscianisi, and Maria Giulia Marini (2018) Narrative medicine to improve the management and quality of life of patients with COPD: the first experience applying parallel chart in Italy, Dovepress, 13: 287-297), dedicated to the possible improvement in COPD treatment strategies. Between October 2015 and March 2016, 50 Italian pulmonologists were involved in the collection of parallel records belonging to anonymous COPD patients. The poor adherence to the therapy and the failure of the current smoking cessation programs show that the current management of the disease can be improved, and it is necessary to educate physicians on new approaches to the care of patients. 243 parallel folders collected: conversations were positive in 78% of the stories, showing a deeper mutual knowledge, confidence in the ability of doctors to establish an effective therapy (92%), in supporting efforts to quit smoking (63%), or restore the activities of patients (78%).
