Narrative Medicine. Creating healing storiesJaume Banqué Vidiella, Irene Borras Vilalta, Tortosa Oest Basic Health Area, Terres de l’Ebre

Josep Vidal Alaball, Artes Basic Health Area, Catalunya CentralCatalan Institute of Health, Catalonia, Spain

“I took care of his wife for months and did not realize that he was really the sick patient... He was coming to the center nearly every week, always at the same time with multiple demands for his wife... both were lovely elderly patients... He always named their little problems at the end of our meeting... how bad I feeled when he was diagnosed with advanced colon cancer following an episode of rectal bleeding... this bad sensation comes back so often....”

Do you think Narrative Medicine could attract you? Are you interested in it? Here’s some bibliography:

Personal contact: jbanquev@gmail.com

“I had decided that I needed some change... I had spent many years in the same health center and I realized that I had lost my ability to enjoy my day to day with patients... I wondered if I'd be burned out and if so how I would face it... I would have to ask for help ... but to who? ....”

“I wondered if all of this is worth of it and today I am totally convinced that it’s not. My daughter has come to visit me for a week and today I can’t have lunch with her again. I’m the only child of my 80+ years old parents and I’m not going to see them this evening because after eating a cold sandwich I'll fall in a semi-comatose state at any place .... For months, I have not been out to have a coffee with my friends. Thinking about all of them is the only thing that clears my head when fatigue makes stamping the car against a tree by the road too tempting... Today I also lost the appointment with my physiotherapist who scheduled me as a favour... I do not know when I’ll get another appointment for treating my sprained knee and my painful spine, evils that worsen after driving two hours each day....”

- Wald HS. Professional Identity (Trans)Formation in Medical Education: Reflection, Relationship, Resilience. Acad Med 2015; 90(6):1-5- Greenhalgh T, Hurwitz B. Why study narrative? BMJ 1999;318: 48-50- Hudson Jones A, Narrative in medical ethics. BMJ 1999;318:253-256- Launer J. A narrative approach to mental health in general practice. BMJ 1999: 117-9- Greenhalgh T, Narrative based medicine in an evidence based world. BMJ 1999:323-5- Lit Site Alaska [Internet] Anchorage: University of Alaska. Available from: http://www.litsite.org/index.cfm?section=Narrative-and-Healing&page=Perspectives- Charon R. Narrative Medicine: A model for Empathy, Reflection, Profession and Trust. JAMA 2001;286(15):1897-1902

- Launer J. Why narrative? Postgrad Med J 2009;85:167-168

New approaches to the knowledge and the analysis of the doctor–patient relationship and the doctor’s inner world appeared as a consequence of the consolidation of the humanities discipline in different Occidental Medical Schools in the late 60s. The appearance of the reflective practice and the narrative medicine within it were products of this circumstance. Narrative medicine, whether oral or written, has been part of the medical science since its origins. Nowadays, it is recognized as a fundamental competence for practicing medicine. Narrative competences help health professionals to understand, absorb and interpret the stories and the illnesses of their patients. Throughout their long careers, family doctors face multiple and complex situations that sometimes are difficult to handle and to cope with. Continuous contact with patients’ worries and thoughts, work overload and the particular professional frame where doctors are involved, could be some of the risk factors that may lead family physicians to develop burnout syndrome. Personal reflection in different work situations and a structured narrative approach to personal experiences seem to decrease the risk of becoming a “burned out doctor”.

Detailed reading of literature and reflective writing about specific circumstances or proposed practical situations would be two of the essential skills to acquire by young family doctors in their initial journey across narrative medicine. By practicing and using these competences they'll expand their abilities to listen, express and interact with patients and with themselves. In the current frame of Evidence Based Medicine, narrative skills expand and complete professional capabilities for facing health problems, moving the doctor's mind from the systematic side of descriptive and etiologic point of view about diseases and treatments to a more holistic approach. Narrative medicine helps putting in context and re-experiencing lived situations of “the suffering human being”, helping family doctors to be resilient in front of complex situations that they will meet throughout all their professional lives.

Some health care workers’ narratives in the Baix Ebre areain Spain: