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Medicina Narrativa: prendersi cura del paziente e non solo della malattia

Diagnosi errate spesso colpa della fretta e della mancanza di comunicazione

 

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“Nelle linee guida che la comunità medico scientifica segue quale indirizzo per le proprie scelte cliniche, spiega Vincenzo Toscano, presidente AME – Associazione Medici Endocrinologi, si parla di malattia ma non dei malati. La medicina narrativa cerca di vedere la persona e la sua malattia nel loro insieme perché entrambe vanno curate: per questo abbiamo dedicato l’apertura del nostro congresso nazionale alla medicina narrativa, grazie ad un contributo incondizionato di IBSA Farmaceutici. È interessante osservare che nel 70% dei casi, il medico interrompe il racconto del paziente sui sintomi e malattia dopo soli 18 secondi e non stupisce che molte delle diagnosi errate sono proprio dovute al non corretto ascolto del paziente. Certo non è un caso che oggi sia sempre più sentita l’esigenza di questa forma di comunicazione a fronte dei tempi così contingentati che gli specialisti sono tenuti a rispettare per la visita del paziente. La medicina narrativa è uno strumento che rende possibile il passaggio dal curare al prendersi cura e aiuta il medico a focalizzarsi sulle informazioni utili per una corretta diagnosi”.

“La figura del medico ha subito negli ultimi decenni del secolo scorso un profondo cambiamento, continua Marco Attard, Unità Operativa di Endocrinologia Ospedale Cervello, Palermo; tecnica e tecnicismi esasperati hanno modificato l’anima della nostra professione. Le attenzioni sono state sempre più indirizzate agli esami di laboratorio e a quelli strumentali; l’obiettivo dichiarato era quello dell’efficienza e della produttività. L’opera del medico è stata quindi rivolta alla malattia e non alla persona. Alla fine degli anni ’90, da un’analisi critica del fenomeno è scaturito il ripensamento della figura del medico e la nascita della Narrative Based Medicine (NBM). La medicina narrativa rimette il paziente al centro dell’operato del medico; è una nuova opportunità che ha le fondamenta in antiche saggezze: il medico deve restare il primo farmaco per il paziente”.

“Il rapporto medico-paziente, soprattutto nelle malattie croniche, è molto importante, introduce Cristina Cenci, antropologa del Center for Digital Health Humanities, per garantire un processo decisionale condiviso tra il medico e il paziente che abbia come obiettivo la cura della persona a 360°. La medicina narrativa integra la medicina basata sulle prove di efficacia (EBM) con le esperienze, il vissuto e le aspettative del paziente per favorire un percorso di cura personalizzato e condiviso a partire da tutte le opzioni terapeutiche disponibili. L’approccio narrativo è fondamentale per favorire l’aderenza terapeutica. Ancora oggi purtroppo prevale un approccio gerarchico al percorso di cura. L’obiettivo della medicina narrativa è favorire il passaggio dall’aderenza a una prescrizione, all’aderenza a una storia di cura condivisa. Le nuove tecnologie digitali, più che rafforzare la spersonalizzazione, possono, al contrario, favorire lo scambio narrativo tra medico e paziente, mitigando il paradigma gerarchico”.

“La medicina narrativa ha 3 accezioni, spiega Michela Armigliato, Unità Operativa di Endocrinologia e Reumatologia ULSS 18, Rovigo, come percorso assistenziale ma anche strumento per acquisire consapevolezza e di autocura. La medicina narrativa è uno strumento democratico che deve far parte del bagaglio culturale di tutto il personale coinvolto nel processo di salute: medici, pazienti, care givers, professioni sanitarie, direttori sanitari e cittadini. Personalmente, aggiunge l’endocrinologa, spero che venga inserita nei programmi di formazione universitaria del medico in quanto aiuta a sviluppare capacità di riflessione, speciali competenze comunicative e l’empatia necessaria per avviare una relazione di cura attraverso l’ascolto attivo del paziente”.

“Un’ampliamento della medicina narrativa è la medicina espressiva, commenta Simonetta Marucci, endocrinologa, Servizio per i Disturbi del Comportamento alimentare, USL Umbria 1, Todi, nella quale la narrazione del paziente arriva a essere arte, attraverso pittura, musica, fotografia, poesia, ecc., nel tentativo di conoscere al meglio il paziente e aiutarlo a ricostruire la sua personalità. Da anni, nel centro dei disturbi del comportamento alimentare dove lavoro, gestisco un laboratorio di poesia Haiku, poesia breve (17 sillabe in tre versi) di origine giapponese che, attraverso una metafora con la natura, aiuta le pazienti a uscire dalla solitudine, facilitando l’espressione dei sentimenti e la condivisione del proprio vissuto. Da questa esperienza è stato tratto il libro “Haiku nei disturbi del comportamento alimentare”, Ed. Sì, il cui ricavato aiuta le associazioni dei pazienti Mi fido di te e Girasole”.

“Comunicare con i pazienti nel modo più convincente e al tempo stesso ripararsi dal burnout è molto importante, spiega Renato Giordano, medico e regista. Già Carlo Goldoni, che prima di dedicarsi al teatro praticava la professione medica, affermava “I due libri su cui ho più meditato per imparar di medicina sono stati IL TEATRO ed il MONDO”, mentre il regista francese Jean Luis Barrault diceva “Il TEATRO è la prima medicina che l’uomo ha inventato per proteggersi dalla malattia”.

“La medicina narrativa, conclude Alessandro Cecchi Paone, a cui era affidata la conduzione della sessione, intesa come raccolta di casi clinici di medici più o meno famosi, costituisce una parte non secondaria della storia della letteratura di tutti i tempi, sia che privilegi la componente scientifica di condivisione di esperienze professionali significative, sia che sia assurta a dignità letteraria autonoma, vera e propria. Scarsissimo invece il repertorio dei racconti delle malattie da parte dei pazienti. Una carenza grave, perché il punto di vista e il vissuto di chi chiede assistenza e cura sono essenziali per garantire meglio l’alleanza fra medico e malato, e rendere più efficace l’adesione al percorso terapeutico. E non solo per motivi psicologici, emotivi e motivazionali. Per questo trovo più che positivo il processo di attenzione focalizzato su una forma di comunicazione, magari mediata dagli strumenti digitali, che integra il poco tempo disponibile per la relazione interpersonale ambulatoriale”.

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