Medicina Narrativa: intervista a Sandro Spinsanti
Quattro domande sulla Medicina Narrativa a Sandro Spinsanti
Sandro Spinsanti, direttore dell’Istituto Giano e autore del libro “La medicina vestita di narrazione“, racconta la sua visione della medicina e della #MedicinaNarrativa in questa ampia intervista rilasciata a Digital Narrative Medicine.
Ricordiamo che Sandro Spinsanti è laureato in psicologia (università di Roma “La Sapienza”) e in teologia (Pontificia Università Lateranense) con specializzazione in teologia morale (Accademia Alfonsiana). Ha insegnato etica medica nella facoltà di medicina dell’università Cattolica di Roma e bioetica nell’università di Firenze. Ha diretto il Centro internazionale studi famiglia (Milano) e il Dipartimento di scienze umane dell’Ospedale Fatebenefratelli all’istola Tiberina (Roma). Ha fondato e dirige l’Istituto Giano (Roma). È stato componente del Comitato Nazionale per la Bioetica. Ha fondato e diretto la rivista L’Arco di Giano (Esse editrice). Ha fondato e diretto la rivista “Janus. Medicina: cultura, culture” (ed. Zadig).
A seguire l’intervista:
Cos’è per lei la medicina narrativa?
Potrei dire, con un po’ di enfasi, che rappresenta il sogno della mia vita professionale. Ho dedicato la mia attività alla promozione di un nuovo modello di medicina, diverso da quello “ippocratico” che abbiamo ricevuto dalla tradizione. Non che fosse sbagliato: almeno così come era praticato dai buoni medici (come in ogni professione, c’erano anche medici incompetenti, e perfino delinquenti…). Ma il rapporto previsto dalla medicina ippocratica non rispondeva più alle esigenze dell’uomo entrato nell’era della modernità. Nel migliore dei casi era una cura fatta sul malato, non con il malato.
Il cambiamento che abbiamo cercato di promuovere con il movimento della bioetica ha dato risultati discutibili. Basti pensare che cosa è diventato il “consenso informato”, tradottosi in una liberatoria a fini difensivistici. Il modello della medicina narrativa riprende l’auspicio del cambiamento, con una etichetta nuova e con una nuova accentuazione. Mette l’accento sull’ascolto, piuttosto che sulla informazione. Richiede la narrazione come elemento essenziale per arrivare a una decisione condivisa. La “scienza e coscienza” del medico sono sempre richieste: come e più che in passato. Ma non sono più sufficienti. Si devono confrontare con i valori e le preferenze della persona malata. E questi sono veicolati dalla sua narrazione.
Come si può “vestire” la medicina di narrazione?
Stiamo parlando evidentemente di una metafora. La “sartorialità” è stata evocata, prima che dalla medicina narrativa, dalla scienza medica più dura e pura. Mi riferisco alla “tailored medicine” promossa soprattutto dall’oncologia, e più di recente dalla “medicina di precisione”, il cui obiettivo è quello di cogliere l’individualità che rende unico ogni organismo. Il vestito su misura che auspica la medicina narrativa è quello del vissuto biografico, e quindi del progetto personale di vita. La scienza biologica cerca, con i suoi strumenti – genetica ed epigenetica – di individuare le migliori risorse diagnostiche e terapeutiche per il singolo organismo; la medicina narrativa favorisce, con la narrazione, quella cura che più si avvicina a un abito tagliato su misura da un abile sarto, perché modellato sulla biografia individuale.
All’estero la narrative medicine è già una realtà ben strutturata, in Italia vede le stesse possibilità di sviluppo?
Anche in Italia si è aperta una felice stagione per la medicina narrativa. Alcuni vertici istituzionali hanno dimostrato attenzione al movimento. L’Istituto Superiore di Sanità, ad esempio, ha convocato nel 2014 una conferenza di consenso sulla definizione e sugli usi della medicina narrativa nella pratica clinica. La Federazione nazionale degli Ordini dei Medici ha creato una commissione dedicata allo studio di questa pratica e diversi ordini provinciali hanno convocato convegni sulla medicina narrativa. Ma soprattutto l’orizzonte si fa promettente se passiamo in rassegna le iniziative che partono dal basso. Dalla pediatria alla geriatria, dagli ospedali agli hospice, dai servizi territoriali alle riabilitazioni: è tutto un fiorire di progetti e proposte che raccolgono il massimo gradimento sia dei professionisti sanitari che dei cittadini coinvolti.
Oggi la buona medicina è…
Per sintetizzare la buona medicina dei nostri giorni non trovo un’aggettivazione più efficace di quella proposta dal movimento della Slow Medicine: una medicina “sobria, rispettosa, giusta”. La sobrietà equivale alla giusta misura (né troppo, né troppo poco) e all’appropriatezza. “Fare di più non significa fare meglio”, come proclama il progetto di Slow Medicine a cui hanno aderito numerose società scientifiche mediche. Il rispetto richiede l’adozione del rapporto proprio della modernità, nel quale l’autonomia della persona che riceve le cure non è un disturbo per il curante, ma una risorsa essenziale. La collaborazione auspicabile del malato al processo di cura non è più la passività e compliance del passato, ma una partecipazione attiva. Che produce anche una corresponsabilità. E la giustizia, applicata al nostro modello di sanità, equivale all’impegno a non smantellare lo stato sociale e a contrastare cure sanitarie a due velocità: per i ricchi e per i poveri.
Il quadro è sicuramente complesso. Ma senza questa triplice scansione di qualità non siamo disposti a chiamare buona una pratica della medicina, per quanto raffinata sia dal punto di vista tecnologico.
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