Academic journal article Journal of Comparative Research in Anthropology and Sociology

Bringing the Doctor Inside the Care: The Use of Stories in Doctor-Patient Communication

Academic journal article Journal of Comparative Research in Anthropology and Sociology

Bringing the Doctor Inside the Care: The Use of Stories in Doctor-Patient Communication

Article excerpt

Communication in medicine

In 1994 in the editorial of the famous British Medical Journal, entitled "The Inhumanity of Medicine", D.J. Weatherall, Regius Professor of Medicine at the University of Oxford (UK), argued that "although doctors may always have had a limited facility to treat their patients as humans, there is no doubt that the current medical scene is highlighting our deficiencies" (Weatherall, 1994: p. 1671). In the same editorial, the author also claims that the social sciences presently show serious limitations with respect to understanding the needs of patients as people, and this suggests that most of the time human medicine is, in fact, inhuman.

It is surprising that the question of doctor-patient communication, although widely treated in healthcare and scientific literature, remains controversial: the importance of relationships and individualized care is not yet accepted by the majority of professionals in the health care area today.

The aim of this paper is to discuss some basic issues concerning doctor- patient communication, proposing a view on how recent narrative models can provide useful and convincing tools to deal with these problems. Starting from a brief review of the models and protocols concerning doctor-patient communication, we will investigate the most recurrent patient-centred care model, focusing on its strengths as well as its weaknesses and in particular on the problems of its implementation. Then we will explore this field in light of recent evidence about the Narrative-Based Medicine approach and the evidence deriving from research on autobiographical memory and narrative. In our opinion, indeed, it is essential to make a strong connection between recent theories on narrative of illness and theories in the field of narrative psychology.

In the present paper we will not present original empirical data on the practical implementation of narrative theories, focusing our analysis on the importance of psychological theories about narrative, considering them as a strong empirical base for communication in day-to-day medical practice. Our considerations are the outcome of the studies of the Laboratory META-ES (methods and techniques to analyse illness experiences) of the University of Florence, which aims to study the role of narrative in medical practice considering the point of view of a multidisciplinary team.

Recent approaches in medical practice and communication

In the last thirty years, especially in western countries, attention to communication between doctors and patients has gradually increased, as attested by the amount of publications, research, training and seminars: the theme of communication has become increasingly central in medical practice. Indeed, this is the case both for the influence that communication exerts on the process of care and the difficulties inherent in the process of communicating. The therapeutic alliance, which is essential for the success of therapy, is centred on the possibility of a relationship between doctor and patient through an open and sincere dialogue (Greenhalgh, 1999; Charon, 2011).

Looking specifically at the main areas of research emerging from the literature of the last thirty years, studies about doctor-patient communication are numerous and basically focus on the asymmetry of the relationship (Albuquerque and Roffé, 2008), the connection between efficient communication and adherence to treatments (Stewart et al., 2000), the relationship between the type of communication and degree of patient satisfaction (Sitzia and Wood, 1997) and physicians' communicative style (Emanuel and Emanuel, 1992). However, few studies have looked into this topic in light of the theoretical knowledge about autobiographical narrative and autobiographical memory (Williams, 2008).

Despite the considerable amount of research on the importance of communication in the therapeutic relationship and the efforts to implement effective protocols of communication, the evidence suggests that doctors and patients have such divergent views of their interactions as to appear two different realities (Stewart, 1995). …

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