Narrative medicine, a creative approach to revisiting the relationship between caregiver and patient
Paris, 2014. Dr. Meriem Sinaceur is walking down the rue de l’École-de-Médecine, when her eye is suddenly attracted by a poster. This announces a conference taking place the same evening: “Rita Charon: narrative medicine, an educational revolution? » The anesthetist-resuscitator decides to go there all the time. She enters a crowded amphitheater. On the stage, Rita Charon, professor of American medicine and doctor of literature, speaks half in English, half in French. Founder of the Department of Medical Humanities and Ethics at Columbia University in New York, she laid the foundations of narrative medicine on the other side of the Atlantic in the early 2000s. About her is Professor François Goupy, one of the pioneers of the discipline in France. Meriem Sinaceur listens and feels “shivers”. Then she starts to cry: “This is what I want to do,” she says to herself.
What is this narrative medicine that so upsets the caregiver? Professor François Goupy gives an enlightening definition*: “The first objective aims to establish a quality doctor-patient relationship marked by empathy and based on attentive listening to the patient (…), the second to help caregivers to reflect on their profession, the exercise of which puts them in daily contact with suffering and death. ” How ? Through reading and writing.
Bring out creativity
Caregivers are invited to discover a work together (generally an extract from a literary text, but sometimes also a painting, a passage from a film, etc.), then to each write a text and finally, if they wish, to share it with the caregiver. rest of the group. “Reading is the time of attention, writing that of representation and sharing that of affiliation and co-creation,” summarizes Isabelle Galichon, doctor of literature and co-holder of the chair of narrative medicine-hospitality in health jointly supported by the University of Bordeaux and the Bordeaux University Hospital (Gironde). Under his leadership, health personnel seized, for example, a text by the Franco-Iranian writer Négar Djavadi in which she evokes an unpleasant interaction at the hospital which ended with a smile of apology and submission on his part. Participants must then write an acrostic poem based on the word “smile”.
At the Créteil Intercommunal Hospital Center (Val-de-Marne), Christian Delorenzo, hospital literary attaché, has led more than 250 workshops since 2018. In one of them, he offered participants an extract from the novel Disease by the Venezuelan Alberto Barrera Tyszka in which a patient writes to his doctor. The exercise consisted of writing the practitioner’s response. How can reading and writing promote patient listening? For François Goupy, by analyzing the reader/writer relationship, we can establish a parallel with the consultation: “Certainly, the doctor does not read a text, but listens to a story and a relationship is played out between the caregiver who listens and the patient who tell. » Isabelle Galichon, for her part, sees the writer as “a somewhat extraordinary patient, because, through writing, he can give us access to the ordeal that a sick person is going through” since the faculty of an author consists of putting into words human experiences that are difficult to express for most of them.
Pediatrician, Dr. Véronique Flurin has been participating in her workshops for two years. She recognizes that, since then, her ability to listen to her little patients and their parents has “increased tenfold”. “I let myself be moved by their stories,” she continues. It taught me to hear their own creativity in others, to marvel at it. Because there is an inventiveness of the patient in his way of fighting against his illness, of making it his own. » François Goupy also sees in narrative medicine a sort of “back to the future”. “Caregivers have always known that listening is important. But today, they are overwhelmed by technical tasks and the fear of making mistakes. However, if we find ourselves in coldness, the therapeutic alliance is non-existent. It seems to me that narrative medicine makes it possible to distinguish sympathy – which consists of putting oneself “in the shoes of” and can lead to burnout – from empathy which also allows one to put oneself “in the shoes of…” everything while remaining yourself. » Isabelle Galichon adds: “Divestment of the relationship is not a solution but if emotions take too much precedence over the rest, that is not desirable either. The challenge of narrative medicine is to support caregivers through reflective and creative work so that they find their place, their attitude in care. »
When we ask Christian Delorenzo if narrative medicine is intended to train better caregivers, he flinches a little. “This would put all the responsibility on staff, when the system and context are important. Let’s say that they will be able to work better within this system. » The hospital literary attaché says that the participants portray the workshops as a bubble. A space that allows you to escape from stress, from a heavy daily life and to store things there. “Thanks to the group, the relationships that are formed there, they tell me that a community of practices is being built. »
Giving meaning to care
A regular at these workshops, Dr. Tsellina Desfemmes, pulmonologist, emphasizes the goodwill that develops there, favored by the mix between different types of staff from various services. “In the hospital,” she says, “we see a lot of people burn out. Narrative medicine allows you to express things, to endure difficult moments. » She remembers the particularly important role of the sessions which continued remotely during the Covid period. Teaching medical students, novelist Mathieu Simonet notes that sharing texts allows everyone to break isolation, “to say to ourselves: we are not the only ones. »
In a worn-out and battered professional sector, narrative medicine allows caregivers to rediscover the meaning of their practice. Nurse and ethics researcher, Frank Ferrari participates in the “Gestures of Care” seminar offered by the chair of philosophy at the Hôtel-Dieu, in Paris. Placing an infusion, a tracheotomy, welcoming patients… the professionals write about their daily tasks: “This restores thickness and richness to extremely complex procedures,” he emphasizes. And this shows that before being a technical act it is a matter of care for the other. » For Véronique Flurin, writing allows you to escape from organizational problems. And to reconnect with the essentials that an intense daily life can sometimes make us lose sight of: why did you choose this profession.
*Narrative medicine: an educational revolution? Under the direction of Professors François Goupy and Claire Le Jeunne. Ed. Med-Line, 2017.