Entrevista en Ingles

1.- What has been your path to reach narrative medicine and the most important thing you can mention about your contribution in that field?

Mi primera licenciatura fue en literatura inglesa, pero luego cambié de rumbo para formarme como médico. My first degree was in English literature but then I changed direction to train as a doctor. I became a family physician and I also became interested in family therapy, so I gained an additional qualification in that field too. Ideas about narratives were starting to become influential in family therapy, and I became aware of their potential application in medical practice as well. Then the narrative medicine movement emerged. It seemed to bring together all my interests – in literature, medicine and more therapeutic ways of working in health care. I began to teach practical approaches to health care based on narrative ideas and skills, and that gradually became the focus of my career.

2.- In your career as a medical educator, what changes have you seen that narrative medicine has brought to your students?

The commonest response we have from students is that they are liberated from the compulsion to try and “fix” every problem. They learn to function more like anthropologists or investigative journalists. They acquire more curiosity about the stories they hear. They become more attentive. They discover that stories have their own momentum. If you inquire into them sensitively, the storyteller will often gain more understanding of what is happening and find better ways of moving forward with their own problems. This doesn’t necessarily take a great deal of time. It can even save time by inviting people to focus on what really matters to them, instead of staying within an entirely biomedical frame of reference which may not meet their needs.

3.- How do you deal with teaching uncertainty in medicine with your students?

We show people that if you demonstrate curiosity rather than telling people what to do, they will find ways of resolving problems themselves. We model this by not pretending to becertain as teachers. We ask a lot of questions ourselves and do not claim to know the answers. We describe ourselves as “experts in not being experts” and our approach as being “dogmatically undogmatic.”

4.- You have been recognized for the methodological proposal of “conversations inviting change”. In this regard, what are the main proposals of themethod and what does it contribute to health professionals?

“Conversations Inviting Change” (CIC) arises from the simple idea that everyone –whether as a patient, client, learner or colleague – can benefit from telling stories about their experiences, and being skilfully questioned about these. We believe this applies in health care consultations with individuals and families, as well as in supervision, coaching, teamwork and leadership. It is effective in helping people to move on when they feel stuck,and ideal for difficult or challenging encounters. It is even effective when professionals need to balance attentiveness to the client’s story with considerations of safety, quality of care, best evidence, or statutory roles. We have taught everyone from family physicians and nurses to physiotherapists, psychiatrists, anaesthetists, paediatricians and right across the medical and health care professions. Along with a team of colleagues, we have now taught narrative practice to many thousands of doctors and health professionals around the world. They find that attentiveness to stories can radically transform the way they work and improve their medical decision-making. There is more information on our website www.conversationsinvitingchange.com.

5.- What is the role of communication in medicine, is there any moral approach to it? What is your opinion?

Communication is central in medicine. It is a mistake to teach it only as an adjunct to the rest of our work. In CIC we usually talk about “interactional skills” rather than “communication skills” because it is about engaging with the other person emotionally and morally as well as cognitively. Moral communication involves giving people choices in the conversation: what they want to talk about (or not talk about), what direction they want to take in the conversation, what treatment they would like to have (or not have) and what kind of life they want to live.

6.- Tell us a story that you remember today and that you think may have generated a change in your way of acting or teaching as a health professional.

Twenty years ago I had a consultation with a cardiologist. I was the patient. He took my history in a very formal way and I felt quite alienated. But then he looked straight at me and asked “Is there anything else important about you that you want me to know?” I told him I had young twins and I wanted to live long enough to see them go to university. I felt very moved. It taught me that it takes very little to build trust and communication with a patient, even in the technical specialties. Incidentally, one of the twins later became a medical student, met the cardiologist and told him I remembered his question after twenty years!

7.- You have pointed out the value of curiosity in medicine, could you explain how we approach the concept in our encounters between patients and healthcare professionals?