Narrative medicine, listening better to treat better

“I don’t know if I was transferred on a stretcher upstairs or when I arrived on the ground floor. Outside, it was gray and cold. There were people, noise and ambulances everywhere, an exhausting carousel of the living. » These sentences are taken from the story The Shredpublished in 2018 by Philippe Lançon, a survivor of the attacks Charlie Hebdo. It is by reading them that Professor Serge Perrot, head of the pain center at Cochin Hospital (Paris), sets the tone for his medical course that day. A somewhat special course, co-hosted with a writer, Mathieu Simonet, and which aims to raise the awareness of around ten students from 3and year in “narrative medicine”.

The concept, seen as a complement to the “evidence-based medicine” – search for the best available evidence to solve a clinical problem – appeared in the early 2000s in the United States (read next page), before being distributed in France, in a still rather confidential way. The idea: based on the narrative tools of storytelling, reading and writing, “Learn to listen to the patient, to better treat him”summarizes Serge Perrot.

Listening to the patient to establish an initial diagnosis: isn’t this a basic reflex for any doctor? “That’s what we do every day”, underlines a doubtful general practitioner. Not so simple, replies Serge Perrot, for whom medical interviews are often “very standardized and techniques. We ask for the background, the health course, like a police interrogation”. And sometimes expeditiously.

The doctor interrupts his patient 17 seconds, on average, after his first speech”, raises the professor. Often to redirect the discussion towards what seems useful to his diagnosis, sometimes simply to move on to the next phase. A rush that tends to increase over the course of the career.

How to strengthen your listening skills? “Through storytelling” answers Christian Delorenzo, doctor in “medical humanities and philosophy” who, at the intercommunal hospital of Créteil (Val-de-Marne), leads training courses for caregivers alongside a child psychiatrist. Reading, writing, then sharing creations aloud… Organized in three stages, the sequences revolve around works that are always more or less linked to care. mend the livingby Maylis de Kerangal, is one of the supports for talking about organ donation; Tales of a young doctor by Mikhail Bulgakov is used to evoke the practice of medicine; Oscar and the lady in pinkby Éric-Emmanuel Schmitt, pediatric cancer; A very sweet deathby Simone de Beauvoir, the end of life…

“What do these texts say about pain, the relationship to the body, the fears of the patient? That’s what we’re studying.” specifies Isabelle Galichon, who co-directs, since the start of the 2021 academic year, a university degree in narrative medicine at the Faculty of Medicine of Bordeaux. She assures us: the texts read “catch the attention, shake up representations and make it possible to appropriate others”. Secondly, the writing workshops, in which the students are invited to compose about their own experience (illness, the loss of a patient, etc.) then to share their text, push each one to develop their own capacities. to tell a story, to question the meaning and perception he has of his profession and his way of improving his practice. “It would be wrong to think that in medicine there are only scientific texts, clinical case studies, research reports that can learn something about the psychology or the feelings of the patient”defends Isabelle Galichon.

“Narrative medicine helps to sharpen the gaze on the patient’s story, completes Serge Perrot. A patient’s journey is a bit like a thriller. It is up to the doctor to spot clues that may have escaped him. »

By story, “we practice living in worlds foreign to ourselves”, wrote the philosopher Paul Ricœur. It is by settling in that of mend the living that Marie-Catherine Reboul, general practitioner registered with the DU of Bordeaux, measured the importance of a “advertising ethics” to patients and their families. “We are told about it during our course, there are even scenarios. But we don’t always realize how much too brutal an announcement can be a bulldozer in the head. » She remembers, in the novel, the “feeling of daze that grips the mother of the young hospitalized surfer (and whose organs will be removed, Editor’s note). » Or of “that hallway to the doctor’s office that seems so long”.

Hervé Guibert’s work also nourishes his practice. ” In The Compassionate Protocol, the author, suffering from AIDS, recounts his last days and how he sees himself becoming a living skeleton. » The degradation of the body, the death that is coming… “Now when I am faced with a patient at the end of life, I have the impression that I understand better”, she confides.

Greater empathy, better diagnostic efficiency, reinforced relational capacities, these would be the positive effects of narrative medicine, the approach of which nevertheless appears too conceptual in the eyes of certain professionals – “It’s bla-bla, isn’t it? »we were told.

One thing is certain: between theory and practice, there is a step to take. And no miracle recipe. “I try to integrate it into my daily practice, but it’s not easy”, recognizes Marie-Catherine Reboul. Narrative medicine is part of the long term, with changes “by small touches”. These are young women who have come for pill renewals whom she questions more about how they experience their contraception. Or foreign patients with whom she now tries to talk longer, despite the language barrier. “But I am in total ambivalence, she admits, because my waiting room is full, appointments are linked and time is constrained. » So many realities that sometimes come up against the laudable ambitions of narrative medicine.


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