Primary Health Care and Narrative Medicine

Effects of multidisciplinary rehabilitation in a patient with Ehlers-Danlos and Behçet's syndromes: a paradigmatic case report according to the narrative medicine

PURPOSE

Narrative Medicine complements the clinically centered approach, which focuses on the analytical and sanitary aspects, with the illness- and disorder- centered models, which deal respectively, with personal coping and social perception of a condition. Hypermobile Ehlers- Danlos Syndrome and Behçet's Disease are two rare multisystemic chronic disease experienced a myriad of clinical symptoms, psychological distress, and poor quality of life. The purpose of this report is to describe application of a multidisclipinary rehabilitation intervention according to the narrative medicine.

CASE DESCRIPTION AND INTERVENTION

a 35-year-old woman with a 23-year history of Hypermobile Ehlers-Danlos Syndrome and Behçet's Disease was admitted. A multimodal rehabilitation approach was implemented and described through the patient's feelings and expected short-, medium-, and long- terms goals. Moreover, she reported her feeling with periodical interview by her therapist.

HISTORY PATIENT

The patient was seen for 32 weeks. A decreased pain, as well as improved function was recorded immediately post-intervention.

CONCLUSION

Narration is not just an interpretation of the illness experience, but the result of reshaping the interpretations of the story that both patient and health professional. This discipline provides enrichment of care, especially when combined with rehabilitation in chronic disease, by paying attention to and using even in the therapeutic phase the stories of patients, family and health care personnel, giving the opportunity to define a tailored effectiveness rehabilitation approach at the light of the different points of view of the subjects.

Narrative in Older People Care—Concepts and Issues in Patients with Dementia

Medical sciences in their classic approach focus on objectively measured dimensions of human functioning and its disorders. Therefore, they are often far removed from the unique identity, experiences and needs of older people. The solution to this type of focusing on the biological, psychological or social dimension of the life of older people may be the inclusion of the narrative in the daily practice of medical care. Narrative medicine supports the development of a holistic approach to care that allows older people to present their own life story, which helps to recognize their uniqueness and to show a genuine interest in the narrative. Attention is increasingly drawn to the fact that the narrative of older people should be recognized and taken into account when planning and providing care in institutions, including long-term care facilities (LTCFs). Despite the fact that LTCFs are often attended by people with multiple diseases and with cognitive impairment, the recognition, respect and maintenance of personal identity should constitute the foundation of caring activities. The basic premise of narration is the recognition that the development of identity does not stop at any age but continues throughout life, and that narrative is an important form of self-expression. The aim of this paper is to present selected issues related to the practice of narrative medicine in caring for older people.

Voices of the "99 Percent": The Role of Online Narrative to Improve Health Care

CONTEXT

Communal blogs facilitate online narratives by providing opportunities for individuals to co-construct meaning and to engage in discussion about lived health experiences.

OBJECTIVE

To examine the role of health as a connective narrative among individuals organizing collectively in an online community. The "We are the 99 percent" Tumblr blog emerged as a spontaneous community platform of the Occupy Wall Street movement in the US.

DESIGN

Researchers conducted a qualitative content analysis of a total of 2003 blog posts.

MAIN OUTCOME MEASURES

Data analysis included a process of data reduction, display, and conclusion drawing and verification.

RESULTS

Bloggers discussed medical crises and the role of injury and illness in maintaining financial solvency. The difficulty of obtaining health care and the lack of accessible quality care emerged as themes. In particular, unemployment and underemployment limited access to health insurance coverage. The bloggers expressed dissatisfaction with the health care system and the impact of financial status on health. These challenges were exacerbated for marginalized populations, such as women and veterans.

CONCLUSION

Findings offer implications for the value of online narrative to improve health care initiatives and to provide insight to integrated health care systems, including health care practitioners, nonprofit organizations, hospitals, and policy makers. Results suggest opportunities to address the health care gaps of marginalized populations and to develop public health policy.