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Counseling fisiologico russo

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Counseling fisiologico russo

  1. 1. IL COUNSELING IN CARDIOLOGIA FETALE Lo sviluppo rapido della tecnologia non sempre si accompagna ad un'altrettanto approfondita preparazione del personale medico sulla gestione del counseling con il paziente. Questo aspetto è ancora più importante in cardiologia fetale, quando si deve comunicare con i genitori di un bambino che non è ancora nato. Il "Counseling" è una professione d’aiuto che, attraverso la relazione tra professionista e cliente (individuo, famiglia o gruppo), mira a facilitare processi di cambiamento ed a migliorare la qualità di vita, valorizzando sia le risorse sia le relazioni con l’ambiente circostante. IL COUNSELING "FISIOLOGICO" Dall'inizio della nostra esperienza nel campo della diagnosi pre-natale ci siamo resi conto di quanto possa essere difficile comunicare con i genitori anche quando l'esame non fa porre alcun sospetto di cardiopatia fetale. In particolare, anche affermare che non si osservano anomalie cardiache ma che l'esame non può escludere alcune cardiopatie (ad esempio: non si può precedere che il dotto di Botallo ed il forame ovale si chiuderanno dopo la nascita; così come non si può escludere con certezza un'eventuale coartazione aortica) genera ansia nella coppia. A tal proposito, alcuni anni fa facemmo uno studio sui livelli di ansia dopo un'ecocardiografia fetale, ed emerse che l'ansia dopo una "risposta non patologica" era alta. Al contrario, alcune volte si pone il sospetto di cardiopatia, come la coartazione aortica, ma data l'elevata frequenza di falsi positivi, si informano i genitori sulla possibile assenza di anomalie, quindi, la coppia è costretta a convivere con il dubbio fino alla fine della gravidanza. Alcuni anni fa, in letteratura emerse il sospetto che piccoli accumuli lipidici a carico delle valvole atrioventricolari (cosiddette golf-balls) poteva essere predittore di anomalia genetica. Nonostante tale dato sia stato ampiamente smentito, ancora oggi la presenza di golf-balls è considerata un'indicazione all'ecocardiografia fetale. Anche tale dato è stato oggetto del nostro studio condotto alcuni anni fa. Dopo anni di esperienza possiamo affermare che comunicare con i genitori è un percorso complesso ed affascinante. A seconda della personalità del nostro interlocutore il tipo di comunicazione deve variare. La prognosi è un evento comunicativo e non semplicemente informativo…accompagnare il paziente nelle scelte difficili senza prevaricarlo è un aspetto della professione medica importante quanto la competenza diagnostica e terapeutica. Il linguaggio non verbale (la prosodia) è parte importante della relazione medico-paziente, in questo caso genitori in attesa di un bambino. La comunicazione significativa passa infatti principalmente attraverso le emozioni. L’espressione delle emozioni è in gran parte non verbale. La prosodia cioè il volume, il tono della voce, l’enfasi sono meno controllabili del linguaggio verbale vero e proprio. Imparare a riconoscere le proprie emozioni è indispensabile per evitare di ignorare o minimizzare le emozioni dei genitori. E’ indispensabile anche evitare il rischio opposto: trovarsi coinvolti nelle emozioni dei genitori perdendo lucidità ed efficacia. In tal senso riteniamo che nel percorso di formazione di “abilità” in Ecocardiografia fetale non si spossa oggi più prescindere dalla formazione anche del counseling sanitario.

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