Perspectiva objetiva y subjetiva en fisioterapia: en la entrevista inicial y en el tratamiento. Evidencia en medicina y Storytellig.

1. www.uvic.cat
Storytelling in Physiotherapy, for the
Understanding and Improvement of
the Therapeutic Possibilities.
International Conference: "Storytelling
Revisited: Gender and Health”
Vic, 24 November 2021
Roberta Ghedina and
Luz Adriana Varela Vázquez

2. Index Presentation
The use of Storytelling in Health in the past and in the
present.
What is Storytelling in Health?
Why did Storytelling in Health begin?
How and where can we use Storytelling now?
“Does Storytelling have a Gender?”
The use of Storytelling in the experience of the authors:
applying it in Rehabilitation in the first interview and in the
treatment.
Final thoughts
2
10/05/2023

3. The Use of Storytelling in the Past
- Bulgakov’s experiences as a newly
graduated young doctor in 1916-18 in
Russian.
- A. Luria: Clinical cases of patients in
Moscow in the 80s. The mind of a
mnemonist and In The Man with the
Shattered World
https://www.amazon.es/Peque%C3%B1o-Libro-Una-Gran-Memoria/dp/8483671786
https://www.casadellibro.com/libro-diario-de-un-joven-medico/9788491042242/2743132
3
10/05/2023
https://www.iberlibro.com/9780465043712/Title-Man-Shattered-
World-History-0465043712/plp?cm_sp=plped-_-1-_-image
Written:1925-26
First edition: 1969
First Edition: 1972
https://www.amazon.es/Mundo-Perdido-Recuperado-Historia-Lesion/dp/8483672847
https://www.amazon.com/Mind-Mnemonist-R-Luria/dp/B000IY5L7A
First Edition in English: 1976
https://www.abebooks.com/servlet/BookDetailsPL?bi=22779384765&searchurl=
an%3Dbulgakov%2Bmikhail%26sortby%3D17%26tn%3Dcountry%2Bdoctors%
2Bnotebook&cm_sp=snippet-_-srp1-_-image2
20th century URSS

4. The Use of Storytelling in the Past
A fascinating case study. A rare record of Erickson's
pioneering genius in facilitating the evolution of new
patterns of consciousness and identity in a patient.
http://marcoskenneth.com/conocias-este-efecto-de-la-ansiedad/milton-h-erickson-4/
https://www.amazon.es/February-Man-Evolving-Consciousness-Hypnotherapy/dp/0415990955 4
10/05/2023
First published in 1982
Milton H. Erickson has been called the most influential
hypnotherapist of our time.
Part of his therapy was his use of teaching tales, which through
shock, surprise, or confusion―with genius use of questions,
puns, and playful humor―helped people to see their situations
in a new way.
First published in 1989
20th century USA

5. Current Storytelling: Stories Explainded
from Doctors about Pacients
Neurological narratives
of neurological
disorders: migraine,
neuropsycological
diseases, Parkinson,
Alzeihmer, etc.
Good tales for all
audiences written with
humanity, poetic
observation about the
patients, their illnesses,
their contexts.
https://www.ebay.com/itm/Oliver-SACKS-A-Leg-to-Stand-On-First-Edition-1984-/163917900233
https://www.oliversacks.com/books-by-oliver-sacks/migraine/
https://www.antiqbook.com/books/bookinfo.phtml?nr=1517608335&l=nl&seller= Amazon.com
5
10/05/2023
1967 1985
1984
Current 21th century

6. A New Concept? Or a New Term?
Really New? Definition
A form of clinical practice
using narrative competences
to recognize, absorb,
interpret and be moved by
the stories of illness (Charon,
2006).
https://www.vox.com/the-highlight/2020/2/27/21152916/rita-charon-narrative-medicine-health-care 6
10/05/2023
https://www.youtube.com/watch?v=c5lDhGOMcYI
Rita Charon, M.D., Ph.D, Executive Director, Program in Narrative
Medicine, Professor of Clinical Medicine, Columbia University Medical
Center and Department of Medicine in the College of Physicians &
Surgeons of Columbia University.

7. The Sources of Narrative Medicine
Science and Humanities
It emerged gradually from
a confluence of humanities
and medicine, primary care
medicine, contemporary
narratology and the study
of effective doctor-patient
relationships (Charon,
2006).
https://www.amazon.es/Rita-Charon/e/
B001IR1E4A
7
10/05/2023

8. The Sources of Narrative Medicine
An answer to the lacks of evidence-medicine and
to patients’ laments
8
10/05/2023
XX Century:
Lucius-Hoene G. Krankheitserz Erzählungen und die Narrative. (2008). Medizin. Rehabilitation 47: 90 – 97
Evidence-based medicine (EBM)
Focused on statistics, evidence about
big groups of people, average
General principle
Objective. Inductive reasoning
Measurable
Quantitative
Scientific knowledge
Not contextual framework
No patient narration
No account of the patient's body
Narrative-based medicine (NBM)
A patient centred form of medical
practice.
Special case.
Subjective. Deductive reasoning
Not easily measurable
Qualitative.
Experiential knowledge and emotion
Contextual framework
Self-Telling Body
Charon R., Narrative Medicine as Witness for the Self-Telling Body (2009). Journal of Applied Communication Research, 37:2,
118-131
XXI Century

9. How did Narrative Medicine Source?
An answer to lacks of evidence-medicine and
to patient’s laments
9
10/05/2023
XX Century:
Lucius-Hoene G. Krankheitserz Erzählungen und die Narrative. (2008). Medizin. Rehabilitation 47: 90 – 97
Evidence-based medicine (EBM)
Focused on statistic, evidence about
big groups of people, average
General principle
Objective. Inductive reasoning
Measurable
Quantitative
Scientific knowledge
Not contextual framework
No patient narration
No account of the patient's body
Narrative-based medicine (NBM)
A patient centred form of medical
practice.
Special case.
Subjective. Deductive reasoning
Not easily measurable
Qualitative.
Experiential knowledge and emotion
Contextual framework
Self-Telling Body
Charon R., Narrative Medicine as Witness for the Self-Telling Body (2009). Journal of Applied
Communication Research, 37:2, 118-131
XXI Century

10. Can we join them?
An Integrate Medicine, a Human Medicine?
“Embodies
Narratives:
Living Out Our
Lives” (Charon,
2015)
“Medicine as
witness for the
self-telling body”
(Charon, 2009)
https://elpais.com/cultura/2018/02/23/actualidad/1519410305_582477.html 10
10/05/2023
Autorretrato, Egon Schiele,
2010.
Tests,
Neuroimaging
techniques, etc.
All the great
new
Technology
apply to
medicine.

11. What is Narrative Medicine?
What patients don't know they know and what
doctors don't know they don't know
11
10/05/2023
A cardiologist in
Buenos Aires
Researcher in
clinical reasoning
and Philosophy of
medicine

12. Dr. Daniel Fichtentrei
Within medical knowledge there is
an experiential, non-scientific
knowledge, that only have those
who suffer from a disease.
Medicine has ignored for
centuries and today is beginning
to be revalued. Medicine
improves a lot in its clinical and
therapeutic aspects when it takes
into account that knowledge
(Flichtentrei, 2017)
12
10/05/2023
https://www.lavoz.com.ar/ciudadanos/daniel-flichtentrei-estar-sano-es-disfrutar-de-la-vida/

13. “Does Health have a Gender?”
Challenging Question!
13
10/05/2023
Gender is an essential determinant
of social outcomes, including
health.
Certain health and wellbeing
issues are more commonly
associated with one gender. For
example, dementia, depression
and arthritis are more common in
women, while men are more prone
to lung cancer, cardiovascular
disease and suicide.
(Broom, 2012).
https://diariofemenino.com.ar/la-importancia-de-la-perspectiva-de-genero-en-salud/

14. Features of Narrative Medicine
Humility
Loneliness
Learning to be present
Letting be, allowing to become…
Compassion (bidirectional)
Narrative skills for doctor-patient
relationship
Accountability of doctor
and patient
Empathy
(Rosas Jiménez, 2017)
https://www.aamc.org/news-insights/narrative-medicine-every-patient-has-story 14
10/05/2023
Acta bioethica, versión On-line ISSN 1726-569X Acta bioeth. vol.23 no.2 Santiago jul. 2017

15. The Narrative in the
Physiotherapy Interview
(Experience of Luz Adriana Varela Vázquez)
1. Did you visit a doctor before coming
here and did he/she speak about a
diagnosis…What do you think/feel is
happening to you?
15
10/05/2023
She reads the medical record before visiting the patient. Then she wants to know what the
patient knows about his/her illness. With this goal she asks three questions:
How patient understood about his/her
diagnosis or about explanation of other
health professionals. What are
believes/images of illness.
2. “Did you visit other health
professionals in rehab before me
as a OT/F/ST/?” “And how did
they treat you?
3. “What do you expect from me?”
Preconceived ideas of patients,
association in the memory, learning
associations, inner world of the patient.
Patient tells me his/her goal.

16. The Narrative in the
Physiotherapy Interview
(Experience of Luz Adriana Varela
Vázquez)
In this way Luz can
generate an
understanding of
her/his patient.
Then she’ll share her
objective with the
patient’s to reach an
agreement.
https://www.aamc.org/news-insights/narrative-medicine-every-patient-has-story 16
10/05/2023
I observed her, I made tests
and WALKING must be her
goal in Rehab. Surely!
I want to speak
again! I can learn
walking later!
We can begin with an
intensive speech
Rehab and a
progressive physical
therapy to improve
walking.

17. The Narrative in the Treatment of Physiotherapy
Therapist: How do you feel the
sponge?
How do you feel your head?
Patient:
“I couldn’t feel the difference
between the sponges, they are
the same!
“I feel as if my neck was a rock”
17
10/05/2023
When the body (neck) is tight, the
object of perception (sponge) is
hard.
While the patient tries to feel the
sponge with her body, the sponge
starts to feel softer, and the neck too!
The spontaneous language of the
patient shows his/her the inner
world.

18. What Key Actions Are There in a Narrative
Medicine?
Be ready to listen to understand (human and clinical/scientific listen)
Feel empathy (put yourself in the shoes of others)
Discover who we are and accept it
Make sense of the stories
Respect intimacy
Accompany people through illness
Remember storytelling: give the past a new meaning
18
10/05/2023
http://www.massaludfacmed.unam.mx/index.php/la-medicina-a-traves-de-la-pintura-en-la-historia/
Picture of Bonifacio
Veronese
(Verona, 1487 - Venezia,
1553)

19. We celebrate the meeting
of EBM and NBM
https://elpais.com/cultura/2018/02/23/actualidad/1519410305_582477.html 19
10/05/2023
Thanks
Egon Schiele

20. Milota M.M., van Thiel G.J.M.W.,van Delden J.J.M. (2019). Narrative Medicine as a mdeical education
tool: A systematic rewiew. Medical Teacher, 41:1, 802-810
Palacios Gómez, M. (2019). The quality of research with real-world evidence. Colombia Médica, 50(3),
140-141.
Rosas Jiménez C. A. (2017). Medicina narrativa: el paciente como “texto”, objeto y sujeto de la
compasión. Acta Bioethica 2017; 23 (2): 351-359
Smorti A., Fioretti C. (2016). Why Narrating Changes Memory: A Contribution to an Integrative Model of
Memory and Narrative Processes. Integr Psych Behav (2016) 50:296–319
Charon R. (2015). Embodied narratives: living out our lives. Journal of Humanities in Rehabilitation 04
Published on-line, Emory University.
Fioretti C., Smorti A.(2014). Improving doctor–patient communication through an autobiographical
narrative Theory. Communication & Medicine Volume 11(3) (2014), 275–284
Lewis PJ.(2011). Storytelling as Research/Research as Storytelling. Qualitative Inquiry, 17(6):505-510.
Charon R., (2009). Narrative Medicine as Witness for the Self-Telling Body. Journal of Applied
Communication Research, 37:2, 118-131
Carrió S, De Cunto C, Cachiarelli N, Ceriani C, Catsicaris C, Usandivaras I.(2008). Medicina narrativa en
pediatría: relato de una experiencia. Arch Argent Pediatr. 106(2): 138-142.
Lucius-Hoene G. (2008). Krankheitserz Erzählungen und die Narrative. Medizin. Rehabilitation 47: 90 – 97
Charon R., (2006). Storytelling. Reditorial Oxford University Press.
Charon R. (2006). Narrative medicine. Honoring the stories of illness. Oxford University Press
Bibliography
20
10/05/2023