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Best Practice

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Document Typology: Article
Target groups: Caregivers,Patients
country Where It Took Place: UK
Name of compiler: tania
name of institution: cipes piemonte
role: project coordinator
language Of The Description: English
title: New Stories for Old : Narrative-Based Primary Care in Great Britain
description Of The Best Practice:
The first of these movements, narrative-based medicine, has been pioneered in Britain by two professors of general practice (family medicine), Tricia Greenhalgh and Brian Hurwitz ( Greenhalgh & Hurwitz, 1999). They have established a network of connections with academic colleagues in the social sciences nationally and internationally, particularly in the fields of sociology and anthropology ( Greenhalgh, Hurwitz, & Skultans, 2004). This network has promoted the idea that narrative studies can inform practitioners of medicine, for example, by helping them to understand the importance of illness narratives from the patient's perspective. Such ideas will be familiar to family therapists and to many family physicians who have been influenced by the work of writers such as Kleinman and Frank ( Kleinman, 1980, 1989; Frank, 1998). Together with an increasing number of British and international colleagues, Greenhalgh and Hurwitz argue that narrative-based medicine offers the potential to counterbalance (although not to oppose) the powerful influence of evidence-based medicine, presenting a different voice to those of mainstream science and the pharmaceutical industry ( Kirmayer, 2001).
The main training for family systems medicine in Britain has been running since 1995 at the Tavistock Clinic, the leading training institute for psychological treatment in the National Health Service ( Launer & Lindsey, 1997). The majority of participants have been general practitioners, but we have also attracted primary care nurses, pharmacists, optometrists, and dentists. Although a small number of participants have gone on to complete training in family therapy (and also to become tutors on the course), the majority have regarded themselves as becoming systemic practitioners, or more commonly as eclectic practitioners who use systemic thinking and skills as part of their clinical and organizational approach. We have also placed a special emphasis on the use of systemic approaches in peer supervision; indeed, much of the training is based on teaching colleagues to help each other by systemic styles of interviewing when discussing difficult cases ( Burton & Launer, 2003).
Quality indicators:
Use of means of narrative medicine
In the research the narrative medicine indicators are use. As told before, in anglo saxon countries, medical humanities and narrative medicine are older and are part of the training for health professionals.
This storytelling has a primeval drive behind it, a drive that is universal and far older even than medicine. Doctors, by contrast, generally approach conversations with patients in quite a different way. Our professional utterances are largely aimed at matching patients' words against known patterns of description. So although patients may try to carry on expressing the uniqueness of their experiences—and to take as much time as they need to do so—usually our own main concern as professionals is to find out the common denominators in these stories and then to move our conversations to a close as rapidly as possible. Although patients are sometimes in a hurry and only want their doctors to get on with the task, and conversely doctors can be possessed by curiosity about someone's story and forget about time constraints, this discordance between the two styles is probably present during most of our encounters with patients.
One of the most difficult tasks in health care may to be manage each consultation so that it continually meets both narrative and normative requirement.

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