Narrative medicine to highlight values of Italian pain therapists in a changing healthcare system

摘要

In the last years, a number of important initiatives has been undertaken to improve pain management, and the most important development in Italy involved a dedicated law (Directive 2010 n. 3816). The VEDUTA project was designed to evaluate the role of clinicians involved in pain management, the work environment and their needs/problems. A 'written interview' was proposed between April and June 2012 to 350 Italian pain clinicians working in hospitals, university pain units or hospices. The interview comprised a questionnaire on responders' personal data, a description of the participants on themselves and their workplace using metaphors, and a story from a narrative outline supplied. A modified version of the Maslach Burnout Inventory (emotional exhaustion, depersonalization, personal achievement) was used to measure the level of 'burnout' of responders. In Italy the majority of healthcare professionals work within the public health system on a permanent contract but a high percentage of responders work under part-time contracts. Interestingly, 20% of therapists work alone or independently. Infrastructural issues such as lack of beds, shortage of personnel and suboptimal organization were frequently reported. Patients constitute a stimulus to do better for 98% of doctors. Clinicians show dedication to their patients over and above their official role. The most frequent metaphor used (39%) deals with pain relief intended as aid to the patient; recurring images indicate that the responder is seen as a 'protective benefactor'. The presence of a psychologist was extremely modest (only 1%). Thirty-six of the 81 stories described an unexpected event perturbing a steady-state situation, such as a change in the working organization or the input of an authoritarian fiaure.