Narrative medicine to evaluate the relationship between clinicians and patients living with severe asthma

Introduction: The severity of asthma varies individually and the main factors leading to such differences are resignation towards the symptoms, stress and physical activity. Narrative medicine is a medical approach that allows the accommodation of both patients’ and physicians’ cultural construction, including emotions and values on the illness and the pathways of care. Objective: The aims were to evaluate risk factors and positive triggers in doctor-patient relationships and to give clinicians new strategies to improve quality of care. Methods: In 2016 Italian pulmonologists, allergists and paediatricians narrated their relationship with people living with severe asthma (5 each). The collected narratives were analysed according to the Grounded Theory approach. Results: Out of the 314 narratives written by 66 clinicians (246 adult and 68 paediatric patients), the most frequent risk factors for difficult relationships are physicians’ moral judgment (73%), frustration about treatments previously prescribed (60%) and patients’ anger (50%), followed by smoking, independent internet researches, homeopathy and obesity. Difficult relationship lead patients to refuse a therapy change in half of the cases (50%) and to a lower rate of restored activities. On the other hand, physicians could master, beyond acceptance and listening, difficult emotions as fear and sadness, providing reassurance and comfort. This last behaviour improved the patients’ alliance and the effectiveness of treatments. Conclusions: The clinicians learnt to pay more attention to the cultural mindset of patients. The results are positive when dialogue, scientific expertise and effective therapies, as biological drugs, are there.