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A New Way To Wellness
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Tel Franklin, MD
Do any of the following statements ring true for you?
· I’ve seen doctors and taken medications for years, but I don’t feel any better.
· I sometimes feel like my doctor speaks a different language.
· I always seem to have more questions after a doctor’s visit than I had before it.
· I feel alone, lost, and unsupported as I try to navigate through the maze of refills, tests, checkups, and referrals to specialists.
If you have a chronic health condition—such as diabetes, allergies, asthma, depression, obesity, chronic pain syndrome, or fibromyalgia—chances are you agree with some of the statements above, and feel frustrated by the lack of help you’re getting from your primary-care physician. You’re probably disappointed with your progress and not very hopeful about your future health prospects.
Here’s something that might surprise you: We doctors also feel dissatisfied with the care our patients receive, and we’re equally disappointed with the slow pace of our patients’ improvement and the quality of our doctor-patient relationship.
The U.S. spends 1.7 trillion dollars annually on health care, yet America’s health-care system ranks 37th in the world. A 2002 Newsweek article found that Americans make more visits to nonconventional healers (some 600 million a year) than we do to MDs, and spend more money out-of-pocket to do so—about $30 billion a year by recent estimates. Yet statistics show that, even with all this spending and so many treatment choices, as a nation we aren’t getting any healthier. Is there a better way to achieve wellness?
Why the Problem-Oriented Approach Doesn’t Work
The way our system works, patients use illness as a “ticket” to see their doctor, and doctors often see the illness rather than the patient. This is known as the problem-oriented approach. At your appointment, your doctor asks you what the problem is, you discuss the history of the medical problem, and then the doctor addresses the problem by recommending blood tests, prescribing medications, or referring you to a specialist, who will ask you the same set of questions. The entire framework of health care is set up around the problem-oriented approach, whereby patients get caught up in always going to the doctor for yet another problem.
We need a better, more positive approach to wellness, a solution-based model that fundamentally shifts the focus from illness, disease, and problems to wellness, hope, and healing.
What a Solution-Based Model Looks Like
Imagine a scenario in which your primary-care physician asks you what good health means to you, what your long-term health goals are, and how your emotional state, nutrition, and habits might be playing a role in how you’re feeling. Imagine a physician who asks you what kinds of complementary treatments you’d like to try, in addition to the conventional medical ones he or she recommends. Just imagine a doctor who consults with, say, your acupuncturist and your yoga instructor on a regular basis to assess how well you are achieving your health goals. Finally, imagine a network of multidisciplinary health-care workers and healers working in concert to support you in achieving optimal wellness.
These scenarios are not fiction or wishful thinking. They happen every day for patients and health practitioners who are part of a growing new solution-based health-care movement begun in California, called Appreciative Medicine.
The Appreciative Medicine Model
Five years ago, some physicians started practicing medicine in a new way that would redefine the patient-doctor dynamic and replace the problem-oriented approach to patient health. Using the Appreciative Medicine model, patients—particularly those with chronic health conditions—are now actually meeting and exceeding their health expectations for the first time in their lives, and physicians are recapturing the enthusiasm they once had for the healing arts back in medical school.
The Appreciative Medicine model helps bridge the gap between patient and the doctor, and between every other type of health practitioner, conventional or alternative. With this approach, the patient designs an individualized optimal health plan, with her primary-care physician taking the role of resource, guide, and partner, who coordinates treatments from various health-care disciplines that work synergistically to help the patient meet her health goals.
A central element of Appreciative Medicine is therapeutic journaling, which keeps both patient and primary physician in touch with the emotional components of the patient's healing journey, and serves as a comprehensive medical record that the patient now possesses, complete with test results, medical history, and progress reports. Patients are asked to complete a basic structured workbook to help them identify goals, evaluate different treatment modalities, and journal about aspects of their lives and day-to-day circumstances that impact their healing journey. This gives the physician true insight into the individual patient. The journal is also instrumental in changing our focus so we dwell on healing strategies.
Benefits of a Patient-Centered Approach
A remarkable thing happens when patients and doctors form a true partnership: Patients start to heal. Appreciative Medicine asks patients to take responsibility for their own health and wellness, instead of passively handing over problems to doctors. With this approach, the focus shifts from patients depending on doctors, to doctors supporting patients. Numerous studies have shown that patients who are proactively involved with their healing process get better more quickly than passive patients. And guess what? Appreciative Medicine saves money, as patients need fewer medications, tests become focused, and treatments are not redundant and are less evasive.
Appreciative Medicine has a number of other benefits as well. This solution-based model gets patients and doctors alike to focus on prevention and lifestyle. The NIH reports that nearly half of all deaths are associated with lifestyle and behavior choices, yet this nation spends less than 5 percent of its total health-care dollar on health promotion. Appreciative Medicine addresses multiple aspects of a health condition at once. Scientific studies agree that patients enjoy significantly better rates of healing when emotional and spiritual components of health are integrated into treatment plans. And Appreciative Medicine empowers patients to take responsibility for ongoing self-care, with regular feedback and support from their doctor, rather than waiting for problems to arise.
Wellness—The Next Frontier
Modern medicine has made amazing strides when it comes to sophisticated diagnostic tests, procedures, and pharmaceuticals that can stabilize and save lives. But for chronic health conditions, neither conventional medicine nor alternative medicine gets a passing grade. What’s missing are four fundamental changes that still need to be made in the wider health-care community: (1) Patients and their doctors need to build trust through creative dialogue; (2) Physicians and complementary health practitioners must start cooperating; and (3) Patients need to take responsibility for their health; and (4) Patients and physicians need to change their focus from a problem-oriented approach to creative, individualized solutions that maximize our own innate healing systems. As more doctors and patients learn about and shift to the Appreciative Medicine model, the prospects for positive change in our health-care culture look promising.
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November,
2004
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ABOUT THE AUTHOR:Dr. Tel Franklin was recently recognized as one of the fifty outstanding family physicians in the state of California by the California Academy of Family Physicians. The founder of the Appreciative Medicine movement in California, he is author of a therapeutic journaling book for patients, called Expect a Miracle (Celestial Arts). His website is www.appreciativemedicine.com. |
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