The woman (we will call her Joan) was 45 years old, and she did everything she could for her health. She ate right, worked out, took vacations, worked hard, and had a great family. But 15 years ago she was in a motor vehicle accident and sustained whiplash on her right side. Although there was no severe physical damage, she began to develop neck stiffness and pain down her shoulder that was intractable. It was then that her 15-year journey of pain began. Continue reading “HOPE for Pain: From Treatment to Healing” »
Author Archives: Wayne B Jonas
Opioids are commonly prescribed for pain. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. But opioid pain medication use presents serious risks, including overdose and opioid use disorder. From 1999 to 2014, more than 165,000 people died from overdose related to opioid pain medication in the United States. Continue reading “A Response to the CDC Opioid Guidline: Implementing Integrative Therapies into Chronic Pain Care” »
In 2009, the Chairman of the Joint Chiefs of Staff commissioned a study to look at how to develop a whole systems approach to prevention, wellness, recovery and resilience.
At that time, the military was seeing increases in obesity, diabetes, lowering of psychological resilience, chronic pain, PTSD and suicide. It became clear that a fit force could not depend upon a health care system to improve health, as health care focused primarily on disease treatment and little on prevention. What was needed was a whole-systems approach that came from the units, the families and the communities in which service members were living. Continue reading “Learning in and from the Military” »
In health care and in science, there are lumpers and then there are splitters. Scientists tend to be splitters, dissecting different aspects of a disease, different parts of your brain receptors, and looking for different effects on different organs. Then, they look for drugs that inhibit those different parts form the basis for a medical treatment. Nobel Prizes and profits are based on splitting up the body into finer and finer parts down to a cell and its genome and showing that they have broad implications.
Continue reading “Non-precision Medicine for Maximum Impact” »
It’s time we got rid of the SOAP note.
The SOAP note is the subjective-objective-assessment and plan around which every medical encounter in the country is framed. The priority is to identify the disease, measure it to confirm that it is a disease, and develop a treatment plan to try to control and eliminate it. This disease-based approach frames everything that goes on in health care.
It works well when a cause of a disease is easily identified and eliminated. However it works poorly for the factors that are now seen to impact most of health— prevention, lifestyle and holistic practices.
We now know that 80 percent of health care actually comes from outside of the clinic, and it won’t fit into that particular diagnostic plan that we create with SOAP. Patient’s goals and their decision-making are crucial for the creation of health and healing, even more so than the specific treatments of disease medical professionals sometimes provide.
Putting all encounters into a framework of subjective-objective-assessment and plan, around a specific diagnosis and verification of treatment, is no longer the model needed in the health care box.
From SOAP to HOPE
We need a new model for structuring the visits within the health care system. To achieve patient-centered care this new model must include the factors that change behavior and create health. These include social determinants of disease, holistic and integrative medicine, the importance of lifestyle, as well as the key role of purpose and meaning in the patient’s life.
In this new Healing Oriented Practices and Environments (HOPE) model, the patient and their own goals in life would be part of the diagnosis and the plan – all components that don’t currently fit into a standard SOAP note. Expectations and beliefs are a key part of healing, and so are social support and the relationships that are essential for recovery and the optimization of any kind of treatment. Thus, the social components must be part of the note.