Tag Archives: Wayne B. Jonas

Non-precision Medicine for Maximum Impact

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headshot of Dr. Jonas

Wayne B. Jonas, MD, President and CEO, Samueli Institute

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.
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From SOAP to HOPE: Adding Healing into the Traditional Medical Encounter

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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. 

Interested in incorporating HOPE in your practice? Here are 4 questions to add to your patient encounter.

4 Questions for Medical Providers to add HOPE to Health Care

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Doctor with patientWhat would a medical encounter look like if we were focused on Healing Oriented Practices and Environments (HOPE) in health care?

I propose it would consist of four components that are essential to creating health. These would be in addition to the areas already included in the traditional medical assessment called SOAP, which are the subjective-objective-assessment and plan assessment that come in making a traditional medical diagnosis and treatment.

The four components of HOPE are reflected in the following questions:

1. What is your goal and intention for your healing? What do you want to heal?

  • This may be  a certain percentage less pain, ability to climb stairs or play with a grandchild
  • Rate your health and what you expect can happen (1-10)
  • Why are you here in life? What is meaningful for you? What is your purpose?

This addresses a person’s the inner environment — their desires, their beliefs, and their needs—their  reason for getting up in the morning, their purpose in life—what’s meaningful for them?  What gives them a sense of wellness and motivation? 

Sometimes a simple thing such as spending time in the woods, or with family, is the primary avenue into treating their pain. Sometimes the goal of being able to play with their grandchildren will generate the physical activity necessary to prevent a future illness or disease that could impair them. Sometimes it’s the desire to serve their country, or their God.  

2. What are your connections and relationships?

  • Do you have family, friends, live alone, have hobbies, and have fun? Can you get rides to airport?
  • Tell me about yourself. Tell me about your traumas. Do you have a best friend? Are you part of a group? A club? How often do you meet?

So often the reason and process for healing has to do with social relationships — with family, friends, communities and colleagues.  Therefore, after we finish putting lines around the box of the diagnosis and the treatment, let’s capture the social components and the interpersonal components that drive an individual in their daily life. 

3. What do you do during the day? What is your lifestyle like?

  • Do you smoke or drink? What about diet, exercise, sleep and water?
  • What do you do for stress management? How do you relax, reflect and recreate?
  • What is your CAM use (supplements, herbs, other practitioners)?

Lifestyle and behavior can impact up to 60-70 percent of chronic illnesses; therefore these behaviors are essential for creating health.

4. What is your home like? Your work environment? Do you get out in nature?

  • This includes light, noise, clutter, colors, plants, walls.

The communities, the work sites, the schools and the environment in which our patients live, often dictate what they’re able to do, what happens, how long they live, and how well flourish, and how well they function. The physical environment, then, needs to be explored.

Let’s make asking these questions a routine part of medical care. 

The HOPE note is one powerful component in transforming your practice into an Optimal Healing Environment. To learn more about Samueli Institute’s research into Optimal Healing Environments, visit SamueliInstitute.org.

Acupuncture for the Trauma Spectrum Response: A Reading List

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Faced with more than 11 years of combat deployment, the US military is motivated to find innovative solutions to sustained problems. Samueli Institute’s collaborations with the US military expand drugless pain management, alleviate post-traumatic stress disorder (PTSD), heal from traumatic brain injuries (TBI), develop resilience, and promote Total Force Fitness.

One factor that makes treating Service members challenging, is that when they return from combat, their symptoms, such as chronic pain, post-traumatic stress disorder (PTSD), cognitive deficits, sleep and drug use and neuropsychiatric conditions often coexist. They have multiple problems that occur together. Continue reading “Acupuncture for the Trauma Spectrum Response: A Reading List” »

How Communities Heal

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In most Western cultures, illness or injury is a very individual experience. Doctors fix the body, provide medication, and refer to counselors as needed. Those who are not sick go on with life as usual.

However, many traditional cultures have a different view of illness: a shared view that shifts the responsibility to the community at large.

These two fundamentally different ways of seeing the nature of human beings is manifested in how we help, or do not help, those who are sick or injured. One approach holds an assumption that outside help will be provided to those in need from those who have resources and no need. The other assumption is that there will be collective action in which all engage in finding a community solution.

Can these opposing views of illness shed light on how to resolve issues and heal trauma within communities?

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