3. Proceedwalworth2024-10-24T13:32:21-05:00

1. Pause, 2. Presence, 3. Proceed

Proceed: Using mindful speech and action to respond skillfully, compassionately, and with positive intention to whatever needs attention in this moment.

Proceed in the clinic: After obtaining insight into your patient’s needs during “presence,” it is now time to use this information to create a plan towards health.

Mindfulness for Yourself

There is a saying that you can’t give what you don’t have. Taking care of yourself and addressing your needs is a vital part of providing good health care, improving wellbeing, maintaining balance, and preventing burnout.

There is another saying that says, knowledge without wisdom is dangerous and wisdom without action is useless. In proceeding, we are combining our medical knowledge with the wisdom of the patient’s story to create mutual action towards health.

Preventing Burnout Video (One Foot In and One Foot Out)

Circles of Suffering

Starting With Ourselves

The Pearl

Resources

Mindfulness for Others

Creating a Salutogenic-Oriented Session (SOS)

Creating a Salutogenic-Oriented Session (SOS) (salud health, genesis creation of)

Protect Time

Carve out at least a 40 minute visit for an SOS clinic visit. You may choose to do these on a specific half day of the week or at the beginning of a clinic half day. Work with clinic schedulers to create an SOS visit, just as they would schedule a procedure or well-child check.

Create space

Reserve an exam room for the SOS visits. In this space;

Bring in an element of nature (a single flower, a plant, a water element)
Use warm and inviting colors and decorations.
Limit medical paraphernalia and reduce distracting noise.
Incorporate art in the form of paintings, sculptures or poetry.
Avoid physical barriers between patient and clinician
See video “Creating a Healing Environment”

Create Positive Expectation

Educate nursing and scheduling staff to communicate to the patient that this is a type of visit that allows the clinician to go deeper into their clinical history to understand how to get to the root of the problem. This creates the expectation that the intent is to go beyond the physical symptom and encourages them to feel more comfortable expressing information beyond the physical symptom that will give insight into key ingredients towards health.
Consider allowing the patient to see the clinician handing off their pager or cell phone to the medical assistant asking for privacy and no disturbance.
The initial intent is health creation. Symptom or disease management is secondary.
See video: Creating positive expectation (scenario with patient where we communicate the need for an SOS)

Create a Plan of Action

Combine your medical knowledge with the unique needs of the patient’s story to write down a plan that both you and the patient agree will bring health.
Focus more on what is right with the patient compared to what is wrong with them.
Use goal or solution driven action plans towards health creation. For example, a health creation plan for pain may be to “live life with less pain.” Compared to a disease oriented goal of “treating pain.” One requires that you recognize the non-physical factors that influence pain, whereas the latter may only address the physical components.
The Health Plan is defined by the patient’s needs. It may be one item long (if one item stands out as the most important ingredient for health) or 7 items long. See examples of Health Plans for different Health goals.

Code Appropriately

For an SOS visit to be sustainable, we need to honor it as much as how many patients are seen in a day. With time, the cost savings of a healing-oriented approach will be recognized but first we must create a visit that can be studied for its potential value.
Forty minutes of face-to-face time is needed to bill a 99204 (new patient) or a 99215 (established patient). It is important to document the amount of time spent with the patient and include in your note that “greater than 50% of time was spent counseling and/or coordinating care.”

For a more in-depth peer-reviewed paper on creating a Salutogenesis-Oriented Session, read this article:
SOS Explore Paper (PDF).

Transition to Independence

Resources

Integrative Primary Care
RELIEVE Mnemonic to Help Remember the Key Influences of a Healing-Oriented Encounter
Mindfulness Meditation Podcast Series (audio)
Mindful Practice by Ronald Epstein
Health Plan Examples

Mindfulness for Yourself

"Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first."

William Osler

The Journey

by Mary Oliver

One day you finally knew what you had to do, and began, though the voices around you kept shouting their bad advice -- though the whole house began to tremble and you felt the old tug at your ankles. "Mend my life!" each voice cried. But you didn't stop. You knew what you had to do, though the wind pried with its stiff fingers at the very foundations, though their melancholy was terrible. It was already late enough, and a wild night, and the road full of fallen branches and stones. But little by little, as you left their voices behind, the stars began to burn through the sheets of clouds, and there was a new voice which you slowly recognized as your own, that kept you company as you strode deeper and deeper into the world, determined to do the only thing you could do -- determined to save the only life you could save.

Mindfulness for Others

"What kind of doctor do I need to be for this patient today?" -Michael Balint

"To write prescriptions is easy, but to come to an understanding of people is hard." -Franz Kafka

"There is nothing like a difficult patient to show us ourselves." -William Carlos Williams

"Change takes time, and is meted out in the mutuality of human relationship - where the doctor and the patient cling to a common log on a rising river." -David Loxterkamp

Transforming Health Care for All

On this page:

Mindfulness for Yourself