How healing works

How do we get from healthcare to health and wellbeing, asked Wayne Jonas, MD, at the 2019 Institute for Functional Medicine Annual International Conference in San Antonio, Texas? 

Opioid prescriptions have increased by 60 percent from 2000 to 2010, Jonas said. Opioid-related deaths topped 60,000 in 2017, and 11.8 Americans misused opioids.

“We need to start asking, where is the value in health,” said Jonas. “We are not facing an opioid problem. We are facing a chronic pain mismanagement problem.”

Several federal and national organizations are calling for non-pharmacological approaches to pain, including the U.S. Department of Veteran’s Affairs and the American College of Physicians. These complementary and integrative medicine approaches include therapeutic massage, yoga, acupuncture, spinal manipulation, and mind-body therapies.

Take Sally, a patient who was in a car accident. She had neck and back pain, was taken to the hospital, and was given a nonsteroidal anti-inflammatory drug and told to go to physical therapy. A few months later, she bent over to pick something up and heard a pop, followed by excruciating pain in her back and legs. She went back to the hospital and they prescribed her opioids, which she felt completely managed her pain. Over time, she developed a tolerance and required more opioids to manage her pain. She eventually had to leave her job. Her physician became concerned and sent her to a surgeon, and a sports medicine specialist for steroid injections. followed by a behavioral medicine specialist who prescribed yet another drug.

In conventional medicine, a Subjective Objective Assessment Plan (SOAP) is the structure around how medicine operates. It focuses on making a medical diagnosis and treatment plan and asking, “what’s the matter.” Patients now come in expecting the SOAP note, pills, and procedure, Jonas said.

“You have the power to change the culture,” said Jonas. “The culture happens every day in your practice. All you have to do is change the conversation.”   

We must shift from the SOAP mentality to what Jonas calls a healing-oriented practices and environments (HOPE) mentality, exploring a patient’s personal determinants of health and asking, “what matters” to the patient. Instead of a SOAP note, Jonas creates a HOPE note for his patients, and incorporate body and external, behavior and lifestyle, social and emotional, and spiritual and mental health and wellbeing.

For Sally, she and Jonas identified medication management, heat and stretching, sleep and stress, developing a place and time to heal, and addressing loss of purpose as her top priorities. Her integrative healthcare “team” included a collaborative effort between her physician, pharmacologist, behaviorist, and yoga therapist. In addition, she needed the support from her family and she needed to prioritize her own health.

After focusing on her priorities for six months, Jonas said Sally’s pain was reduced but, more importantly, she started looking for a new job.

“This is what it’s all about,” Jonas said. “Not just making the pain go away but dealing with the suffering that goes with chronic disease.”

Integrative healthcare is a different kind of healthcare, Jonas said. We need conventional medicine, but we must incorporate complementary and alternative medicine and, most importantly, self-care, Jonas said. This is the healthcare we need, he said.

We need healthcare that empowers and supports self-care, Jonas said. Evidence shows that patients actively managing their care are healthier.

Practitioners can continue this standard of offering integrative care to their patients:  

• Do an integrative health visit using a personal health inventory and HOPE note. Reframe questions and goals to address health determinants.
• Add simple methods, such as ear acupuncture, mind-body, nutrition, and safe supplements.
• Advanced healing technologies, such as HRV biofeedback, CES devises, behavioral apps, and telehealth.
• Redesign teams for health, such as health coaching, team care, group visits, and shared decisions.

“We’ve really flipped from the ‘why’ to the ‘how’ in caring for the whole person,” Jonas said. “We’re on our way to making whole-person care routine and regular.” 

Editor’s note: This article is part of Integrative Practitioner’s live coverage of the 2019 Institute for Functional Medicine Annual International Conference. For a full list of coverage, click here.