Part IV: Goal Directed Treatment Plan
In the
penultimate post for this 4 part series, we will delve into the idea of the
Goal-Directed Treatment Plan with regards to healing for our patient. Now, any
doctor or medical student will be very aware of the treatment plan, and will
certainly attest to the fact that all patients receiving care ultimately
receive a treatment plan. I argue, argue, however, does this standard treatment
plan actually address the desired goals, the true needs and most importantly
the “Nourishing Review” conducted previously in our 4-step medical encounter.
Even with my optimistic attitude, I am hard-pressed to believe that this is
actually the norm. Now critics may say that the treatment plan implemented by
the doctor is perfectly sufficient for the majority of illness and I would
reluctantly agree. My hope, however, is that even if you arrive at the same
ultimate treatment strategy, regardless of whether one intimately discusses
ideas, goals and desires with the patient, the fact remains that in one instance
YOU ACTUALLY GARNERED PATIENT INPUT. In this age of health care, empowering the
patient and allowing them to dictate his or her course of healing is the
PRIMARY GOAL OF CARE, not simply prescribing a drug or implementing a temporary
intervention.
Here is
where I may begin to sound a little crazy, but I am not afraid to say, in my
mind, if I was able to have a patient choose to spend 30 minutes less each day
on his or her cell phone and replace those minutes with family time, yet do
absolutely nothing to change diet, exercise, or drinking habits, I would
consider that a successful completion of a goal as part of our adopted
treatment plan, You see, this is completely independent of any changes or
improvements to the individual’s physical health that can be quantifiably
determined. If at the end of a visit I have a patient leave without taking any
drugs to modify HTN, DM II or HLD, and they are unable to commit to any dietary
or lifestyle changes, yet they choose three activities identified from his or
her Nourishing Review to implement on a daily basis, I am entirely satisfied.
Investment into one’s own health is the first step to positive changes and
improved well-being, not drugs that artificially improve blood markers of
metabolic health. Patients that improve their happiness and feel satisfied with
their lives will ultimately be in the right place to adopt healthier lifestyle
habits, this is a simple truth. I like
to tell people all the time, humans are generally only good at attempting one
task or changing one habit a time. Add even one additional change or modify up
to three habits, and invariably nothing happens, and we simply feel worse for
it. So with this in mind, I encourage patients to conduct the Nourishing Review,
cultivate happiness in their lives and spend at least 5-10 minutes a day
practicing mindful self care- whether that is meditation, gratitude, a body
scan, journaling or simply deep breathing, all of these mindful activities can
center the mind and put us in a place where we can actually think and act on
lifestyle changes.
Like I say time and time again, my job as a physician is not
to make you better or solve all of your problems, my job is to engage in a positive
discussion of what may be your current roadblocks to optimal health, and what
may be the best strategies for achieving your goals. I can support and
prescribe medicines, supplements, or herbals to help you achieve these
improvements, however, I cannot live your life or tell you what to expect along
the way. A world of empowered patients will ultimately make for healthier
patients, regardless of what treatments you actually utilize. The reality is
that proper nutrition, adequate sleep, positive social and human connection,
spending time outdoors in nourishing sunlight, engaging in regular
movement/exercise and practicing routine mindful activities/stress reduction are
the cornerstones to optimal health. This will never change and anyone that
tells you of a perfect cure that does not involve these principles is downright
wrong. The resources, apps, online tools/protocols used to successfully modify
behavior and allow one to successfully adopt new habits following these
fundamentals will always vary, and this is exactly what a capitalistic
economy/society provides.
Gary Kraftsow of the Viniyoga Tradition used to say frequently
during our RYT training lectures, one method/sequence is never right for
everyone, however, one method/sequence is always right for someone. So I
encourage everyone to create a nourishing list, use this as your guide for a
treatment plan with your physician, and engage in a positive discussion
regarding the lifestyle principles outlined above. As doctors we want to
believe we are doing right by engaging in shared decision making, however, if
the decisions still ultimately revolve around only our understanding of the
potential treatment options, what good is it to be considered “shared?” Whether
you are a patient or a healer, we can all benefit from the understanding that
shared decision making isn’t the perfect answer, but that cultivating an active
discussion regarding what nourishes the patient, in addition to following our
fundamental lifestyle pillars, all within the context of addressing an
individual’s primary presenting complaints, will provide healing and vitality
to all willing to invest the time and energy to find it.
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