by Wayne Jonas
Lastly, make the most of your entire health care team in addition to your physician. If your practice has physician’s assistants, nurses, or health coaches, they may be able to supplement the time you spend with your physician. Use their services.
A HOPE CONSULTATION
One of the fastest and most direct ways to engage your health care system in helping you access your own healing capacity is to ask your physician to do a HOPE consultation with you.
We know that both before and after a diagnosis, and between states of health and disease, there are specific health-promoting conditions and actions that can prevent, slow, or reverse chronic disease, strengthen overall health, and improve function, quality of life, and overall well-being. Suffering can be reduced with healing no matter what a person’s illness or stage of life—provided those behaviors are meaningful to the person and tap into their inherent healing capacity. Those factors and how they connect to the patient personally are explored during a HOPE consultation and are captured in a HOPE note.
The HOPE consultation is done after a complete medical diagnosis and treatment is completed, including a SOAP note. During the HOPE consultation, the practitioner goes over the core domains of healing with the patient and seeks to reframe the orientation from one of disease treatment to one emphasizing self-healing integrated with medical care. After examining the medical diagnosis and learning about the history and the context in which the patient lives, the HOPE consultation explores the factors that can enhance healing for the individual. These factors are not specific treatments for disease; rather, they focus on activities that complement those treatments to facilitate improvement in symptoms, function, quality of life, happiness, and well-being. Sometimes the disease also resolves during this process. You and your doctor can learn more about how to do a HOPE consultation in the appendix of this book and on my website, DrWayneJonas.com.
THE HOPE OF HEALING
From the minute we are born, we are subjected to the stresses and traumas of life—all of which steadily erode our bodily systems and structures. These onslaughts include fear, anxiety, pain, toxicity in the environment, the need to keep our bodies upright against the force of gravity, the energy it takes to fight off a cold. Even eating and breathing in oxygen causes our cells and tissues to break down.
When you are having a bad day and everything seems to be going wrong, do you sometimes feel that you are battling emotional and physical disintegration? It may be small comfort to know that there is a principle in physics, the second law of thermodynamics, which holds that everything in the universe moves toward entropy—a state of disorder and chaos. Forces of nature are constantly acting to dissipate us into the universe, to make us disappear.
But on most days, we do not disintegrate or fall apart—because we also have an inherent capacity to maintain order and repair damage caused by the stresses and traumas of life—to reverse the chaos of the universe and heal. However, when these repair and restoration mechanisms break down, we develop disease or lose our mental, emotional, and/or physical well-being. Of course, there are virulent diseases or traumatic injuries that will initially overwhelm even the most tuned-up repair systems. But by building up and maintaining your inherent healing capacity, you have a better chance of resistance, resilience, and recovery from the onslaughts of life.
I hope that the journey we have taken together through How Healing Works will help you find a path filled with courage and hope. You do not have to feel helpless or in despair when things fall apart. The more aware you become of your response to the forces that influence your life, the more you will realize that the conscious decisions you make every moment of every day can change your future for the better. You can influence all the dimensions of your life, surrounding and infusing yourself with the forces of healing.
You can be whole. You can be healed.
APPENDICES
The HOPE Consultation
This guide is designed to help you work with health professionals to enhance your own healing capacity. The purpose is to integrate the usual disease treatment, or pathogenic approach, with a health-promoting or salutogenic approach (Aaron Antonovsky, a professor of medical sociology, coined the term salutogenesis for this approach, to contrast it with pathogenesis, the process of disease).
Every day, often dozens of times a day, hundreds of thousands of physicians and health care professionals around the world write SOAP notes. This behavior is so automatic and engrained that they rarely even consider the implications—how it molds and directs their thinking about every patient they see. SOAP not only extends pathogenic thinking to what’s done to the patient, it also creates a set of cultural expectations, frameworks, and behaviors to which all modern medicine conforms.
Healing requires a different type of assessment—an assessment of those behaviors and interactions that facilitate salutogenic thinking, and framework a set of expectations and action focused fostering our inherent healing capacity. A patient’s clinical diagnosis may or may not be relevant to the ways in which healing happens. For example, the components of healing are often generic—meaning a process that facilitates healing for one disease also facilitates it for another disease. Therefore, the assessment and the plan in a SOAP note is usually not directly relevant to health promotion and healing. This is where a HOPE consultation comes in.
The HOPE consultation—the healing-oriented practice and environments visit—consists of a set of questions specifically geared to evaluate aspects of a person’s life that facilitates or detracts from healing; that is, it seeks how to enhance the processes of recovery, repair, and the return to wholeness. The goal of the HOPE consultation and HOPE note is to identify those behaviors that stimulate or support healing processes. It involves evaluating a patient in four different dimensions. First is the inner dimension—the perceptions, expectations, and awareness held in the mind. Certain types of mental framing around a life can either facilitate and enhance healing, or impair and block it. The second, interpersonal dimension, focuses on social relationships and the culture in which we operate. Again, certain types of social connections and relationships, and the nature of those relationships, can either support healing or interfere with it. Third is the behavioral dimension—things we do every day to either support and nourish the body’s healing capacity or interfere with it and cause further damage. Finally, there is the external dimension; that is, the physical environment in which we live. This includes home, work, school, errands, and recreation, including time in nature and exposure to nourishing or toxic elements around them.
The HOPE note provides a focused, intentional, and systematic way of documenting these healing dimensions, per whole systems science, during a patient visit, providing a tool for addressing each dimension and the elements of healing. The natural overlap of the dimensions enables the patient-practitioner conversation to flow. It complements the disease treatment framework provided by the SOAP. In chronic disease, it fills in dimensions often missed by the SOAP—the environmental, behavioral, social/emotional, and mental/spiritual determinants of health. The HOPE consultation can guide both doctor and patient to improve health and well-being—not simply the treatment of disease. As with any intervention, what happens depends upon the patient’s disease and his or her state of health and wellness orientation and readiness. In most patients, the recommendations from a HOPE consultation have a positive impact. It may not cure the disease or improve it significantly, or it may cure the disease or provide major improvement in the illness. In chronic diseases, it can almost always enhance wellness and well-being and improve function, whether the disease is cured or not. However, fully 70% to 80% of what the patient needs from an encounter in the context of a chronic illness is illuminated by the HOPE consultation.
At DrWayneJonas.com, I provide patients and professions with a detailed guide for doing a HOPE consultation. What follows is only a summary of the HOPE elements to familiarize you with the approach. The HOPE consultations four dimensions
are: inner, interpersonal, behavioral, and external.
INNER DIMENSION
The inner environment often holds the key to healing and well-being for the patient. This sometimes comes from a spiritual or religious life, or one grounded in meaning and purposeful activities. Often, it involves helping others. It can also be found in a creative pursuit or family activities—any endeavor that brings purpose and meaning beyond the individual. The goal of this part of HOPE is to explore the patient’s most profound insight into themselves and see if and how this is connected to their illness, suffering, and healing.
INTERPERSONAL DIMENSION
The social environment is essential to health and healing. Both health and happiness are socially contagious. Social cohesion is not only health enhancing but also essential for sustainable behavioral change in any culture and in any setting. Questions in this part of the HOPE consultation seek to explore the extent of a patient’s social connections and support, especially from family and friends.
BEHAVIORAL DIMENSION
Certain behaviors are linked to chronic illness and healing. This section of the HOPE consultation explores what the patient does to help herself or himself heal. Four primary areas are explored; others can be added, as guided by the patient.
Stress management: Research has demonstrated the benefits of achieving a deep relaxation capacity, a mind-body state known to counter the stress response and improve receptivity to personal insight and motivation for lifestyle change. These practices can also enhance health and strengthen personal resilience on their own. In the HOPE consultation, the practitioner explores what the patient does to relax and introduces options such as breathing, visualization, mindfulness and meditation, or biofeedback for regular use.
Physical activity: Physical activity can reduce stress, improve pain and brain function, slow aging and heart disease, and help a person reach and maintain an optimum weight. Fitness, along with proper rest and sleep, maintains functioning and productivity of the whole person throughout the lifespan and in any stage of health or illness. The patient is asked about his or her level of activity, and exercise and methods are offered to assist the patient in attaining an appropriate level of movement.
Sleep: Adequate quantity and quality of sleep improves most symptoms and can reduce stress, relieve pain, improve brain and immune function, slow aging, reduce incidence of heart disease and cancer, and help with achieving an optimum weight. Good sleep helps maintain functioning and productivity of the whole person throughout the lifespan and in any stage of health or illness. The patient is asked about the quantity, quality, and effectiveness of his or her sleep, and the practitioner offers methods to assist in attaining good sleep.
Optimum nutrition and substance use: Ideal weight and optimal physiological function are best supported through proper nutrition and reduced exposure to toxic substances—nicotine, alcohol, drugs, and environmental toxins—that impair function. Food and substance management requires motivation, environmental controls, food selection training, and family, peer, and community involvement. In the HOPE consultation, the patient is asked about use of these substances, about his or her normal diet, and any symptoms of gastrointestinal dysfunction, such as GERD, excessive gas, IBS, or constipation.
Complementary medical care: The patient is asked about his or her use of and/or interest in practices such as acupuncture, traditional or indigenous medicine, naturopathy, or chiropractic, and use of nutritional supplements and herbs. These practices—sometimes referred to as complementary and alternative medicine (CAM)—can facilitate healing if used appropriately or can harm if used inappropriately. They can be integrated with conventional medicine and self-care based on good evidence.
EXTERNAL DIMENSION
A healthy outer environment affects and supports a healthy person. This dimension attends to the physical structures and settings in which the patient lives and how these facilitate healing and minimize adverse impacts on and from the earth. The patient is asked what his or her home and work environment is like and if she has created a special place in which she feels relaxed and truly at home. Attention to architecture and art, time in nature, sound, smell, and light are key elements in producing such an environment. In addition, the HOPE consultation evaluates and attempts to minimize exposure to toxins that can impair healing and produce disease. I recommend a recent book by Dr. Joe Pizzorno, The Toxin Solution, to learn more.
Together, these healing-oriented practices and environments spell “HOPE,” for individuals and for society.
SAMPLE QUESTIONS FOR A HOPE CONSULTATION
The following questions are used to guide the conversation between the patient and doctor during the HOPE consultation. Other questions can be added and personalized for each patient, personality, readiness, and circumstances.
Inner
• Why do you seek healing? What is your goal and intention?
• Rate your health (1–10) and what changes you expect can happen (1–10).
• Why are you here in life? What is your purpose? What are your most meaningful daily activities?
Interpersonal
• What are your social connections and relationships?
• How is your social support? Do you have family and friends you can discuss your life events and feelings with? Do you have people you have fun with?
• Tell me about yourself. Tell me about your major traumas in the past.
• What makes you feel happy?
Behavioral
• What do you do during the day? What is your lifestyle like?
• What do you do for stress management? How do you relax, reflect, and recreate?
• Do you smoke or drink alcohol or take drugs?
• How’s your diet (describe your last breakfast, lunch, and dinner)?
• Do you exercise? If yes, what types and amounts?
• How is your sleep (quality and hours)? Do you wake refreshed?
• How much water, sugary drinks, and tea or coffee do you drink?
• What is your use of complementary and alternative medicine (CAM)—supplements, herbs, use of other CAM practitioners and healers?
External
• What is your home like? Your work environment?
• Is there a place at home where you can go and feel joyful and relaxed?
• What is your exposure to light, noise, clutter, music, colors, or art?
• What contact with nature do you have?
• What are your exposures to toxins, especially heavy metals or EDCs?
See the illustration on this page for the map I use to guide patients toward their own healing path.
THE HOPE NOTE
The answers to these questions form the basis for a HOPE note placed in the medical record. From this assessment, a plan for a meaningful response, to enhance what the patient is already doing to heal, is developed together. The goal of the plan is to match additional evidence-based healing methods to the patient’s current activities. That match is summarized in a HOPE list for goal setting and tracking.
After the HOPE consultation, I ask my patients to send me their summary of the top three areas they would like to enhance in the first month and a single goal for that month—expressed in terms of actions or symptom improvement. Usually patients need further assistance in accomplishing their goals. Several tools are available to help with this, including:
• A workbook on healing. I give my patients a workbook called Optimal Healing Environments: Your Healing Journey, which is also available free from DrWayneJonas.com.
• Health coaching: If appropriate, I connect the patient with a health coach to help them navigate behavioral change, or further testing.
• Health promotion groups: Clinics offer health and well-being groups for general health as well as for specialized populations who need support with managing pain, diabetes, weight loss, cardiovascular problems, and cancer.
• Health analytics: If needed, there are options for science-bas
ed testing and artificial intelligence systems to explore specific factors that can increase the probability of health improvements.
• Graphics of the healing dimensions (see this page) are sometimes provided to help patients visually navigate their many options for healing.
Constructing Your Healing Journey
The following guidelines may seem like simple, even obvious, steps, but they are powerful. Together, they hold the key to 80% of health and healing. As you go through these items, find ones you already enjoy, and then use the ideas and resources in this book to enhance their power. If you find you can incorporate the primary components from each of these dimensions of healing, you will markedly increase the probability of staying well if you are well, or recover if you are under treatment. Working with you doctor or primary care practitioner and a health coach can enhance the effect of these activities.
Many people have told me that they can implement these practices on their own, without professional assistance. The ability to heal is inside you. Making small changes in your day creates large changes over your life. Your hopes, relationships, activities, and places you live and work can spark these healing abilities. As you absorb the ideas described in this book and the summary suggestions in this appendix, note your thoughts, intentions, and expectations. Find the ones that inspire you to live a healthy, vibrant, joyful life with purpose and meaning.