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.
On this page:
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
Mindfulness for Others
Creating a Salutogenic-Oriented Session (SOS)
Creating a Salutogenic-Oriented Session (SOS) (salud health, genesis creation of)
- 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.
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.
- 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).