Turn Your Clinic Into A Healing Haven In 10 Easy Steps

Today I had the honor of accompanying my Aunt Emma to her doctor in Southeast El Paso. This is a fairly impoverished area of my hometown and just like much of El Paso, it’s medically underserved. The clinic was nondescript, hardwood floors, a couple posters on the wall, cold coffee and cookies for the patients. Her doctor was adorable, compassionate, caring and remembered my aunt well and all the drawings she has brought her over her five years as a patient there. My momma had taken my aunt off of statins after some fight from me and her LDL (bad) cholesterol had gone up. “We thought that food had something to do with cholesterol, but we’ve learned that that is no longer true, you can eat what you want, as long as it’s not fried”. Those of you who know me as the food as medicine/root cause PA, know that it took every fiber in me to stay silent, but I did. I really liked that her doctor went over her cardiac risk stratification and tried to figure out her individual chance of heart disease, “you don’t smoke, you’ve never had a heart attack, you don’t have diabetes, therefore, you likely don’t need a statin to control your cholesterol, but we’ll reevaluate in three months”. Again, the thought “no we won’t, she will not be placed on a statin drug” came up but not out. She proceeded to examine my aunt, through her clothes and when she looked in her mouth she said “perfect”, which was not accurate again. I had seen some pieces of food and a non-brushed set of pearly whites just minutes earlier as I was shooting some pics of her in the waiting room, come on doc, be real, honest, teach!

Our job as medical providers is to teach, educate, pass on the very important information that patients need in order to make educated decisions about their health. The word doctor comes from a latin verb that means ‘to teach’. Our duties as medical professionals is to teach at every single chance we get with our captive audience, our patients. This doctor was so charismatic and had a tremendous capacity to encourage change, but didn’t take advantage of the opportunity. We’re considered experts to our patients, particularly in underserved communities and they listen to what we have to say with the most open ears and hearts. With that power comes great responsibility and by ignoring the spaces for educating and empowering, we’re not serving them in the most effective way we could. Her doctor had so many missed opportunities to talk about changing one thing in her diet, brushing her teeth, asking her about any kind of exercise or even what she does for fun. Many of you who know my aunt, know she is the happiest, cutest, most shining example of a ‘pure heart’ (as my niece Lily said), which goes a long way in physical and mental health, some of this does not apply to her. But there was so much that could have been said and asked in that ten minute visit that may have gone a long way and for sure would have made a difference after every three month visit in the past five years.

This experience, among others, inspired me to spread the word on what I have learned in the last three years about the art of medicine, integrative approaches and our responsibility as provider as partner. Because we now spend so much time in the clinic waiting rooms and exam rooms, we should be enveloped in information about how to make the lifestyle changes that prevent or reverse chronic disease. Turn off the Cops and novellas on the TV and get some entertainment that involves education. I’m not talking about health TV sponsored by drug companies to encourage our patients to ask for the newest treatments. If you’re insistent on having a TV, stream”Hungry for Change” or “Fed Up” and offer headphones or put on closed caption. Studies have shown that ads add to stress in patients and violence on TV increases physical discomfort.(1) We need to help our patients take their health into their own hands and make changes at home, work and life. The first step as a medical provider is to educate yourself, to practice self-care and use some of these evidence- based techniques that work on many levels in many aspects of health. The magnificent Florence Nightingale believed that the healthcare environment should “put the patient in the best possible condition so that nature can act and healing occur.” (3) So this is my list for 10 ways to transform your traditional clinic into an integrative space that will help you, your patients and your staff create a healing environment in a way that drugs cannot.

The research in the field of Evidence-Based Design is not vast, but what does exist is robust and relevant and is rapidly growing. Dr. Roger Ulrich is a leading researcher and expert in the field and is right in the heart of Texas at A & M. What does exist focuses on the connection between the healthcare environment and its impact on patients and their families, staff and organizations.

Here are some benefits to creating an patient- centered environment (2):

– Reduction of stress and anxiety for patients and family members

– Reduction in pain and less need for pain management

– Improved patient satisfaction

– Improved job satisfaction

– Greater staff productivity

– Overall cost savings through increased operation efficiency and improved medical outcomes

So how do you do this? Easy, take a weekend, buy some paint and some artwork and get ready for some major patient impact:

1) Paint the walls a soothing color. (http://www.managedcaremag.com/archives/0111/0111.colors.html)

2) Put a plant in each corner, a small plant in exam rooms, bright colored flowers in waiting room. (Leather, Beale, Santos, Watts, & Lee, 2003)

3) Play relaxing music or sounds. (Groff, Carlson, Tsang, & Potter, 2008)

4) Diffuse soothing and relaxing essential oils throughout waiting room and in hallways of clinic. (http://www.hindawi.com/journals/ecam/2013/927419/).

5) Place artwork of nature, landscapes, vistas, bright vegetables, fruits or other pieces of positive visual distractions. (http://healingphotoart.org/about-us/scientific-evidence/)

6) Hang pictures and infographics of relaxation techniques that are easy to do while waiting. (anecdotal evidence from patients I’ve seen who love to have interactive information on walls while waiting in exam room)

7) Pictures of food as medicine. Want to reverse your DM? Try eating more vegetables on a daily basis. An accurate food pyramid or just pictures of a plant-based diet = healthy mind and body. (No one is going to go vegetarian because of a picture, but maybe it will prompt a conversation about adding more veggies than they already eat).

8) As much natural outdoor lighting possible and less artificial lighting. (http://www.hfma.org/Leadership/Archives/2014/Spring/The_Business_Case_for_Patient-Centered_Facility_Design/)

9) Have a handout of all the ways they can exchange one unhealthy habit for a healthy one. Drink one glass of water before each meal, eat a small salad before each meal, trade one of your five sodas a day for water, buy nuts and seeds in bulk and have them readily available. (no brainer here, increase health literacy)

10) Turn your physical exam into a real teaching opportunity- teeth full of plaque, talk about the importance of brushing and decreasing sugar intake, BP elevated let them know that just moving for 5 minutes an hour is beneficial or going outside to walk for 30 minutes is healthy.

These simple transformations can also be implemented in your home to make it more relaxing, inviting and a decompression zone for the hectic life that we have to auto-pilot through on a daily basis.

 

1. Ragonesi AJ, Antick JR. Physiological responses to violence reported in the news. Perpet Mot Skills. 2008;107:383-395.

2. https://accc-cancer.org/oncology_issues/articles/mayjune08/fouts.pdf

3. http://www.minnesotamedicine.com/Past-Issues/Past-Issues-2008/March-2008/Clinical-Zborowsky-March-2008

 

Photograph from nuchylee at freedigitalphotos.net

Alzhiemer’s Disease, It Takes A Village

Forgetting familiar faces, phone numbers, your way home, how to bathe, dressing  yourself, these are all sad realities of people who have progressive dementia. When my dad’s decline started happening, I was just starting college. He drove me to Austin from El Paso, an almost 600 mile trek and got lost on his return home. This was a man who taught me how to read maps and had the best sense of direction of any man I’ve ever known. The next stage consisted of a personality change from the kindest most happy-hearted man in my life to a reactive and at times mean father. Those two extreme changes prompted me to call his doctor and beg him to put him on medicine for Alzheimer’s disease (AD), “Erica, you know that this is a diagnosis of exclusion and if I diagnose your dad with this abysmal and irreversible disease the outcome is not good”. Yes, I knew this, even with just a BA in English/pre-med, I knew that Alzheimer’s was a progressive disease and my dad would never be the same.  I held onto the hope that a drug would fix him and keep him as my daddy for just a little while longer.

Now, 15 years later, he’s in a home, at peace, happy and my momma is able to live her life again. From the extensive conversations we had before we placed him in a home came this idea, that it takes a village. I believe it takes a village to get through everything challenging in life. We’re meant to have a tribe, a community, people who will not only catch us if we fall, but will always offer a hand to pick us up again and again.

Late last year, the conversation that struck the strongest cord was one my sister brought to our attention. The fact that neurodegenerative diseases, those that rob a person and their loved ones of the mind, but keep the body intact, lack a village, lack a community. For fifteen years, my mother took care of my dad, entirely by herself, with the occasional drop-in visits from my sister and I, some lasting months, but most lasting days. We talked about how if dad had been diagnosed with cancer, that the world he built, the tribe he had once had, would be at his aid. Those people from around the world who he went to college with, Vietnam, the Peace Corps, St. Josephs, Seton, housing authority, foster grandparents, all the lives he touched and saved, would have been calling, visiting, making food for my mom, helping take care of him while she took a breath, and showering him and her with love and support. I know this to be true because the second I I took a sabbatical to go back to El Paso to figure out his next step and I reached out to my friends via social media and the universe, we received that very support that had been lacking all of those years. The shift in asking also happened after my dad was diagnosed with leukemia last summer. Once he received a diagnosis outside of his Alzheimer’s, we started seeing more of a community form and also when we felt more inclined to ask for help from others.

When I talk about community as medicine, this is what I’m talking about. I wrote about this in 2011 and how if you know someone with Alzheimer’s to visit often and be cool. But that only happens if you ask. The power of asking for help becomes difficult when your caring for someone with Alzheimer’s, there is a pride issue there, I get it, I felt it. Once my dad had cancer, my mother wasn’t expected to do it alone. Yet, around the world, as more and more people are being diagnosed with this terrible disease, they’re lost and alone and without a village. That’s why a friend of ours wants to move her husband, who has Alzheimer’s, back to Colombia, so she could have that community to assist her. That’s why I believe caretakers, who know more about the disease than most medical providers do, need a place to breathe, exchange ideas, vent, talk about the latest research and ideas in the care.

I’ve been so fired up the past few weeks when I heard about an actual Dementia Town in Holland. This has been my inspiration for my dream to build a dementia village in or around the Austin area. I’ve been looking at land, emailing the founder in Holland, researching the specifics as much as I can figure out and putting it out there as a must do in this lifetime. Of course it will be called Benny’s House and will house a restaurant, a coffee/tea shop, grocery store, library, garden, a laundry mat, maybe some office space (for those workaholics),  and a holistic clinic. It will take a village to build, but I know it’s one that will be full of life, love and community, just like I believe my parents and anyone with AD and their caretakers have deserved for a long time.

If you haven’t heard of The Roseto Effect, read about it here. The study showed how important social networks and communities are for our health and well-being. We’re in this together folks and none of us is getting out alive, so why not reach out to a stranger, why not talk to the homeless man on the way to the next SXSW venue? Believe in community, believe in the goodness of others and practice it as much as possible.

Thank you for reading.

(Photo from the community who helped me during a 500-mile pilgrimage)

Meditation, My Drug Of Choice

Yesterday morning I woke up with swollen, itchy, red eyes again, exhausted from not breathing well and didn’t want to get out of bed and go to work. Eventually I peeled myself off of my bed, late and found my bathroom occupied by my housemate. “I should have woken up earlier!” I texted my boyfriend to let him know I was going to shower at his house and ran out the door with my clothes and my dog. She was stubborn this day and ran all the way out until the end of the driveway and sat down. I was at my car, putting all of my stuff in, holding the door for her. She stayed sitting for what seemed like forever. “ELLIE!! GET IN THE CAR”, I yelled. “GET IN THE CAR!!”, even louder. I saw my housemate through the window peeking out to see what the ruckus was all about. Ellie sheepishly got up and slowly walked towards the car. I guess she didn’t want to go to work with me and that was fine, but I was already running late and just needed to get going. As we drove to Justin’s house, she started wining and crying, which she only does when I’m on edge. This made me stress even more and I could feel my frustration rise up inside me. When we finally got to his house, I ran to his door and knocked hard and fast like it was going to get him there faster. Ridiculous, I know. He opened the door and gave me a kiss. I responded, “HI, Ellie’s being crazy today, I’m late and I need to take a shower and I didn’t even get to meditate and it’s a shit day!” Justin, being the prince that he is, offered to keep her for the day as I walked into the bathroom. I took a moment and tried to meditate in the shower and just couldn’t do it. Finally, I made the decision to give myself five minutes to breathe. I went into his bedroom, shut the door, sat and put my timer on for ten minutes. When I finished, which was only about 7 minutes in, I came out like a new person. He said I looked better, more energized, less panicked. I felt like I had just taken a sedative or just finished a massage therapy session, I felt good and grounded.

It’s amazing what a few minutes of real belly breathing can do for your sanity, that’s what meditation does for me. There has been some evidence that shows that 20 minutes of meditation can feel like 7-hours of good sleep. Whatever the reason, however lacking the science may be (which it’s not), I know it works and I’ve seen it work with patients, in house, during a busy clinic day.

So what are some of the benefits of meditation? I did a whole 77 reasons piece a few months ago. Here are some of the highlights:

– Helps decrease anxiety

– Helps with time management

– Increases memory ability

– Aids in insomnia

– Reduces neurosis

– Increases endorphins (feel good drug)

– Makes it easier to manage stress

– Makes you look younger!

If you’re anti-meditation, I’ll let you in on a trade secret. People who are not ready or willing to do the uncomfortable and challenging inner work- forgiveness, self-love, reflection, all the tortuous labor that leads to growth-are also adverse to sitting in silence. If you’ve had a difficult time attempting to meditate or think it’s for the birds, count the percentage of time throughout the day that you’re able to sit in silence. How much time do you spend with no music, no smart phone, no tv, no computer, no voices, simply doing nothing? Sleeping doesn’t count. And if you need white noise to sleep, take note! If the majority of your day is full of hullabaloo, then you need meditation the most.

The misconceptions about meditation are:

– I should be able to completely clear my mind

– I will not get more anxious while I am meditating

– I should not be making to do lists while I’m meditating

– Meditation is easy

Nope, nope, nope and nope. Meditation means different things for different people, but the most impactful explanation is that it allows for transformation of the mind. We meditate every single day, it’s what we choose to meditate on that makes the difference. On a daily basis we meditate on our finances, relationships, job drama, kids, debt, car trouble, politics, sports teams, new coaches, old relationships, plumbing issues, family conflicts, and all other worries and concerns of our life. Meditating is doing this but for more productive and positive outcomes.

Russell Simmons says “if you don’t have 20 minutes to meditate, then you need 2 hours”. Start small, baby steps, wake up five minutes earlier and just lay there and count your breath. Do this for as long as possible, 20 seconds, 2 minutes, whatever works for you. As long as you’re doing it, you’re creating brain patterns and habits to keep on doing it. Then in a week, increase to five minutes. You can also focus on mindful movement with no outside stimuli beside the action you’re performing, in the shower, washing dishes, watering the lawn, just focus your activity on the breath.

It’s self-care people and so imperative to our health. Do it and do it now. Thank you for reading.

Here are findings from a functional MRI: (http://lifehacker.com/what-happens-to-the-brain-when-you-meditate-and-how-it-1202533314):

Frontal Lobe This is the most highly evolved part of the brain, responsible for reasoning, planning, emotions and self-conscious awareness. During meditation, the frontal cortex tends to go offline.

Parietal lobe This part of the brain processes sensory information about the surrounding world, orienting you in time and space. During meditation, activity in the parietal lobe slows down.

Thalamus The gatekeeper for the senses, this organ focuses your attention by funneling some sensory data deeper into the brain and stopping other signals in their tracks. Meditation reduces the flow of incoming information to a trickle.

Reticular formation As the brain’s sentry, this structure receives incoming stimuli and puts the brain on alert, ready to respond. Meditating dials back the arousal signal.