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.
Photograph from nuchylee at freedigitalphotos.net