The National Institutes of Health (NIH) has put itself firmly on record as being deeply concerned about our national epidemic of stress at the individual, organizational and societal levels. NIH’s National Center for Complementary and Integrative Health (NCCIH) broadcast on September 7th its annual Stephen E. Straus Distinguished Lecture in the Science of Complementary Therapies. The lecture was titled A Nation Under Pressure: The Public Health Consequences of Stress in America.
The American Psychological Association (APA) recently documented a worrisome increase in stress in the U.S. population (Stress in America https://www.apa.org/news/press/releases/stress). Uncontrolled stress can cause or worsen anxiety, depression, PTSD and a wide range of clinical conditions affecting every organ system. Medical students, residents and practicing physicians experience higher levels of stress than their age-
Of all the sciences, medicine uniquely combines all domains of the human condition-
Medicine has always attracted the best and the brightest. Most applicants to medical school are also inspired by a desire to be of genuine service and express their deepest human values through their professional lives. This ethic of altruism, compassion, meaning and service distinguishes medical students from most other professional students.
This new patient was a desperate, mid-
Modern life is taking its toll on our nation’s mental and physical health. Physicians and their patients both suffer from stress-
Former Surgeon General Vivek Murthy MD has sounded the alarm regarding our country’s epidemic of stress.(1) He calls for a serious national effort to mitigate the corrosive effect of chronic stress on every organ system. He calls for a nationwide campaign to spread a preventive, behavioral lifestyle prescription of healthy eating, physical activity and genuine social support (other than social media). Based on solid peer-
Behavioral medicine research confirms the value of mind-
Relationships are at the very heart of medicine. I recently saw one of my favorite patients whom I had not seen in 10 years. I have thought of her often since the hospital took over my Estill County practice in Irvine and I moved to Lexington. Wanda always lifted my spirits. She always asked me how I was doing because she cared about me. We joked and laughed while managing her chronic medical conditions. She was good medicine for me.
Defining resilience: The American Psychological Association (APA) describes resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress, such as family and relationship problems, serious health problems or workplace and financial stressors. It means ‘bouncing back’ from difficult experiences.” APA further describes resilience as “ordinary, not extraordinary. People commonly demonstrate resilience.
Wayne Jonas MD is clinical professor of family medicine, Georgetown University, retired Lt. Colonel United States Army Medical Corps and a complementary medicine researcher. He previously served as Director of the Office of Alternative Medicine at NIH, which is now called the National Center for Complementary and Integrative Health. He has recently proposed the HOPE note (Healing Oriented Practices and Environments) as a clinical tool to help physicians….
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The word “doctor” is derived from the Latin, docco, which means “to teach.” Our health care system is incorporating more health and wellness education addressing the whole person-
The HOPE Note
Jonas developed the HOPE note to complement the SOAP note (Subjective, Objective, Assessment and Plan) as a clinical assessment and documentation tool in patients with chronic conditions-
The HOPE note has 4 domains. Answers to these questions can help doctors and patients cooperatively develop strategies and plans to implement healthy lifestyle changes.
Relationship Centered Care
Relationships are the very heart of medicine, disease management and patient education. As doctor and teacher, our unique humanness is part of the ‘medicine’ we administer or prescribe. Our commitment to our own physical, mental, emotional, interpersonal and spiritual well-
Let’s assess ourselves using the HOPE note and then inquisitively and empathically use it to assess our patients. They will appreciate your interest in their lives outside the exam room. They are more likely to adhere to a care plan you co-
Wayne Jonas MD is clinical professor of family medicine, Georgetown University, retired Lt. Colonel United States Army Medical Corps and a complementary medicine researcher. He previously served as Director of the Office of Alternative Medicine at NIH, which is now called the National Center for Complementary and Integrative Health. He has recently proposed the HOPE note (Healing Oriented Practices and Environments) as a clinical tool to help physicians add integrative health care to a routine office visit.
Social determinants of health
The conditions in which people are born, grow, live, work and age are increasingly recognized as assets or barriers to living a healthy life. These conditions include socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. Our use of the HOPE note can reveal unexpected information about our patients that can dramatically affect our perception of their health-
The patient who has the disease
Over 100 years ago, William Osler’s The Principles and Practice of Medicine contained the often-
about who their patient is and provide better disease prevention and management, specifically integrating safe and effective complementary approaches with conventional medicine.
The imperative of chronic disease management
Chronic conditions are a growing concern as the aging population and lifestyle factors combine to increase treatment costs and overall health care utilization. More than half of the U.S. population have at least one chronic condition, such as hypertension, diabetes, obesity, heart disease, hyperlipidemia, chronic back pain, anxiety, depression and arthritis. Risk factors for these so-
Dr Patterson chairs the Lexington Medical
Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998. Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-