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Appreciative Medicine™:
Meeting The Challenge Of Chronic Illness

by Tel Franklin, M.D. (printer-friendly version)

The time for change is upon us. Patients and physicians alike are looking for a more human approach to health care. Patients want to be proactive, empowered. They want choices. But our health care system has become overwhelmed with costs, utilization, and redundancy. The practice of medicine does a good job when it comes to acute health crises. We often stabilize, cure, and save the lives of patients who suffer acute myocardial infarction, appendicitis, or even sepsis. However, when it comes to chronic health concerns such as back pain, diabetes mellitus, allergies, depression, or anxiety states, conventional health care would have to receive a failing grade.

We often end up placing our patients in a maze, where they feel isolated and lost in an array of costly lab tests, X-rays, consultations with specialists, and a plethora of medications. Our intentions are pure, but our approach is flawed. Our system often just perpetuates the "problem." In particular, our problem-oriented approach when addressing chronic concerns needs to be replaced. To really get beyond a particular "complaint," we need to change our perspective and focus. We need a better way, a new approach. We need Appreciative Medicine™.

Appreciative Medicine™ ushers in a new era of health care that challenges patients and doctors, and their paradigms, and begins to immediately create innovative healing options. By changing our focus from "problems" to "solutions," we open a whole new world of healing. To begin, we need to help our patients change the way they view their health and their interactions with the health care system. Patients need to make informed decisions about their health along with gaining access to the entire spectrum of health care, both traditional and complementary treatment modalities. There is no better way to promote healthier living than by lifestyle modification. Empowering patients to become proactive, to make those lifestyle changes, is at the core of Appreciative Medicine™.

There are over a million interactions with the health system every day— doctor visits, trips to the ED, and a host of ancillary health professionals. Patients’ problems are their "tickets" to see the doctor. They go from one illness to another, always with a bit of problem-patching instead of just changing their lifestyle. For the most part, health care providers interact with their patients using a formula, a template that has been around for over forty years, called "S-O-A-P."

It’s this problem-oriented formula that focuses on problems that needs to be changed. The systematic approach of S-O-A-P may work well enough for the acute diagnosis and treatment of a multitude of health problems. But, I recommend we instead adopt the more effective and comprehensive "S-O-A²-R" model.

Allopathic Medicine vs. Appreciative Medicine
	S-O-A-P		S-O-A2-R
S	Subjective low back pain	S	Solution "My back pain has resolved. It feels stronger than ever. How can I keep feeling strong and flexible?"
O	Objective multiple trigger points; decreased range of motion; reflexes intact	O	Objective range of motion normal, strength good, reflexes intact
A	Assessment lumbar strain	A	Assessment Continue with back strengthening exercises. Recommend stretching and swim therapy.
		A	Action Take a course in yoga. Be conscious of your posture.
P	Plan analgesics, muscle relaxants; return to clinic in 2 weeks if symptoms persist	R	Reinforcement Walk daily. Learn more about the Mediterranean Diet. Update tetanus-diphtheria. Schedule yearly physical.

We are privileged to be medical doctors, gifted with careers that reward us with a humbling life experience. It’s up to us to take that first step, to learn about Appreciative Medicine™, a new infrastructure of health care that fundamentally challenges us to really partner with our patients on a true healing quest. I appeal to all physicians to bring forth your resources for the common good by utilizing Appreciative Medicine™ to pursue a dialogue with your patients. When we change our focus and dwell on wellness and actually have individual personalized health plans that focus on wellness, not only will the system change, but health care itself will take a quantum leap forward. lf will take a quantum leap forward.