4/15/16. It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.

Transcription

1 4/15/16 It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. WHOLE HEALTH: Change the Conversa5on - William Osler THE PERSONAL HEALTH PLANNING PROCESS: CASE STUDY - PTSD 1 Personal Health Planning Four Organizing Principles Shared Whole Health Assessment Self-reflection Health risk assessment Clinical exam Goals Life goals Health goals Personal Health Plan Skill- Building & Support Personal mission Shared goals Self-care Professional care Skill building/ education Consults/referrals Timeline and follow-up Education, training, and tools Healthcare teams Groups Family, friends Community Personal Health Inventory Nate Nate 32 year old Veteran - pg 55 Complex past medical history: PTSD Sleep concerns Depression High Cholesterol IBS Asked to fill out a Personal Health Inventory (PHI) Nate s Scales Physical, Mental, Life 1

2 Working the Body Recharge 6 7 Food and Drink Personal Development 8 9 Family, Friends, and Co-Workers Spirit and Soul

3 Surroundings Power of the Mind PHI Highlights The Big Questions PHI Highlights The Self-Care Questions What REALLY maeers? I want to be happy again Success with girlfriend, family, job Be able to relax What brings you joy and happiness? Sleep No pain or diarrhea Working with my hands and mar]al arts Well- being ra5ngs: Physical = 2/5 Mental = 1/5 Day- to- day life = 1/5 (Check suicide risk) Photo credit: The U.S. Army via Foter.com What stands out as you read his ra5ngs? Working the Body is 2 out of a desired 5. Wants to exercise more Recharge also 1/3. Seems desperate to sleep beeer. Has low energy Food and Drink 2/5. Struggles with weight and needs guidance Personal Development. Wants more educa5on to become an engineer Family, Friends, Co- Workers, 1/5. Wants partner and family, emo5onal control; limited social connec]on More Self-Care Questions and Reflections What stands out as you read his ra5ngs? Spirit and Soul 3/5. Searching for meaning, finds peace working with his hands Surroundings 5/5. Finally can just focus on this as a posi]ve for now Power of the Mind 3/5. Wants to learn more, sees the role of mind/ stress Around the Circle Manically Yoga Biofeedback Martial Arts OMT Relaxation Exercises Recreational Therapy PTSD Psychotherapy Exercise Prescription Mindfulness Course Educational Opp s Chaplain Consult Vocational Training Is doing his professional care, probably not a lot of a budget for things VA doesn t cover His final reflec]ons emphasize, but don t add much more, to what you already know Couples Therapy Volunteering Sleep Clinic Pain Management CBT-I Substance Use Help Dietician Acupuncture Glycemic Load Sleep Supplements 3

4 Step 2: Shared Goal Setting If you aren t a lidle overwhelmed by the number of things you could talk about rela]ve to how much ]me, you are superhuman! The other million dollar ques]on: What do you want to accomplish with our visit today? He replies that his main priori5es are: PTSD overall Sleep Stress management! Topics Time Step 2: Shared Goal Setting Life Goals and Health Goals Life goal something someone would answer to the What really matters? question Health goal achieving a specific measurement or preventing or treating a disease Your Goals Prevent suicide Ease depression Decrease cardiac risk (weight management) Nate s Goals Sleep, so I don t go crazy Find some joy in work, rela]onships, spirituality, exercise, hobbies Lose weight (but lower priority) 19 It is NOT about how many sugges]ons you can make, it is about making the BEST sugges]on(s). How will you know? 1) It will ]e in to what really maeers to them 2) It will work with your goals for them 3) It will be something they will actually do 4) It is personalized, proac5ve, and pa5ent- driven. That is, it is tailored to them, prevents future problems, and/or involves their ac]ve par]cipa]on 21 Some More Guiding Principles : SMART Goals Remember what you learned in The Power of You. Listening, expecta]ons, empathy, etc. count a lot. You won t always have the answers. That s okay. Start where the Veteran is willing and mo]vated to take ac]on and be successful Ask, before or ajer you make sugges]ons, What are you willing to do to reach your goals? Be mindful of their ]me, finances and access to what is put into the PHP Keep it simple consider using SMART goals Specific Measurable Ac]on- oriented Realis]c Time- bound Only outline one or two goals during a visit Photo credit: Helena Eriksson via Foter.com / CC BY-NC-ND

5 Brief PHP Template Ø NAME & DATE Ø LIFE GOAL (What really maders: Mission, Aspira]on, Vision) Ø PRIORITY SELF- CARE AREAS ON THE CIRCLE SPECIFIC GOAL (with date and ac]on steps, a SMART goal): Ø TREATMENTS AND INTERVENTIONS Ø PREVENTION AND HEALTH PROMOTION STRATEGIES Ø FURTHER KNOWLEDGE AND EDUCATION Ø RESOURCES / REFERRALS Conven]onal and Complementary Groups, Classes or Health Coaching Ø FOLLOW UP PLANS Step 4: Skill building and support Includes what plans can look like May be just one sugges]on or more elaborate Different elements: Things you teach them about Things the healthcare team teach Handouts and other Vet- facing materials Referrals to others, in and out of the VA Follow up with you / others on the team Defining their team, who is on the team? Things they do for themselves. *Remember, the en]re green circle is focused on self- care prac]ces Step 4: Skill Building and Support A few more tips Teamwork, what would you do? Be strategic about referrals Communicate consistently with others on the team Document well Empower the Veteran to become even more involved Encourage family/friend support Focus on successes Photo credit: p medved via Foter.com With a partner, discuss for a few minutes what you would do for Nate if he came to see you What would you consider punng into his health plan? How would the team be able to help him out? What referrals would you consider making? What could you teach him right on the spot?