•  Relative to size, the strongest muscle in the body is the tongue.

What is “Appreciative Medicine”?
The State of Medicine Today

The State of Medicine Today

Every day we hear about breakthrough technologies that support conventional medicine, such as MRI, PET and CT scans that detail the inner workings of the human body or sensational new wonder drugs. This is in keeping with a health care system primarily based on allopathy. According to Webster, allopathy is the study, diagnosis and treatment of disease.  The method of treating disease by use of agents that produce effects different from those of the disease treated.

Although most health care today is focused around the allopathic management of chronic disease, acute care centers exist to handle cases of major illness, such as chest pain, cerebral-vascular accidents or traumatic auto collisions. Many times, the emergency department is still the optimal setting to stabilize and save life.

At the same time, patients often feel less than satisfied with the scope of conventional medicine. For routine care, more people are gravitating toward the holistic, natural treatments promised by practitioners of “alternative medicine.” Patient response in this direction has fueled what is now a 40 billion dollar industry.  We commonly encounter the terms wellness – health –optimal well-being – peak performance. Are these concepts more than a convenient marketing tool?  Some alternative methods are clearly gimmicks, but research shows that others truly complement allopathic care.

Regardless of the healing modality one may choose, two questions still remain: 1) As a physician, how can I better advise my patients to create an improved state of functioning? 2) As a person (remember that doctors are patients, too), how do I achieve optimal health? Patients and physicians alike want to enjoy more life in their day. We all see the limitations of the disease model and want our patients to experience improved well-being.

Is “Alternative Medicine” Really an Alternative?

No doubt, alternative medicine in combination with conventional allopathic care has brought comfort, healing and good health to literally millions around the globe. Nevertheless, alternative integrative health systems are not always a true alternative. Many health care approaches may utilize holistic treatment options, but they often encompass the same philosophical approach to patient care--the problem-oriented approach.*3

For medicine to be a true alternative, physicians need to consider a new paradigm in patient care. That is, we can redefine health challenges as wellness solutions and provide partnership models in the patient-doctor relationship. These activities will parallel the worldwide paradigm shift currently taking place in other spheres as we become more aware of the interaction of our bodies, feelings, insights, and essence of being.

I believe we can achieve the inner vision of wellness for which we all guest. Even though an optimal quality of life often appears to be just out of reach, amazing “secrets” of health are revealing themselves to us at this progressive moment in history. To hasten the process, I suggest each person create a personalized “road map” of wellness, a unique vision of health offering the highest quality of life on all levels. I explore the advantages to medicine of such an approach in this article. 

Patient-Centered Health Care: An Integrated Approach

We physicians have all questioned our methods when experiencing, after examining a patient, that something was left missing, undone during a particular encounter. Could there be a more constructive way to interact with patients? I took a course in acupuncture, thinking it might provide some value for patients. But even after integrating medical acupuncture into my traditional allopathic practice, I felt the need for something more. I identified what was missing as the need for creative dialogue with patients. So I attended numerous workshops and seminars, but none offered a satisfactory alternative approach to patient care that included the communication patterns I believed necessary.

Now, after a three-year search for the essentials of holistic dialogue, I have developed an integrated patient-centered approach, which I call “appreciative medicine.” It includes a four-part, interactive guide to assist health seekers through the maze of care options. Using the question and answer format, they enter a process leading to a fundamental change in how they view their health challenges. Appreciative medicine also restructures the physician’s role to that of a partner, working with patients to create new healing dynamics.

Using appreciative medicine, patients are encouraged to become proactive, take responsibility and assist in developing their own optimal health plans. On a regular schedule, they review their progress with their primary care physician and critique goals as they plan the next step. This system utilizes medical technological advances appropriately and to the fullest while building upon doctor-patient relationships of trust to provide the most appropriate choices. Appreciative medicine opens the door to a full range of healing strategies that include complementary medicine options, some of which have become almost routine, such as acupuncture for back pain or yoga to help lower blood pressure.

At the heart of appreciative medicine is a personalized approach that highlights patients’ unique, positive characteristics and targets solutions for optimal healing. Patients are empowered to access directions of choice by journaling, with the help of prepared guidelines in a question-answer format. This process of reflection and journaling benefits both patients and practitioners in subsequent office interactions. Written responses are carefully reviewed with practitioners, often propelling patients beyond their previous limitations.

Implementing an Appreciative Medicine Program

As in all new beginnings, professionals in the practice of medicine must learn how to implement new tools for change. It begins with us--one patient at a time. Appreciative medicine is not for all patients, but this inclusive approach can create a bridge that links the entire continuum of health care services, ushering in an era of health options based on partnerships and teams. Best of all, appreciative medicine offers an opportunity for us to understand the uniqueness of our patients and, at the same time, to recapture our enthusiasm for the healing arts.

Designing and implementing an appreciative medicine program is relatively simple: 

• Physicians and other practitioners are briefed on the “appreciative dialogue” method, including a journal-oriented workbook; they learn how to share the approach and resources with patients, schedule review conferences and measure results.

• Select patients receive the workbooks, along with invitational letters from their physicians or a program coordinator, which explain appreciative medicine and encourage patients to participate.

• Patients are asked to complete the basic workbook pages (objectives, modalities to explore, and summary), bringing their responses to health care providers for discussion and development of individualized treatment plans.

• Because the workbook allows for ongoing entries, patients are encouraged to continuously reflect on their progress and evaluate the efficacy of the treatment plans from their own perspective.

• After six to eight weeks, patients meet with physicians to review and monitor their progress and receive further direction in their treatment plans.

• Results of the program can be assessed by participating physicians and patients, accomplished in reviews and evaluations set up by an appreciative medicine coordinator. 

Appreciative medicine thus meets challenges that have long beset the health care delivery system: separation, isolation and fragmentation of services and healing modalities. This is a perspective that seeks to resolve several issues: separation between patient and physician, between practitioners in specialized areas, and between allopathic medicine and complementary disciplines. At the core of appreciative medicine are two basic principles: 1) deeper participation by those seeking health care and 2) increased efforts of primary care physicians to unify all treatments, guiding consultations through integrated and supportive protocols.

This is a solution-based, proactive way to achieve the goal of optimal health. Patients progress when they envision total wellness with the help of many professionals working together. Further, both patients and their health care providers benefit from positive outcomes that make a difference in the quality of life for all concerned.

V.  Meeting the Challenge of Widespread Chronic Illness

The time for change is upon us. Clearly, patients and physicians alike are looking for a more human-centered path to health care. Patients say they want choices, especially when it comes to chronic illness. But our health care system has become overwhelmed with costs, utilization and redundancy. We don’t deny that today’s medicine can excel in an acute health crisis. For instance, our approach can 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, conventional health care would have to receive a failing grade.

Physicians often end up placing patients in a maze, where they feel isolated and lost in an array of costly lab tests, x-rays, consultations with specialists and over prescribed pharmaceuticals. Our intentions may be pure, but our approach is flawed, often perpetuating “problems” inherent in the system. But we can go beyond particular “complaints” and adopt a better way that maximizes health.

I know of no better way to promote healthier living than by lifestyle modification. Yet, too often we are recruited to patch a problem rather than as partners in making a significant healthy lifestyle change.  Patients’ problems have become their “ticket” to see a doctor, leading them from one illness to the next. Over a million interactions occur daily within the health system—doctor appointments, emergency visits and countless ancillary care procedures head the list. In contrast, appreciative medicine empowers patients to become more independent; but actively involved in making positive lifestyle choices, which often translates to improved compliance.

After an appreciative medicine orientation, what did patients themselves report of most value in achieving renewed vitality? What did they do to gain balance and be able to enjoy life again? The following are typical of selections from patient journal entries, written in the context of the appreciative medicine approach:  “In my quest for optimal health, I… 

1. Am silent and listen.

2. Listen and trust; I believe in myself.

3. Understand how my body digests and utilizes food.

4. Walk, move, stretch every day.

5. Spend time in nature; I let it saturate my soul.

6. Avoid all negativity. I avoid all negativity. I avoid all negativity.

7. Optimize my innate healing systems.

8. Pray every day.

9. Celebrate my life.

10. Love--and don’t miss an opportunity to share it.

11. Breathe (fresh clean air).

12. Acknowledge what I feel.

13. Learn; every day presents new lessons.

14. Turn off the television.

15. Respect animals—to adopt one is to receive 100-fold payback.

16. Protect the environment; I am a trusted steward.

17. Volunteer; I have something unique to give.

18. Take the word procrastinate out of my vocabulary.

19. Respect myself as well as all people, animals, and things.

20. Keep a journal and write in it often.

21. Use all of my senses—touch, sight, hearing, taste and smell.

22. Forgive myself (as well as others); I strive to be nonjudgmental.

23. Love art in all its forms.

24. Am grateful; I am thankful.

25. Open to new experiences, ideas, and relationships.

26. Family time is a priority.

27. Drink water.

28. Eat healthy.

29. Plant a garden.

30. Smile (a lot).

In summary, medical doctors must take that first step, to learn about the new infrastructure provided by appreciative medicine. They must learn to partner with their patients on a true healing quest. All physicians should bring forth their resources for the common good, pursue creative dialogue with patients and develop personalized health plans that focus on wellness. Together we can effect not just a system of change, but also assist health care itself to take a quantum leap forward.

Tel Franklin, MD, is an award-winning physician, a nationally recognized speaker and educator in the field of integrative medicine, and author of Expect a Miracle (Celestial Arts).