Social prescribing in the clinic
I recently listened to the Salugenology Ologies episode, which really sent me down a (good!) mental rabbit hole. Salugenology, or maybe more accurately salutogenesis, is the study of health practices that maintain or create wellness. In many ways, it's the opposite of pathology/pathogenesis, or the study of what makes us unwell or causes disease.
Alie Ward
Most of our Western healthcare model has historically focused on discovering what makes us sick and how to treat the diseases we've discovered. Which, of course, has been vitally important and has extended lifespans. But Western medicine hasn't spent nearly as much time learning what helps us create health - and now, with our longer lifespans, I think we're learning that just treating disease may not be enough.
The podcast guest, Julia Hotz, is a journalist who wrote the book The Connection Cure. Interestingly (at least to this introvert), social prescribing isn't about socializing, per se - it's about connecting to things that matter to you. In the podcast, Hotz lists the key factors:
- Movement
- Nature
- Art
- Service
- Belonging
All of these are characteristics of activities or hobbies that help contribute to improving health. The more factors that are layered into an activity, the more positive health outcomes it seems to have.
The key focus in social prescribing is connecting people with well-vetted programs/activities and reducing barriers to attendance, such as finding specific times in schedules that work, accessing assistance to help pay for programs (like discounts with gyms through health insurance), etc. - not just telling people they should pick up a hobby and leaving them to it.
Hotz sums up the idea of social prescribing as shifting the focus from "What is the matter with you?" to "What matters to you?" - and helping people find a way to do more of those things.
As I listened to the podcast, I couldn't help but compare our Western medical model, which struggles to incorporate this type of care into short appointments, to how we can practice in our acupuncture clinics. There are lots of pluses in favor of our model: We often have longer appointments and more autonomy in how we practice. Often, we're cash-based, so we are free to include different aspects in our appointments if we choose. All of these factors make it easier for us to incorporate a social prescribing aspect into our care.
But, even deeper than that, "social prescribing" echoes the concept of yang sheng (nurturing life) practices that are foundational to Chinese medicine. Qi gong is a movement practice often done in community and often outside, providing a sense of belonging (4 aspects). Adjusting our lifestyle to the season helps us be more in tune with nature, and there is a community of people celebrating these seasonal changes alongside us. Chinese and East Asian medicine have promoted "wellness" (longevity) practices for a long time.
But, when it comes to integrating the prescribing aspect - with a focus on well-vetted programs and helping reduce barriers to access - this can be tricky. There aren't always Qi Gong classes or groups where we live; there may not be a community practicing the seasonal changes. How can we find and vet resources for our patients? How can we more effectively connect patients to health promoting activities outside of their appointments? We're not social workers, and there are limits to what we can accomplish in a single visit.
One thing I have tried is getting more specific on my recommendations. For example, I created a Meditation page on my website that has links to local meditation meet ups (with the day/time/location listed), online meditation meet ups, some articles, and more. When I recommend meditation to a patient, I can point them to this page as a starting point, and I often try to recommend a specific link for people to check out.
Think about some of the things you regularly recommend to patients; how can you create a resource that reduces some of the friction patients face in trying something new? Maybe that is a webpage or a handout you can give them. This doesn't mean you need to create something new for each patient - just the opposite! By creating a handout or link that you can provide, it lets patients reference it later and makes it easier to remember, which is much better than a verbal instruction that is quickly forgotten when people leave after their appointment.
Another thing I love to ask patients is "What is something you'd like to do, but are putting off?" Or "Is their a hobby or past time you've been wanting to try but haven't?" (Or other variations on the theme of "what's something you're looking forward to?") Inviting people to share something that interests them is a great way to see what you're working towards, update your treatment goals, and maybe encourage people try that thing they've been putting off - or even help find a way to make it happen!
Do you have a method for sharing resources for your patients? What works well for you? Share in the comments below!