Chapter 3: The Healing Encounter

Question 1

What are the goals of a healing encounter

Answer 1

• salutogenesis! (vs a pathogenesis-focused encounter addressing the creation of a disease)
• healing process allows both pt and clinician to b transformed together

Question 2

Rank in order of increasing effect size: self-healing, intrinsic power, mode of therapy, and relationship.

Answer 2

1. self-healing (regression to mean)
2. intrinsic power (ie a steroid vs nsaid)
3. mode of therapy (injection > cream > pill)
4. relationship (clinician effect)

They have accumulative power.
Example is from arthritis treatment. “Maybe it is poking people with sharp things that has the largest effect? And if there is a kind, caring, and compassionate person in whom someone trusts poking them with sharp things, the healing effect will be greater.”

The gold standard in medical research, the double-blind placebo-controlled trial, focuses on removing nonspecific variables that can often be more powerful than the pill or procedure being studied.

Question 3

What are he nonspecific effects that have been most thoroughly studied in influencing healing in the clinical encounter?

Answer 3

PEECE:
1. Positive prognosis
2. Empathy
3. Empowerment
4. Connection
5. Education

Question 4

True or false: the personal practice of clinicians may influence the outcomes of patients in their care.

Answer 4

True. (A study of psychotherapists in training found that the patients under the care of those therapists who practiced mindfulness had better outcomes and greater symptom reduction than the patients of therapists who did not practice mindfulness.)

Question 5

What is empathetic distress and how to combat it?

Answer 5

• It is negative feelings, withdrawal, nonsocial behavior, and even burnout that can arise from feeling someone’s suffering all day
• Compassion training can combat this.

Question 6

How do provider insight and intuition benefit from long-term patient relationship? What is the effect on healthcare systems?

Answer 6

• We get more information from repeat continual encounters with a patient, so our isnsight and intuition are increased and become more accurate
• Strong primary care infrastructre results in 15-fold return on investment
• Loss of PCPs lead to increased urgent care and ED visits

“when trust is present, healing happens quickly and inexpensively. When there is lack of trust, it goes slowly and costs a lot of money” - Steven Covey

Question 7

What are the three Ps of a healing encounter?

Answer 7

1. Pause - before entering the exam room and direct full attention to the pt.
2. Presence - physically ground yourself, check in with your body, be mindful and alert, be present.
3. Proceed - use the insight that develops to help create a plan that both pt and clinician think will be of benefit.

But first you must self-reflect! Be aware of biases / beliefs.

Question 8

How can you make the act of giving prescription more effective in the context of a healing encounter?

Answer 8

The power of the ritual process around the actual Rx should be tapped into. Give written recommendations to patient at end of visit. It’s a ritual transfer of knowledge and sense of control.

Question 9

What are 5 questions to consider before prescribing a therapy?

Answer 9

1. Does the therapy result in symptom resolution or suppression?
2. What is the evidence?
3. What is the potential harm?
4. What is the cost?
5. Does the therapy match the pt’s culture and belief system?

Sx resolution is always preferred over suppression, when possible.

Question 10

What is one risk of a salutogenesis-oriented session (SOS) and how to handle it?

Answer 10

SOS is a longer session (often protected time in a clinic in a therapeutic space, where you have set expectations ahead of time with the patient) to dive more deeply into issues underlying health symptoms. It can bring up past traumas. Likely need to collaborate with a psychologist.