For the past three years, I have been providing primary care and functional medicine consults within my home office (see pictures below) and sometimes within the client's home, particularly when I was meeting with a family with #children. This really has been exceedingly joyful, but it also invites a number of challenges. One being that I am sitting in my car far more than I desire. What I had done previously, with my midwifery practice, was all-consuming and a seemingly never-ending challenge to overcome. I had no desire to return to that level of practice again, that is, until I dug in, discovered what is most authentic to me, and found a partner who helped me see a new vision.
As clinicians we aren't taught how to execute the skills of owning a business. We focus on being advocates for our clients, understanding the literature and how best to apply that to clinical care, and how to truly connect with our clients. We seek to heal. The reality is that conventional medicine really doesn't allow for much of any of this, as we barely have time to #diagnose and #prescribe. Our training fails to really build the skills required to create that healing environment, let alone a therapeutic relationship.
This was my previous home office for the first three years of practice, including the quiet months of isolation through the pandemic. Healing environments are necessary for both the client, and the clinician. It was also my office when I first opened my midwifery clinic in 2007. We met with pregnant women here for about three years as well, until the practice grew too big for the space.
As we've made our transition into full scope practice and secured a new clinic location in Carmel, every step along the way has caused me to pause and ask myself, "is this authentic to me and my mission for this practice" even when it may oppose a more cost-effective approach? What was it that made my prior practice successful that I need to capture once again and how might I recapture this without overwhelming myself?
When we were looking at space, I sought a site that not only allowed sufficient space to meet with clients, but also space to implement the wellness practices we so often recommend. A #yoga studio within a medical clinic seems like a great deal of space to pay for without likeliness of seeing sufficient return on investment. I suppose with a different mindset this would be a bigger concern, but for me, my focus is on achieving genuine outcomes for my clients which are long lasting. Application is so often the hurdle when we offer integrative and functional wellness plans. Having space for education, yoga, #mindfulness, and maybe some light weights means wellness plans can be immediately implemented and as importantly, I am offered opportunity to self-invest so that I can avoid professional burnout.
As most are familiar, yoga demands a certain feel, a relaxing and balanced environment. We have spent hours muling over paint colors, various chairs, and storage options. We want to honor the commitment to peace and tranquility while also being respectful to our Mother Earth, yet eco-friendly yoga mats are many, many times more expensive than their plastic or foam counterparts. Add cork yoga blocks to that and the coin purse is quickly depleted. This extends into choosing flooring, medical equipment, and even decor. What we choose needs to be environmentally friendly if we are to remain authentic to our vision.
We have our website to update, a new logo to implement, and extensive educational programs to streamline, even professional coaching programs to roll out. Jeremy is fast on the mark in this regard. We've researched, consulted many, received quotes, dreamed, critiqued, and finalized a great deal more plans than I would have ever imagined just a few months ago.
Healing Intentions & Personal Wholeness
This healing environment goes far beyond the clinic and immediate work environment however. Our mind, body, and spirit directly impacts our potential for healing. This internal environment is vital. Our thoughts, emotions, and spirit have a direct effect on our genetic expression. Our inner beliefs and expectations foster what type of healing and wellness can be achieved. Self-awareness, self-reflection, and most importantly, true embodiment is necessary to own internal wholeness. We really can't connect with intention until we have explored our own inner nature.
As a healer, we really do have to prepare ourselves first. We have to get into therapy if that's what it demands. We have to foster cohesion within our body, mind, and spirit. As this connection grows, our ability to sit fully with another suffering human will be enhanced, and appreciation in this work will grow. We will start to see the beginnings of this when we can better sit in traffic and manage those who would otherwise easily irritate. We will find a sense of peace within the chaos. We will come out of our triage mode, out of a sympathetic dominant state, and rest in our parasympathetic nervous system. Savasana.
When working with clients, this means addressing trauma as we address obesity. This means addressing toxic relationships as we address insulin resistance. It may mean addressing self-worth while navigating sexual dysfunction. The 15-minute "problem-focused" office visit that only addresses the most prominent symptoms and disease is the current conventional medicine model, but this falls short of true healing. A practitioner who seeks to heal will work to determine what each client requires for their own healing journey.
Having taken a few years to really evaluate my practice and to envision what I want into the future, my thoughts are these, healing is more than symptom relief. That simply isn't good enough. Vitality is what I want for my clients and for myself; however, this requires a much different approach.
Practitioner versus Pill
The mind often attributes healing to external influences such as drugs, herbs, and acupuncture needles. These are often the most studied variables and so believed to offer the most benefit, partly because they can be easily quantified. The gold standard in 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. These nonspecific variables include those aspects of care which are harder to quantify, such as trust, empathy, a sense of control, and compassion. These are key to the healing encounter.
When I was working as a midwife, I would offer my clients a fairly large stack of cards with various points that I would ask them to prioritize. These included such things as being able to move about or eat as they desired, not having their newborn taken away from them, having breastfeeding support, birthing in water, avoiding a cesarean, birthing at home, making their own choices, and trusting their provider. Essentially 100 percent of the time over more than a decade in practice, each and every couple would choose having a safe birth as their first priority and then trusting their provider. Homebirth was not about fad; it was about being in an environment they could be an active participant, with a practitioner they had developed a relationship. Our outcomes were phenomenal.
Mindfulness in Practice
Medical training conditions us to label patients with disease and ultimately to find the right pharmaceutical for their treatment. As we become more equipped at applying these labels we can detach a bit from even recognizing the individual behind the label. We watch the disease progression and look for patterns and diagnostic criteria, but don't really investigate or come to know the person beneath. There are more than 68,000 differentials with which we can diagnose a client in the tenth edition of the International Classification of the Disease code book, much to demand our attention.
How might we work to intentionally come to know our clients and their needs for healing? Funny enough, this is often about self-investment. Studies have demonstrated that therapists who practice mindfulness have better outcomes and greater symptom reduction in their patients than those who did not practice mindfulness. The personal practice of clinicians may influence the outcomes of their client's care and allow them to engage in a therapeutic relationship with more intention and awareness.
When we serve others, we must keep in mind that we can't give more than what we offer ourselves. There is nothing like a difficult patient to show us ourselves, right? We must not listen simply with intention of developing a reply. We must sit in the consult and simply be, without preparing to speak or label or diagnose or even prescribe. Just be. Taking notes without bias, without writing our own narrative. We must set aside what we know, feel what clients are communicating, and then communicate this back to them so they know they were heard. They may not even remember what you said, but they will remember how you made them feel.
Insight and Intuition
Insight requires empathy. Intuition is both subtle and complex. It's a process of perception, of incorporating a variety of different unrelated bits of information and arriving at a logical conclusion. Some of this isn't even conscious. The more information we have, the more accurate the intuition. If we see our clients only as a label, as their disease, then we limit ourselves to the training we obtained in medical or nursing school and this additional information we obtain through listening and feeling will not be incorporated into our care. This is why ongoing face-to-face relationship-centered care is so important and enhances the accuracy of our intuition and insight. It makes us more accurate as clinicians.
Consider that often we may prescribe a treatment or therapy that the client doesn't initiate, and then we, as clinicians, feel if the client would simply do as advised their health would improve. Might "noncompliance" be failed communication and the practitioner having failed to really listen and understand what might best serve the client? Are the practitioner and the client working towards different goals? Our focus might better be, "what matters to you," more so than "what's the matter with you."
Individuals know whether or not you rare truly present and listening. If they sense that you are compassionate and attentive, they will feel more comfortable and will often share important information and amazing stories. Creating this space is critical for healing. More meaningful conversations result. Many times as clients share their stories, they discover the underlying cause. This insight can be empowering and help motivate them to create change themselves. We should give our clients what they need before we give them what we know.