I recently had the opportunity to hear visionary physician Wayne Jonas, MD, speak on the topic of “How Healing Works.” which is the title of his latest book. Jonas emphasized that “a full 80% of healing comes from constructing a meaningful treatment response, unique to you, which is internal and highly personal, using simple principles and components.”
In his presentation titled “From SOAP to HOPE,” Dr. Jonas explained how health care professionals, including dietitians like me, have been taught how to organize their thinking around a patient encounter. Electronic medical records are also built around the SOAP methodology. “S” stands for “subjective” or the patient’s chief concern. “O” stands for “objective” or what the health provider observes (from the physical exam, lab tests, or image results). “A” stands for “assessment” or the provider’s opinion regarding the reason for the presenting symptom or chief complaint. This generally includes the diagnosis or diagnostic code entered into the medical record by care providers with authority to assign diagnostic codes. “P” stands for “plan,” which is what to do about the diagnosis, whether a treatment, advice, or further assessment and testing.
Dr. Jonas points out that “SOAP uses a pathogenic framing: it is about disease and illness, not healing. It is the way modern medicine diagnoses diseases and aligns them with treatment … This then restricts what is allowed in health care. It keeps modern medicine focused on seeking cures”… rather than taking the time/effort to support healing and quality of life.
To balance the standard medical encounter with healing, Jonas encourages following up the SOAP process with a HOPE note. He explains that “HOPE stands for healing-oriented practices and environments, and it addresses dimensions of physical, behavioral, social/emotional, and mind/spirit” – [to] “tap into the 80% of how healing works.” The HOPE questions proposed by Dr. Jonas “probe how the person is already engaged in healing, and then seeks to match that with good evidence to enhance those activities. It highlights what the person has intuitively discovered and adds the rational elements derived from rigorous research.”
For those of you interested in healing, either for yourself or for helping others, Jonas’ book HOW HEALING WORKS will inspire you and provide you with hope. And for more on Dr. Jonas and his work to heal the health care system, visit his website.