An Appreciative Clinic
Appreciative Inquiry is all about dreams. In fact, it is the second step in the 4-D framework that Dr. Cooperrider devised in the 1970s (i.e., discovery, dream, design and deliver). What would my dream clinic look like?
In my dream clinic, I wouldn’t see people for their chief complaints, but rather for their greatest desires. I wouldn’t ask about deficits, such as swelling, pain or stiffness, but start by asking what they dream of doing if their disease were under better control. I would solicit stories of their everyday lives and what gives purpose to their existence—and then co-design a management plan that would get them to where they would want to be.
Of course, that is my dream. It is a dream I am sure is shared by many of you. To be honest, that dream is still far away, but Appreciative Inquiry can help us begin to figure out how to make this into reality.
For example, we can alter our own practices to embrace a more supportive patient model. In fact, I’ve already started to change the way I solicit the review of systems. Instead of inquiring about a laundry list of symptoms, I ask my patients, “If it is applicable, tell me a story about how the symptom I’m asking about has impacted your life.” Yes, it takes a little longer, but the data are so much richer. I find I’m repeating myself less and less because a more comprehensive narrative starts to emerge.
Another, quick way in which I apply Appreciative Rheumatology in the clinic is that I ask patients, just before their assessment and plan, what their dreams are and how I can be of service. I get robust answers to guide what type of pharmacologic and non-pharmacologic approaches I may incorporate to support that patient’s care.
I’ve clocked how much longer it takes to implement these practices, and for each patient, it takes only two extra minutes. The decision is simple: Spending two extra minutes with the patient is a worthwhile endeavor.
Solution to Burnout?
On a similar note, I see Appreciative Rheumatology as a potent tool to address the pervasive and seemingly insurmountable problem of burnout in the rheumatology community. Our current perspective seems to emphasize the features that lead to burnout (e.g., electronic health records, prior authorizations, poor salaries and moral injuries stemming from chronic illness and healthcare disparities). Reducing these through mandatory yoga sessions and online modules simply is not going to be enough.
