Saundra Jain, MA, PsyD, LPC, and Andrew Laster, MD, on Wellness for Patients With RMD: Part 3

Drs Jain and Laster continue their discussion about wellness for patients with rheumatic diseases, focusing on practical tips for clinicians to help their patients implement specific wellness practices.

Saundra Jain, MA, PsyD, LPC, is an adjunct clinical affiliate at the University of Texas at Austin with the School of Nursing a psychotherapist in private practice in Austin, Texas. Andrew Laster, MD, is a rheumatologist in private practice in Charlotte, North Carolina.

Listen to podcasts 1 and 2 here and here.

TRANSCRIPT:

Welcome back to this podcast with Drs Saundra Jain and Andrew Laster on wellness for patients with rheumatic disease. Today they’ll be discussing some practical tips on how to incorporate these practices into visits with patients in the clinic.

Dr Laster: Sandra, we've gone over these 5 elements. It's a lot at first glance to incorporate. I know you've spent a lot of time working with clinicians and busy practices and you have a real appreciation for these wellness behaviors. So tell us some practical tips about how the busy provider can begin to incorporate the things that we've been talking about today.

Dr Jain: Oh, I'd love to talk about that, Andy, but before I do that I'm smiling because earlier I said, "Ooh, sleep and social connectedness, 2 of my favorites." But as I'm listening to you talk about exercise, diet, nutrition, mindfulness, I'm thinking, "No, that's my favorite. No, I really like that one." So I just made my own point. We should never rank-order because we simply don't know what our patients are going to gravitate towards. We want them to dip their toe in all of them over time so they can really decide for themselves which they can actually sustain long term. When you mentioned exercise, I just read an article, you may have seen it, it's a recent meta-analysis that was published in Sports Medicine. And they reported that just 2 to 5 minutes of walking after a meal positively impacts wellness by improving blood sugar levels. It was just so fascinating. And of course, 60 to 90 minutes was better. But I still like the fact that they took something that can sound overwhelming even to me, 60 to 90 minutes total? Like, okay, I'm not sure I can pull that off. But 2 to 5 minutes, that's a bite-size chunk. I can do it and I'm more likely to keep doing it.

So, yeah, there's just so much to share. It just makes me so excited. But I want to go back to what you asked me to talk about, which is how do we take all of this great information, these great practices, these complimentary practices and integrate it into what we know is a busy clinical practice for all of us? Time is a precious commodity. There never seems to be enough of it. But I really do have some good news for all of us. We do not have to tackle all of these wellness practices that you and I have just reviewed all in one fell swoop right in that first encounter. We can break it up. We can spread it out. We can chop it into bite-size chunks across several different appointments or sessions with patients.

I think the other piece to that that really increases our chance of being successful, helping our patients be successful is we can ask our patients, what do they think they can handle? What's doable for them so we don't overwhelm them with too much information all at once? And the thing you talked about, Andy, that I absolutely love and just want to stress for our listeners is this, I loved when you said, "Ooh, I use apps," but it's not like you're just telling your patients. You're actually showing them and letting them see what it looks like. And I think that is just one step closer to really engaging our patients.

I'll add a couple more practical tips around how we really integrate this successfully without it being too big of a burden. This has worked really well in our practice, that we offer our patients handouts. And again, we're sort of dinosaurs. We do at the old-fashioned way, printed paper. But those can be shared electronically as well either via email, a text, patient portal, just so that patients have access to what we call enduring materials, something they can go back to, review it later, try it in between appointments or in between sessions. I think that just makes it more likely that they will be successful.

And at each visit, I always try to ask patients, "Hey, with regards to the wellness stuff we've been talking about, what's working for you? What are your successes? What kind of challenges are you encountering?" Those kind of conversations and take homes, those practical tips, I think are very, very helpful in making it not overwhelming for us nor for our patients.

I don't know, you may have already answered this, Andy, but maybe just in sort of us chatting back and forth, I'm wondering for you in regular clinical practice, what else have you found to be really effective in engaging patients and sustaining their motivation, increasing their motivation to just stick with these practices?

Dr Laster: Yeah, I think you pointed out a number of them, Sandra, that the enduring materials and actually showing them something. Both Sandra and her husband Rakesh have an incredible program called The Wild 5 Wellness Program. And there's a 30-day and a 90-day one. And I have the book and I'll ask patients to go ahead and take a picture of it on their phone and go ahead and look at it on Amazon. And it's a great workbook. Dr. Calabrese at the Cleveland Clinic has developed a monograph on wellness which is not copyrighted and readily available to everybody, and so we provide that or have the link posted on our website. And again, showing them the apps for wellness. I think when patients can see that and it's concrete, it definitely helps to motivate them. And then when they come back for follow up, we talk about that. And well, "What did you think about this? And have you begun to incorporate any of that? Do you have any questions?" And as you pointed out, look, we take care of patients who have chronic disease. This is not a one type visit thing, and patients know that we're going to be following them over a long period of time.

Be sure to join us for part 4 of this podcast on wellness for patient with rheumatic diseases, as Drs Saundra Jain and Andrew Laster discuss the power of positive emotions in enhancing a sense of well-being and wellness among these patients.