machado: prescriptions for pleasure reimagines care in a system that can barely hold itself up
sexual satisfaction, social connections, and spending time in nature are all things that impact our physical and emotional well-being — just as important as anything we can get from a pharmacy.
7 minute read
about 20 per cent of patients consult their family doctors for social issues, an indication that maybe proponents of social prescribing are, in fact, onto something. getty
it’s now jokingly known as the “green tea emergency,” but at the time, there wasn’t anything funny about it.
an emergency doctor from a north toronto hospital was on the phone, said the nurse, as she popped her head into the examining room. my oncologist and i had just begun a debate about whether or not the daily medication that i took had anything to do with the skull-crushing headaches i was waking up with every day.
as he left to take the call, i decided to wave the white flag — debating side effects was mostly a losing battle with him. he was about the science, he’d say, rhyming off the most likely reasons for said side effect. in this case, my head was pounding probably because of stress, dehydration, or not enough sleep, he reasoned confidently, standing up, leaving to take the call.
when he came back, he said that one of his newly diagnosed patients had been admitted to hospital with severe nausea and vomiting, and test results were showing worrying changes in his blood work. after talking to the patient’s wife, it was ascertained that the man had been drinking close to a gallon of green tea every day — roughly 16 mugs — to, as she put it, help with treating his cancer.
turns out the guy, a life coach, was a worrier, she had explained to my oncologist. he hadn’t slept in weeks, pacing back and forth beside his bed in the dark, stressing about the possibility that the medication would stop working and that it was poisoning his body. they had also been having some marital problems since his diagnosis, she volunteered, with the constant brooding and panic weighing heavy on the romance.
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the solution was to stop the green tea and see if the numbers corrected themselves and the symptoms disappeared, which is what all the experts involved expected would happen. i imagined that then the bye-byes were said and off they went.
arguably, from a patient perspective, while the green tea overdose in itself was worrying, and could have had serious consequences (the patient recovered, as did his marriage, i am told) it did highlight the importance of addressing the pressures that led him to gulp the tea in the first place.
doctors should make patient care about more than test results
the story replaced our headache debate, igniting a discussion not only about the impact of mental health on how we treat our bodies, but also, how perhaps doctors need to make conversations with patients about more than just a numbers game. of course, how your health condition is responding to treatment is critical, but that’s not all that determines how “well” a person is doing.
around the same time, the cancer communities that i worked with began to share more and more stories of patients getting sicker because they weren’t taking their medication the right way — skipping doses or cutting tablets in half for a whole bunch of reasons, including that they didn’t want a reminder that they had cancer, the side effects were unmanageable, or they were worried about the health impact of long-term medication. and those were just the health-related reasons. other answers given to justify not following treatment instructions were dealing with the loss of a loved one, difficulty with sexual relationships, depression, loneliness, workplace issues and marital breakdown.
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perhaps it should be a best practice, if, right alongside the clinical discussion about platelets and hemoglobin, there was a compassionate check-in on what was keeping the patient up at night. and not only the things that had to do with their physical well-being, but also what was happening with other gritty “life” stuff, like relationships, love, work and sex. after all, can you really fully treat a patient without knowing their whole picture?
social prescribing reimagines the meaning of a prescription
there are many who don’t think so, if you consider the growing popularity of ‘social prescribing,’ where some healthcare providers are reimagining the traditional clinical meaning of a prescription — a way to get medication — and instead, turning it into a referral tool to connect patients to their community in ways that benefit their health.
it’s a method of care that requires conversation and time spent going beyond what tests show and identifying the social needs of a patient. it adds minutes (gasp!) to visits that are shaped around turbocharged diagnostic decisions, but it could mean that, instead of a prescription for a bottle of pills, a patient leaves their doctor’s office with something more fitting with their needs, like a recommendation to take a daily walk in a forest, attend an exercise class, or take part in a mental health support group. think of the difference this way of treating could make to the life of a lonely widower struggling with depression or a burned-out executive. even the green tea guzzler might have avoided a scary er visit had someone asked him about how he felt about having a rare cancer and what state his marriage was in.
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it’s also a health equity tool — tearing down the barriers to access that may face a patient, which could be anything from psychological to economical, so that they can be empowered to improve their health and well-being.
certainly, not everyone believes that a walk in the park or a few hours spent in a soup kitchen is enough to cure the non-clinical things that ail us. but there are a plethora of organizations around the world studying and promoting the concept of using social interventions to improve health — the national health service (nhs) in the u.k. and the canadian institute for social prescribing (cisp) are just two. and while solid supporting data is hard to find, according to researchers at the university of plymouth, about 20 per cent of patients consult their family doctors for social issues, an indication that maybe proponents of social prescribing are, in fact, onto something.
imagine getting a prescription to hang out in a park
but despite some of the challenges in quantifying the impact of social prescribing, which the university of plymouth study authors identify as inaccurate tools to measure benefits, differences in perceptions of what constitutes a social prescription and lack of resources, the idea that a doctor’s advice can — and should — include more than just the worn ‘eat better, exercise, and get eight hours of sleep’ rhyme is gaining traction globally and nationally.
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take, for instance, canada’s parx program which allows healthcare providers to prescribe free national park passes to patients who they think would benefit from more time in the great outdoors. the initiative, founded by family doctor dr. melissa lem, originally began in british columbia and has since been expanded to other provinces with the help of a partnership with parks canada.
“nature is good for a wide variety of conditions, from diabetes, to high blood pressure to adhd and depression, there’s almost no health condition that nature does not make better,” lem told forbes.
last year, dr. dominik nowak wrote in healthing about one of his patients, george, who had lost his partner to cancer. nowak, who practices at toronto’s women’s college hospital, and is the president-elect of the ontario medical association (oma), acknowledged that while george needed mental health treatment, just as important was a “prescription” for the loneliness he had described since his partner passed.
“we talked about a prescription for ‘social connection,’ and what that might mean for him,” wrote nowak. “george chose to take a step to re-finding his sense of purpose and connectedness by volunteering with a local hospital.”
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identifying and helping with intimacy issues might be a little more intense, especially since the topic can be awkward for both patients and doctors. but in a recent medscape commentary, dr. pebble kranz suggests that primary care doctors should offer a “pleasure prescription” for patients who are living with chronic illness.
doctors should ask about sexual satisfaction
kranz, a sexual medicine specialist, advises doctors to regularly ask their patients about sexual well-being and pleasure, determining the level of importance they ascribe to sex and then using three questions to evaluate how things are going: what are the patient’s goals, what does sex mean to them, and what kinds of sexual play are important for their (and their partner’s) pleasure.
just like social connections and interacting with nature, sexual satisfaction also has health benefits, she adds, “influencing health through improved survival, improved medical adherence, better quality of life for the patient, and improved life satisfaction.”
although providing tips on sexual satisfaction may not fall into the category of social prescribing exactly, what it does do is remind clinicians that asking the not-so-obvious and sometimes difficult questions — the ones that take time and emotion — can go far, not only in terms of ensuring that care includes the “whole” patient, but also that outcomes are the most positive possible.
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and perhaps the associated reimagining of what it means to “treat” health challenges goes even further, offering solace in a healthcare system that can barely hold itself up, let alone those that desperately need it.
lisa machado is the executive producer of advocacy & better health.
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