PERSONAL HEALTH PLAN

During the appointment, Jim’s clinician talked with him about the mind-body connection.  The clinician described that stress can cause or exacerbate back pain.  He educated Jim about common grief reactions and anticipatory grief.  He pointed out that a number of the symptoms Jim reported were consistent with grief.  He reflected back to Jim how important the relationship with his nephew was to him. (Jim had said that fishing and going to baseball games with his nephew brought him joy and happiness.  Jim was also looking forward to starting new activities—like setting up a woodworking shop—with his nephew when he retired.)

Jim and his clinician have a good relationship.  Jim has often said that he trusts his clinician.  Jim’s responses to questions about purpose and meaning in his life—“It’s hard to find purpose and meaning sometimes when you’ve seen some of the things I’ve seen in the service,” and, “It would be good to feel at peace; I’ll keep trying”—caused his clinician to question if Jim has ungrieved losses from his combat years that are compounding his anticipatory grief reactions over his nephew. 

Knowing that Jim could be at risk for disenfranchised grief his clinician gently asked, “Jim, is there anything from your years in service that is still troubling you?”  The timing was right.  The clinician noted similarities between Jim’s nephew and situations Jim had seen during his work as an EMT.  Jim mentioned guilt over both situations—guilt that he was surviving and many of his patients did not and his nephew might not. 

Jim’s clinician asked him the five questions in the Brief Grief Questionnaire.  Jim scored a 3, which is not indicative of complicated grief.  While Jim’s diagnosis did not indicate a strong need for a referral to a mental health specialist, he has some issues that he may want to explore to promote future health and happiness.

Together Jim and his clinician developed a Personal Health Plan (PHP) that was do-able with Jim’s current energy level.  They will revise it as needed. 

(Note that this is an elaborate PHP; the level of detail will depend on the amount of time available, what else needs discussion during a visit, and how well Jim’s clinical team members know him.)  Even setting 1-2 initial goals is a great start to a plan.

Name: Jim

Meaning, Aspiration, Purpose (MAP):

Increase my awareness of how grief is affecting me and to focus on ways to increase my health so that I can enjoy my retirement and be actively involved in the lives of my sister and nephew.

My Goals (will focus on the first three to begin):

• Increase awareness of mind-body connection when experiencing symptoms.
• Keep track of amount of sleep each night.
• Explore issues of grief and forgiveness.
• Start gentle yoga.
• Receive acupuncture treatment.
• Balance providing support for my family with taking care of myself.
• Improve nutrition and limit alcohol intake.
• Explore new leisure activities.
• Spend more time with others.
• Spend time outdoors.

Strengths (what’s going right already)

• Family, friends, neighbors.
• Not giving up.

Challenges

• Nephew's condition and sister's well-being.
• Fatigue and pain. 

My Plan for Skill Building and Support

• Mindful Awareness:
  • • Pay attention to my thoughts, especially when symptoms are worse.
• Areas of Self-Care (will focus on one at a time, but these are all the potential options):

• • • Physical Activity
      • Attend a weekly yoga class offered at a local senior center.  Ask the instructor about her credentials and tell her about my back pain and the limitations with my knee.  If her responses feel right, join the class or inquire about other classes focusing on gentle yoga.  
    • Surroundings
      • Spend time outdoors in a restful setting (my yard or near a lake) at least 30 minutes twice a week.
    • Personal Development
      • Plan new leisure activities for retirement.  Purchase trade magazines to research the woodworking tools I may want to purchase.
    • Nutrition
      • Pay attention to the amount I eat.  Focus on something other than food when I am worried.  Gradually add more healthy foods to my diet—fruits, vegetables, healthy fats (such as olive oil), and whole grains. Have no more than one drink containing alcohol per day. 
    • Recharge
      • Continue to follow good sleep hygiene practices.  Track how many hours of sleep I get each night and bring to next appointment. 
    • Family, Friends, and Co-Workers
      • See sister three times a week and visit nephew in the hospital twice a week, which allows me to be supportive without daily hospital visits. Chat with a neighbor at least once a week. Contact a grief support group for information.
    • Spirit and Soul
      • Consider scheduling a counseling session with my sister's minister
    • Mind and Emotions
      • Work on forgiveness for the following issues: some experiences during work as an EMT, the person who caused the crash that sent my nephew to the hospital, and myself for mistakes I’ve made in my life. Consider seeing a grief counselor (pastoral counselor, psychologist, or social worker).

Professional Care: Conventional and Complementary

• Prevention/Screening
  • • Up-to-date
• Treatment (e.g., conventional and complementary approaches, medications, and supplements)
  • • Acupuncture to prevent lower back pain from turning into a chronic condition
    • Grief/forgiveness counseling (future)
    • Yoga
• Skill building and education
  • • Forgiving
    • Grief rituals
    • Leisure activities for future retirement
    • Nutrition
    • Spirituality

Referrals/Consults

• Acupuncturist
• Grief counselor—pastoral counselor, psychologist, or social worker

Community

• Minister
• Veterans’ group
• Yoga class

Resources

My Support Team

• Acupuncturist
• Grief counselor
• Minister
• Primary care clinician
• Yoga instructor
• Co-worker
• Neighbors
• Nephew
• Sister
• Support group

Next Steps

• Professional and self-care as outlined above.  Return visit in 8 weeks, sooner if symptoms worsen.

Please Note: This plan is for personal use and does not comprise a complete medical or pharmacological data, nor does it replace medical records.

FOLLOW-UP WITH JIM

Jim returned for a follow-up visit in eight weeks.  He reports his back pain is mostly gone, his sleeping has returned to normal, and he has more energy.  His nephew survived and is in a rehab facility.  Jim has identified two unexpected ways to help his family and increase his own health.  As his back pain decreased, he took over the care for his nephew’s dog and is now going for daily walks.  He has decided to plant a garden (which he did years ago with his wife); helping with the garden will also be good therapy for his nephew.  Jim’s nutrition has improved somewhat.  He does not feel ready to cook most meals.  But he is now motivated to eat from the salad bar at the local grocery store at lunchtime on workdays.  While there, he has been purchasing oranges, berries, carrots, and peapods that he adds to the meals he eats at home.  He is no longer consuming alcoholic drinks daily.  To his surprise, Jim has enjoyed the yoga class with his co-worker and practices a few poses at home between weekly sessions.  He has had three acupuncture sessions with several more planned.  Jim has obtained the contact information for a grief support group in his area.  Jim met with his sister’s minister twice.  The sharing they did was cathartic for Jim, and he is now ready for a referral to a grief counselor to work on issues of forgiveness.