Community as Medicine (Preview)

Re-Designing Healthcare

I’m Dr. Elizabeth Markle. I’m a psychologist, an innovator and entrepreneur in the fields of human health and well-being, a scholar of Intentional Community (literally, community shaped by design), and Co-Founder of Open Source Wellness.

Open Source Wellness participants enjoy a meal and small group coaching. Image courtesy of Open Source Wellness.

By Dr. Elizabeth Markle, Co-Founder of Open Source Wellness

Behavioral Prescriptions

My co-founder at Open Source Wellness, Dr. Benjamin Emmert-Aronson, and I have worked and trained in many different healthcare delivery systems: tiny clinics, federally qualified health centers, massive hospital systems, and the Veterans Administration. Our jobs were to provide mental and behavioral health support to patients, and consultation to doctors struggling with the behavioral aspects of their patients’ care—in clinics, hospitals, and even emergency departments. It was wild, wonderful, and profoundly challenging work!

During this time, we started keeping track of what we now call “Behavioral Prescriptions.” Back then, we just called them, “things that doctors tell their patients to do.” And here’s what we found: no matter the patient’s diagnoses—diabetes, hypertension, depression, anxiety, heart disease, etc.— and no matter the provider’s professional identity, (primary care doctor, specialist, therapist, case manager, etc.), 80 percent of patients were receiving the same four behavioral prescriptions: exercise more, eat better, reduce your stress, get some social support.

These big four behaviors and practices underlie human health and well-being broadly, and they are appropriate “prescriptions.” But here’s the part that made us apoplectic: the doctor would deliver these instructions, and then say something like, “Good luck with that! Take care now!”

Our patients, alone in a tiny sterile room, intimidated and disoriented next to their fast talking, rushed, and authoritative doctor, would look down and meekly say, “Yes, ok, I know, I should, I will, ok…” and that would be the end of the visit. Until the next time we saw that same patient, often in the emergency room, for a predictable worsening of their chronic condition, and the conversation would repeat…









From Design Museum Magazine Issue 017