Family doc shines a light on health care's emphasis on patients' weaknesses rather than their strengths.
By Anthony Fleg, M.D., M.P.H.
From the second Tim came into the emergency room, he was labeled “alcoholic.” Tim had had two alcohol-related hospital admissions in the last month. As a family medicine intern, I should have looked deeper, but admittedly, I, too, defined him by his addiction. On the night before leaving the hospital this third time, he asked the nurses if he could borrow a pen. He worked all night using a scrap of paper to draw up his vision of wellness and sobriety. And as he walked out of the hospital the next day, he handed me the drawing (below), letting me know that "artist" is the trait he would prefer to be known by, should he come to our hospital again.
The experience had a profound influence on me. Why hadn’t any of us, in the span of three hospitalizations, realized that Tim had a set of strengths that, if identified, would be more important to his recovery than our endless lectures on liver damage or AA meetings
? Why had no one asked him what he dreamed of doing instead of living from drink to drink?
Indeed, he shared with me later that in three hospitalizations, not a single person had asked him a question that made him feel like he was being treated as a human, as someone with dreams and talents. Instead, we had reduced him to his addiction.
Tim ended up using his art in the months and years that followed to help support not only his sobriety, but also the sobriety of those around him. He began teaching classes at the local Health Care for the Homeless
. And, feeling that his history of addiction was strength, not a weakness, we invited him to become a coordinator of our Native Health Initiative.
Medical training is almost exclusively bent toward "needs mapping," or more commonly “needs assessment.” We talk about the deficits, diseases, addictions and social stressors of an individual ad nauseum. That one-liner we use to describe a person to an attending includes all those deficits and diseases, but almost never strengths or assets. In fact, psychiatry uses a four-axis system to describe a person: (1) Psychological disorders; (2) Personality disorders; (3) Medical disorders; and (4) social stressors.
Would these four realms sufficiently describe you?
Furthermore, when physicians are asked to assist in issues of community health, the default is to focus exclusively on needs and deficits: rates of unemployment, crime rate, STD prevalence, high school dropout rate, poverty and so on.
Whether we are trying to help a patient overcome a medical condition or help a community to overcome barriers to health, we must improve our ability to identify assets and strengths, and then build on these.
Asset mapping is an approach to improve health by identifying and amplifying strengths, assets and resources. This approach recognizes a simple truth that "you cannot build on what is not there," as Dr. Veronica Plaza of the University of New Mexico Institute of Public Health says.
Emphasizing Tim’s artistic talents, for example, would be an approach to empower him toward wellness.
Whether we are trying to help a patient overcome a medical condition, or we are working alongside a community to overcome barriers to health, we must improve our ability to identify assets and strengths, and then build on these.
What we pay attention to will grow. If we solely pay attention to disease and negative statistics, we actually aid in growing hopelessness, low self-efficacy and disempowerment within the person or community involved. If we instead choose to focus on the strengths, assets and resources of a person or community, we help them discover the only place of true healing – from within.
Here are a few examples of asset mapping at work in the community.
La Plazita Institute
(LPI) is a grassroots organization in Albuquerque's South Valley that is grounded in one simple phrase: "La cultura cura" or “culture heals.” LPI's mission is to strengthen community and enable youth to leave behind a destructive lifestyle by tapping into their own roots to express core traditional values of respect, honor, love, family and community. Using cultural strengths, such as ceremonies and cultural ties, and personal talents, such as art, farming or other trades, LPI is gaining recognition for its ability to change the lives of youth in a way the juvenile justice system cannot match.
Our Native Health Initiative (NHI) has developed the Breathe Tradition, Not Addiction
campaign as a culture-based way to prevent youth from smoking. This campaign uses knowledge of traditional tobacco as protection for indigenous youth from using commercial tobacco (e.g., cigarettes, chew tobacco). Since tobacco is used in the majority of indigenous cultures as a ceremonial, medicinal and sacred group of plants, this campaign works to increase knowledge of this aspect of traditional tobacco, differentiating this from commercial tobacco.
Asset mapping is an approach to identify and amplify strengths, resources, and assets to improve individual and community health. Here are a few thoughts that will help you see how to put this into practice.
Anthony Fleg, M.D., M.P.H., is a family physician in New Mexico dedicated to working for the elimination of health inequities. He helps coordinate a love-funded, people-powered partnership called the Native Health Initiative, which he credits with keeping him grounded through his years of medical training and practice. NHI’s work, from its love-funding to the people like Tim who make the partnership happen, is very much a living exercise in asset mapping. Email: firstname.lastname@example.org
Further reading on health disparities and social determinants of health.