Whole Health: What Do People Live For? Lessons Learned from Teaching VA Clinicians about Wellness

By Adam Rindfleisch, M.D.

In the past year, the Veterans Administration (VA) has been receiving a fair amount of negative press.  It is tough to work in the VA right now. Morale is pretty low.  And it is always challenging to be a Veteran – Veterans are one of the groups most in need of support of their health needs. 

For all the challenges, however, the VA has been exploring some exciting new programs.  For nearly two years, I have had the privilege of being involved in the creation of one such program, an innovative course entitled “Whole Health: Change the Conversation.”  Since September 2014, we have been teaching the course in VA facilities all over the US.  To date, there have been 28 courses.  I have taught it everywhere from Seattle, Long Beach and Las Vegas to Biloxi, Little Rock, Boston and East Orange, New Jersey.  So far, 1,250 people – VA clinicians and facility leaders – have taken the course.

And they have jumped right in.  Everywhere we have been, people have been open-minded, curious and excited to explore more.  The sense is that we are fanning a fire that has already been kindled! 

The Whole Health course draws on mindful awareness, self-care and Integrative Medicine to educate clinicians in the VA about personalized, proactive and patient-driven care.  It has been some of the most challenging – and rewarding – work I have ever done. 

Doing this work has been as much about learning as it has been about teaching.  Here are some “lessons learned” I think are most broadly applicable to my patients, my medical colleagues, and anyone else who is interested in moving beyond exclusively disease-focused, find it/fix it, name it/blame it/tame it models of health care.

Lesson 1.  Ask yourself, “What do I want my health for?”

The course encourages clinicians to have Veterans focus on their Whole Health mission.  I have taken to exploring something similar with my own patients.  When I ask them, “What do you want your health for?”, the answers are sometimes startling, always inspiring.  They inevitably leave me, as a clinician, feeling even more invested in the health of the person who has just answered the question than I already was.  I think of one lovely woman, struggling with chronic pain everywhere in her body and wheelchair-bound, who had the following dialogue with me:

Me:  We’ve talked a lot about your various diagnoses, but I would like to ask you something that isn’t related to what’s wrong.  Instead, let’s talk about your overall goals.  What do you want your health for?

Ms. M:  I just want to be out of pain.

Me:  But, why?  What do you want to be out of pain for?

Ms. M:  It just hurts so bad and I want it to stop.

Me:  I understand, totally.  Getting rid of the pain is an important goal unto itself.  If the pain vanished entirely, today, what would you do?  How would you proceed with your life?

Ms. M:  (Long pause.)  Oh, okay.  I haven’t thought about that in so long.  No one has ever asked me that.  I guess … I would start playing the guitar again.  I miss having my fingers able to play my music.

I have heard many answers to this.  “I want to take my dream trip to Italy.”  “I want to see my grandchildren move through their lives for as long as I am able.”  “I want to maximize my time out in nature.” “I want to play in this beautiful world for as long as possible.”  It is rewarding to think about how we can work together to move them toward their objectives, whatever they may be. 

Try asking that question of yourself.  Ask some of the people you are closest to.  What happens if you think of your health based on your dreams and goals, instead of in terms of cholesterol values or a blood pressure? 

What if your doctor talked to you about everything in terms of your personal, overarching goal?  For example:  “Exercising that 150 minutes a day is going to help you feel like you can climb your favorite hill in Ireland again.”  Or, “This cholesterol matters, because the lower it is, the better your chances are of being able to dance with your granddaughter at her wedding someday.”

When I ask myself that question, it is clear to me that two of the most important reasons why I want my health are my sons.  I want to see them live their lives for as long as I can.

Lesson 2.  Remember all the things you can do to promote your own self-care.

The VA has an elegant model for framing Whole Health.

In addition to noting the central position of “Me” – the patient – note the importance placed on Mindful Awareness, the next circle out.

Moving beyond that, you see the “green circles” – the various areas of self-care.  These are the areas we can each focus on ourselves in our pursuit of wellness.  While others can support us in all the areas, the emphasis is on the many ways we, as individuals, are empowered to promote our own health. 

It can help, as you are taking stock of your own self-care practices, to move through these green circles, one at a time.  How are you doing with each one?  What areas are your strengths?  Where would you like to invest additional time and energy?  If you would like, you can write your own personal health goals based on the way the circles are organized. 

The outer circle includes treatment for various diagnoses (we aren’t eliminating conventional care – far from it), but it goes beyond that.  Prevention is featured, as are complementary approaches.  This circle encourages one to ask, “What and who do you need to support your care?”  Health professionals continue to be a part of the scheme, but the focus is on how they can help you, the person at the center of the circle.  You drive the care, and they support you, as opposed to the more paternalistic historical approach of having them telling you, as the patient, how it is going to be.

Finally, the outermost circle, “Community”, reminds us that we exist within a broader context as well.  Our self-care is affected by our families, our neighbors, our communities – all the groups to which we belong. 

You can experiment with trying to focus on one of these parts of the circle each week, or each day.  Notice what draws your attention in the present moment. 

Lesson 3.  Remember, when all is said and done, that everyone struggles, and most people want to do well by others.

It is clear, as our Whole Health course facilitator group has taught our 2 ½ day live course in 28 different sites, that the lion’s share of VA clinicians want to do their jobs well.  They want to make Veterans, and the overall system, better.  They aspire to overcome the obstacles that stand in the way of their aspirations.   

The Institute for Alternative Futures captures this nicely, in a diagram which they have given us permission to use wherever we would like.  In this diagram, shown below, there are two perspectives that a person or group of people can follow as they move through time. 

To the right is what I call the “Hamster Wheel” approach.  We move through life responding to challenges, acting in response to being pushed, or trying to do everything we think is expected of us.  Living this way can feel like running endlessly on a hamster wheel.  Ultimately, we can burn out, or give up, or lose our focus.  Why are we doing all of this again?

In contrast, there is the approach on the left, the “Sunshine” approach.  The sun represents overarching goals, or aspirations.  Yes, challenges come.  Yes, responses are needed.  But every response – everything we do – is informed by that sunshine, which represents our overarching intentions or goals.  This model can offer a helpful perspective in terms of personal growth, and it is also useful to apply to any of the various groups to which you belong.

On the last day of the Whole Health course, we have the pleasure of watching clinicians brainstorm how they are going to apply what they have learned about Whole Health in their work with Veterans. To see people excited about this, thinking about how they can use what they are learning to help the Veterans in their care, is truly inspiring.  Many of them comment it will also have an impact on their personal lives.

If you have negative experiences with clinicians out there, you may be seeing them when they are running on the hamster wheel.  See if you can find practitioners who have their own aspirations in mind, in terms of their healing work.  Trust that most of them really do mean well.

Lesson 4.  The future of health care is bursting with possibility.

Think about it:  All this great material is arising within a government program, with a lot of high-level support.   It is being implemented in one of the largest care organizations in our country.  Over 1,250 clinicians from an array of backgrounds – doctors, nurses, chaplains, pharmacists, psychotherapists and more – are not only learning, but more fully experiencing, mindfulness, complementary medicine and self-care. 

I would encourage you to look at the following videos we use in the course if you ever feel you need a little extra inspiration.  They are all available on YouTube.

• Dream Rangers: A 3 minute video about following your dreams, from TC Bank
• Look Through Each Other’s Eyes: A 4 ½ minute video about empathy and compassion, from Cleveland Clinic
• Wounded Warriors Resilience: A 20 minute video about resilience, from Wounded Warriors

May you fully realize what you want your health for.  May you achieve all your self-care goals. May you be guided by your aspirations.  And may you, despite all the things in this world that challenge your optimism, feel hope about the future. 

Adam grew up in rural Idaho, where doctors are scarce and seeking out non-biomedical approaches is commonplace. He practices family medicine in Wisconsin, and one the most enjoyable aspects of his practice is taking care of health professionals from an array of traditions. Adam’s involvement in co-founding International Integrators reflects his deep interest in enfolding a holistic approach into his care of patients. Adam is Assistant Director of the University of Wisconsin/Pacific Institute for Research and Evaluation Whole Health Course under the VA Office of Patient Centered Care and Cultural Transformation, and he directs the Integrative Medicine fellowship at the University of Wisconsin.  He has the pleasure of teaching a number of fellows, family medicine residents and medical students – the next generation of healers.  Adam will be sharing a Shamanic Journeying workshop at the International Integrators Living Whole immersion in March 2015.