Whole-person healthcare goes by many names: holistic care, integrated care, complementary and alternative medicine, functional medicine, team-based care and more. Yet the goal of each is the same: to treat all aspects of a patient’s health and enable them to achieve their highest level of health status possible.
Research increasingly shows the interconnection between a patient’s physical health and their mental health, nutritional health, spiritual health and other social determinants of health (SDOH) such as food, housing, education, transportation, and access to community and social services.
Read on to learn more about whole-person healthcare, how it works, who benefits most from it and why it will become more important in the future as the world recovers from the COVID-19 pandemic.
When most patients see a doctor in office or through telemedicine, the visit is for a very specific reason: they don’t feel well; they’re experiencing pain; they have unexplained symptoms; or they suffered an injury of some kind. The doctor, in turn, takes an episodic or disease-based approach to that visit. The doctor responds solely to why the patient set up the appointment. The doctor diagnoses the problem and assigns a treatment plan for that problem only.
A whole-person healthcare visit is much different. The patient may seek services for a specific reason, but how the doctor responds is anything but specific. The doctor diagnoses the immediate problem, as well as all the things that may have led to the problem. The resulting treatment plan then addresses all those things to both mitigate the immediate problem and to manage it or prevent it from happening again in the future.
“What you’re doing is a 360-degree evaluation of the person’s health,” said Dr. Melissa Clarke, a 3M physician clinical transformation consultant. “You’re looking at all the possible factors outside of the doctor’s office that could have affected the patient’s condition.”
That full-picture evaluation will become even more important as the non-physical health effects of the coronavirus outbreak exceed physical effects over time. Non-physical health effects may include the lack of food security, access to social services and sleep; the impact of social distancing on emotional health; and stress from losing a job, health insurance or a family member.
When you see Dr. Bernadette Clevenger, a family medicine and functional medicine practitioner in St. Paul, Minnesota, affiliated with Fairview Health Services, she’s going to ask you a lot more than “what brought you in today” or “tell me what’s going on.” Rather, she’s going to ask you about what she refers to as all of the interconnected dimensions of your health. Things well beyond your physical signs and symptoms:
Dr. Clevenger and other functional medicine practitioners extract those questions from evidence-based and widely-accepted screening tools. The tools can help doctors trace a patient’s physical health back to one or more antecedent causes. Clearly, the COVID-19 outbreak has exacerbated those causes.
“The strongest link we find is the mind,” Dr. Clevenger said. “Everything starts in your mind, with your thoughts, your emotions and your mood. What happens in your mind determines your behavior, and your behavior influences your physical health.”
As an example, she says stress at work can lead to the lack of sleep. Lack of sleep can cause an increased appetite. An increased appetite can lead to overeating. Overeating may lead to obesity and obesity may lead to diabetes or high blood pressure.
The resulting treatment plan isn’t just filling a prescription for a diabetes or blood pressure medication. Instead, a whole-person treatment plan may include working with an interdisciplinary team that includes case managers, counsellors, dentists, mental health practitioners, navigators, nutritionists, pharmacists, social workers, therapists and others.
“If you’re going to really provide the optimal level of care to your patients, you need to really dig deep to find the root causes and address each and every one of them,” Dr. Clevenger said.
According to Dr. Clarke, the doctor becomes the leader of the team in a whole-person care delivery model, with each member empowered to practice at the top of their license. As the leader, that doctor deals with the physical parts of a patient’s health and coordinates the services provided by the other caregivers to execute the multidimensional treatment plan.
Obviously, physicians will immediately treat patients who are suffering from an urgent or acute illness or injury—hunting down the antecedents of that emergency can come later. The whole-person approach to care is most effective for patients who suffer from chronic illnesses or diseases like arthritis, asthma, cancer, diabetes or heart disease.
Drs. Clarke and Clevenger agreed that people with these conditions are ones who can benefit most from whole-person care because most chronic illnesses and diseases can be traced back to—or at least effectively managed by—other non-physical aspects of a patient’s health. Patients suffering from chronic medical conditions also tend to be more curious about their health status, wondering why what’s happening is happening, not accepting the status quo and being more open to different ways to come at their care.
Medical practices that excel at whole-person healthcare also operate differently. To successfully execute the whole-person philosophy, they make access to care as convenient as possible with easy scheduling and expanded hours.
They have big referral networks of other types of providers who can address different aspects of health. They also have robust health IT systems to coordinate care across those networks and to pull in patient health data and information from external and non-traditional sources to help them paint a complete portrait of a patient’s health status. And the practices’ physicians have to be humble enough to know that they don’t have all the answers.
“The first thing I tell new patients is that this is slow medicine,” Dr. Clevenger said. “It’s important for them to know that this is a journey toward health that we’re going to take together, and it’s going to take time. Maybe months. Maybe years.”
The whole-person healthcare approach certainly will take on more importance as global caregivers and patients recover from the COVID-19 outbreak. The mental and emotional toll from the loss of loved ones, employment and physical connection will lead to a host of physical ailments that will require holistic care to heal.
By design or by default, an increasing number of medical practices will need to practise whole-person healthcare to successfully treat their patients in the post-COVID-19 world.