Madison, Wisconsin - The UW Health integrative medicine program will work with the Veterans Health Administration, the largest medical system in the country, on a national push to improve how doctors work with patients who are veterans.
The UW program will receive $1.9 million from the VA to participate in a project called Sustainable Engaged Relationships for Veterans Integrative Clinical Education (SERVICE) to work with clinicians in the VA on how to change the way they practice medicine from a focus on disease to a focus on the whole health of the veteran.
“The Veterans Health Administration’s number one goal is to provide veterans with personalized, proactive, patient-centered healthcare,” said Dr. Alan Bridges, chief of staff of the VA hospital and professor of medicine at the University of Wisconsin School of Medicine and Public Health (SMPH).
“We are very excited about the opportunity to partner with the university to create culture change and develop an environment where the focus is on both physical and emotional health.”
Dr. David Rakel, director of integrative medicine and associate professor of family medicine at University of Wisconsin School of Medicine and Public Health called the effort “an investment in health.”
“Doctor/patient relationships are centered on disease, but integrative-medicine practitioners say that focusing more on overall health will help reduce the need for expensive ‘rescue’ from conditions that are not easily fixed,” Rakel said. “This project should widen the lines of communication between physicians and veterans who need medical care.”
“If the nation wants to improve value to health care, meaning better quality and less cost, we must change the conversation to balance what is wrong with you with what is right with you,” he added. “What do you need to have joy and resiliency in your life? We need the tools to get there, but we also need the process for sustainability.”
Focusing on Whole Health
Rakel said UW was selected by the VA for its reputation in research and expertise in integrative medicine. Dr. Adam Rindfleisch, associate professor of family medicine at the School of Medicine and Public Health and fellowship director of the UW Health integrative medicine program, has established online adult learning strategies that have been well received by physician learners.
“They were looking for someone who was grounded into integrative medicine,” Rakel said. “We’ve made great strides, but when you look at a veteran and throw in a lot of emotional stressors including post-traumatic stress disorder (PTSD), sleep problems, depression and anxiety, that requires a whole health picture. Integrative medicine has developed a lot of tools in helping clinicians be more successful in this type of care, and over the past 11 years, we have established ourselves as one of the key educators in this field.”
Rakel said part of the training will allow participants to co-create the type of clinical care that will work best in their own environment.
“We hope to hit the pause button in the busy lives of professionals so they can take time to recognize how to change clinical habits,” he said. “They will also be asked to put themselves in the same situation as the veteran so they can see what whole health means for them.”
For example, a clinical visit involving patients who are diabetic or depressed will focus on the story beneath the disease instead of just treating the disease specifically. Clinicians will explore why some patients eat the way they do or fall back into dysfunctional coping styles. Decisions on treatment and therapy would be based on what is called the Patient Health Inventory, in which the veteran is asked to put together personal goals that they believe will make them happier and healthier.
“We are bringing in the science of why this is important, while helping the physician reconnect with the reason they got into medicine in the first place,” Rakel said. “There is a tremendous amount of burnout going on in primary care, because we are being asked to fit people’s lives into 10 to 15-minute boxes of time. We know that’s impossible.”
Clinicians will have two and a half days to experience, discuss, learn and explore what a model that focuses on whole health would look like. Clinical tools, evidence-based information and patient handouts will be made available on the Internet. Priorities include mental health issues and helping veterans who are struggling with lifestyle related conditions and amputations from combat.
“When we see all this burnout in health care, it’s a win, win, win situation,” Rakel said. “It’s enhancing the health of clinicians, which will give the learner insight into how to best do the same for the vets, and it will give them the power to create these new environments in their clinics, so they can promote health and resiliency in our health care system.”
Rakel said he is pragmatic about how much the pilot program will automatically transform health care and doctor/patient relations, but he believes progress will be made.
“I hope we can at least crack the door toward starting this conversation,” he said. “We want to add a new type of health visit that says ‘What do you really need to improve your health? What are the one or two goals we can work on together that would really enhance your overall well-being?’ If we start to give the person’s whole health attention, it will grow. Over time, we will provide tremendous value in health care with the need for fewer office visits and fewer medications.”
Date Published: 08/28/2013
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