Year : 2013 | Volume
: 1 | Issue : 1 | Page : 20--24
A perspective on wellness: A physician's prescription for enhanced patient care
College of Medicine and College of Public Health, University of Arizona, Tucson, Arizona, USA
Canyon Ranch, 8600E Rockcliff Road, Tucson, AZ 85750
With the beginning of the 21st century, medicine has seen the expansion of clinical interventions that could not have been predicted. Physicians trained in allopathic medicine embrace integrative medicine, prospective medicine, holistic medicine, and various permutations on comprehensive medicine. Recommendation for promoting wellness is often ignored. Wellness prescription complements every physician«SQ»s practice irrespective of specialty. It requires physician to incorporate wellness strategy as a primary intervention. A prescription for wellness should include promotion of physical activity, healthy nutrition practices, management of stress, enhancements of individual relationships and recognizing awareness between mind, body, and spiritual components.
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Vuturo A. A perspective on wellness: A physician's prescription for enhanced patient care.Saudi J Med Med Sci 2013;1:20-24
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Vuturo A. A perspective on wellness: A physician's prescription for enhanced patient care. Saudi J Med Med Sci [serial online] 2013 [cited 2020 Nov 24 ];1:20-24
Available from: https://www.sjmms.net/text.asp?2013/1/1/20/112909
Global Therapeutics - An Historical Perspective
Many physicians are incorporating specific global therapeutic interventions into their practices that have been around thousands of years before the advent of scientific medicine. Within the Western world, the expansion of programs in homeopathic, osteopathic, and naturopathic medicine has emerged with elements of wellness. From the corners of the planet, the combined practices of traditional Chinese and Asiatic medicine, Indian or Ayurvedic medicine, and from the Middle East, the emergence of Islamic medicine are incorporated into main stream health care. Beginning with the formal writing from the Greco-Roman Empire, individuals have been concerned about vigor and fitness in their pursuit of happiness.
As transportation becomes readily accessible, people travel frequently seeking out what has been proclaimed in the media to offer special benefits to the weary, disabled, and diseased. Mineral springs, enriched muds, enhanced vapors, radioactive sands, and natural products from land and sea and from every major continent are available in the commercial sectors of the world's marketplace.
In every part of the world, vendors of herbs, vitamins, and various natural product extracts abound. Acupuncture, yoga, and many varieties of massage are universally available.
Science of Lifestyle
One of the major boards in specialty-oriented medicine is the American Board of Preventive Medicine. As one of the original founding specialties to be incorporated under the American Board of Medical Specialties, the delineation of effort and interest has been classified as to primary, secondary, and tertiary prevention. Beginning over 50 years ago, the Framingham Study looked at cardiovascular risk and the Multiple Risk Factor Intervention Trial (MRFIT) have begun to contribute to the worlds' scientific understanding, and the importance of wellness practices.
Most medical schools today offer a relatively standard curriculum with pharmacologic and surgical techniques as the basic applications of treatment interventions. Today, medical schools located in pre-eminent academic institutions of higher education train individuals in modern health sciences including medicine, nursing, pharmacy, physical therapy, public health, and allied health. Training and educational programs are located in academic environments and urban settings that have concurrently incorporated elements of scientific inquiry and applied investigation. What works consistently in a particular therapeutic situation while minimizing risk, enhancing relief, and promoting cure is sought every day. This quest for truth in therapeutic intervention is the ultimate goal.
Dimension of Wellness
This paper will address a relatively recent dimension which is worthy of practicing physicians' consideration and incorporation into the setting of care. The mechanism is not particularly earth shattering; it has not been a recipient of a scholarly research prize. It is the rediscovery, revisiting, and packaging of traditions that offer a historically focused valued way to live. This new prescription is inexpensive, universally available, and in the main without side effects. This new approach complements every physician's practice irrespective of specialty and is readily available. This intervention is called "wellness prescription."
Current Pedagogical Technique
For young physicians in training, the differential diagnosis is paramount. The physician's observations and notes of the thought process are recorded. Encounters may be handwritten, dictated, and transcribed; they may be entered into a computerized program. The content describes what the patient is seeking and the professional findings. It may include physical and laboratory observations. The medical record contains treatment strategy, thoughts as to clinical course, recommendations, and specific plans. Usually physicians practice some elements of primary prevention by ordering an immunization, screening for diabetes, or checking for elevated blood lipids. There may be a screening chest X-ray in a smoker or use of one of many new high tech diagnostic tools including MRI, NMR, Dexa-scanners; modern genetic testing may be included.
The recommendation for promoting wellness is generally not proactively considered and often ignored. Wellness recommendations require the physician, in conjunction with staff, to incorporate a wellness promotion strategy that will enhance and develop wellness in the patients' life as a primary intervention.
From that period of time between the health professionals introduction to anatomy, physical diagnosis, and experiences on the wards and in the clinics to the transition to the active practice of medicine, the emphasis in training on precision of one's skill does not usually permit the individual physician to monitor closely what is happening in the world he will be entering. People are living longer. It is not uncommon for a child born today to live into its 90s and beyond. The complexity of the world changes each day with new and rapidly commercialized inventions, universal, and totally instantaneous communication such as Facebook, Twitter, e-mail, etc. Diagnostic interventions are growing logarithmically. Aspirations of peoples and cultures continuously change and evolve. Stress is ubiquitous. The geopolitical environment changes in the blink of an eye. Today's knowledge becomes tomorrow's history. Today's therapies become obsolete. For the physician and the patient, the pursuit of wellness is reliable, constant, consistent, comforting, and appears immutable. We know today that the incorporation of healthy lifestyle practices during youth can contribute to health and wellness into middle age and beyond.
As one reviews the literature, the increasing numbers of articles relating to wellness is apparent. A recent review of the last few years ending in January 2010 identified 178 separate articles found in the computer search engine indicusmedicus related to "wellness and lifestyle." Articles transcend all medical disciplines including medicine, nursing, pharmacy, preventive medicine, and occupational health. Specialty journals such as Circulation, Neurology, Journal of Environmental Health, Annals of Surgery, and Journal of Family Medicine contained articles related to dimensions of wellness. Publications from organizations such as Academy of Pediatrics, Journal of the American Medical Associations, National Dietetics Society, and American School Health Association publish the importance of wellness to their reader's attention.
A Private Sector Model
In the early 1970s, the concept of wellness first appeared as a coordinated strategy in the private sector with the creation of Canyon Ranch Health Resorts. Canyon Ranch Health Resorts has been ranked among the best destination resorts in the world promoting and improving ones health through the emphasis of principles of a healthy lifestyle. Wellness practices from around the world have been incorporated into the strategy of Canyon Ranch promoting healthy lifestyles. The ultimate goal is to encourage individuals to choose and practice a way of living that helps them live longer without a significant disease burden.
Wellness Prescription for Patients
It appears reasonable and prudent that physicians, irrespective of the specialty or organization, to incorporate the following into his/her practice for each patient:
There are five elements that have been organized and refined to assist ones approach to wellness. A prescription for wellness should include (1) promotion of physical activity, (2) healthy nutrition practices, (3) management of stress, (4) enhancement of individual relationships, and (5) recognizing the awareness between the mind, body and spiritual components within the human condition. All, when not incorporated into living, contribute to the absence of wellness and the promotion of disease.
RX #1 - fitness
Fitness is not magic. It requires intention, aspiration, dedication, commitment, support, and perseverance. Among the simplest and readily available exercise is walking. Instruct patients to walk with purpose each day. One can walk morning or evening, indoors or out, around malls and shopping centers, next to sea, mountains sidewalks, or around one's neighborhood. Use the stairs, park at a distance from your destination, walk to the supermarket, etc., walk with one's spouse, family or friends.
It would appear reasonable and prudent that physicians should incorporate the following into his/her practice for each patient seen. Exercise daily, starting with three times a week. As the patient performs selected routine (s) that strengthen muscles and promote balance, the benefits become apparent to the individual. Bone health is maintained and fractures are prevented. Muscle strength is maintained. Enhanced muscle tone promotes living independence. Recent data suggest that exercise is somewhat better than mental activity in preserving cognitive vitality and the delay onset as well as prevention of dementia. It is well documented that the benefits of exercise lowers cardiac mortality and reduces cerebrovascular disability. Exercise maintains a healthy weight and has important benefits on psychological wellbeing.
RX # 2 - nutrition
Many different types of professionals have emphasized the role of nutrition both to maintain and enhance a healthy lifestyle. Nutritional information is routinely included in newsletters, articles in the popular press, televisions, and social networks. For the many diseases afflicting mankind, one can find a recommended diet, and in marketing and promotional journals, an absolute cure for a price. The natural products business encourages vitamins and minerals as a habit of daily living. There appears to be a plethora of what to eat and not to eat. In the health profession one suffers from information overload without a "seal of approval" from a reliable and reputable source. Sometimes the health establishment forgets that there exists too much misinformation and not enough knowledge to be transmitted. The boundaries between health promotion and capitalism become blurred. A recent comprehensive study indicates that there is no benefit to the early use of multivitamins in preventing cardiovascular disease.
Purely from the epidemiological perspective it is best to eat a modest amount of saturated fats, and reduce total fats from animals, minimize the consumption of processed food, incorporate more fruits and vegetables, and expand products eaten from the sea into the diet. Encourage patients to be mindful in what they eat. When people are working, watching television, or are nervous, they tend to consume extra food and when asked, they do not remember what they are eating or how much they have consumed. Ask patients to write down what they eat, when, and what they are doing, on a daily basis. Include portion size and calories recommended. Use a small plate, avoid seconds, and engage in conversation with family and friends, when eating, while enjoying their companionship without rushing off to do something. Encourage those at the table to share their day's interests and activities with those at meal. Avoid shopping for food when you are hungry. Read labels. Sit down and write your weekly meal plan in advance. Reduce the number of times eating out where you are unable to control portion size and unseen additions such as excessive salt, oils, and sugars. Calories do count, about 1400 per day for non-lactating females and 1800 for most men.
In addition to office handouts on better nutrition habits, some physicians have hired nutritionists as part of their practice. Usually these specialists will conduct classes, see patients in hospitals, and have individual sessions with the patient and his or her family in the office setting. Nutritionists will measure skin folds, body weight, and perform an overall nutritional assessment for the physician.
RX # 3 - stress reduction
Stress appears to be a by-product of modern society. There is always something to do and lists of items to be accomplished daily. People are on the go continuously. Restful sleep becomes compromised and interpersonal relationships are taxed. Stress reduction is not necessarily about medications. Behaviors with unacceptable side effects such as smoking, abuse of alcohol, and addictions creep into one's lifestyle. For centuries, people have meditated, prayed, journeyed to the desert and mountains for solitude, practiced Tai-chi and Chi-gong, and explored Aruvedic practices as found in Yoga. Executives have found that by building "time-outs" in one's daily schedule, and minimizing phone calls, responses to e-mails, voice mails, text and instant messages, order and efficiency are enhanced. One's workday is optimized and stress triggers are engineered out of daily life. Stress hormones are decreased and balance restored. Glucose metabolism improved, cardiovascular stressors such as tachycardia as hypertension reduced.
RX #4 - enhanced interpersonal relationships
There is no survival advantage in being a hermit. Individuals should have friends; couples should have friends. Women generally do a better job in creating and nourishing friendships than men do. In general, men have fewer close friends than women. This becomes particularly hazardous as one ages. Depression and loneliness become debilitating and healthy lifestyle hindering. Explore volunteering in schools, and with community agencies serving those with needs. Develop habits and hobbies that include others. Develop new business interests. Explore activities available in communities conducive to preparation for a long life span after work has ended, and retirement becomes the rule of life.
RX #5 - spirituality
Physicians, in general, are uncomfortable talking with their patients about topics surrounding spirituality. Well over 98% of the people living on this planet believe in a power beyond themselves. Over the centuries, man has used many words to define the relationship In Eastern and Western societies spiritual practices can be found entwined with use of "God." In the Native peoples of the world, there are words for God and spirituality are seen as integral parts of life. In Hinduism and Sikhism, there are many different descriptions of man's involvement in the spiritual dimensions of life. Monotheistic beliefs found in Hellenic, Christian, Jewish, and Islamic theologies are well described. Physicians, irrespective of their beliefs can acknowledge to their patients the importance of loving, forgiveness, beauty, kindness, and sharing as facets of human spirituality. Biologically when participating in these types of things one experiences a healthy lifestyle dimension with lower stress hormones, lower blood pressure, and psychologically experiences an inner sense of peacefulness, calmness, contentment, and relaxation. When one studies the brain functioning with the use of NMR's (nuclear magnetic resonance), a change in the intensity of electrical, biological and neuro-transmitter activity, the patient confirms a sense of wellbeing and contentment. These dimensions of living can be nurtured through physical prayer, visiting a place of worship, or retreating to observe and experience the quietness and beauty of the world in which every patient lies. When used with some of the meditation practices, the restfulness of mind and spirit becomes enhanced. It is not uncommon when the physician encourages the patient to see and act in the world differently, from his position of authority and care giver, new opportunities for the patient are discovered and reinforced.
In summary, wellness has begun to evolve to the state where it can be used by physicians to care for their patients and the patient's family, regardless of the medical specialty. There is preventive and therapeutic potential of the above tools when added to the physicians' medical armentarium. The strategies described have been in use and recommended by the author at Canyon Ranch Health Resort for over two decades. The epidemiological infrastructure of many practices has been in place for many years and continues to evolve and become documented. The individual wellness strategies described have been utilized for centuries. Their effectiveness has been handed down through word of mouth and tradition. They are without adverse side effects and complement the allopathic practices of the modern trained physician. Wellness enhances the role of physician as a care giver for his patient.
For Further Reading
Bernstein M, Munoz M. Position of the academy of nutrition and dietics: Food and nutrition for the older adult; Promoting health and wellness. Netherlands: Elsevier Press; 2012.Sun Q, Shi L, Prescott J, Chiuve SE, Hu FB, De Vivo I, et al. Healthy Lifestyle and Leukocyte Telomere Length in US Women. PLoS One 2012;7:e38374.Liu K, Daviglus ML, Loria CM, Colangelo LA, Spring B, Moller AC, et al. Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Circulation 2012;125:996-1004.Malouf M. Implementing a strategic approach to employee wellness, globally and locally. Benefits Q 2011;27:13-6.Gow A. Exercise may beat mental activity in preserving cognition. Neurology 2012;79:1802-8.Pitt Barnes S, Robin L, O'Toole TP, Kettel Khan L, Leviton LC, Dawkins N. Results of evaluability assessments of local wellness policies in 6 US school districts. J Sch Health 2011;81:502-11.Roehr B. US government to promote wellness among its employees. BMJ 2011;342:d1995.Shendell DG, Johnson ML, Sanders DL, Nowakowski AC, Jefferies CD, Weisman JE, et al. Community built environment factors and mobility around senior wellness centers; The concept of "Safe Senior Zones". J Environ Health 2011;73:9-18.Ashing-Giwa KT, Lim JW, Gonzales P. Exploring the relationship between physical well-being and healthy lifestyles changes among European and Latina American Breast and Cervical Cancer Survivors. Psycho Oncol 2010;19:1161-70.