February 04, 2021
By Wayne Jonas, MD
Having spent much of my 40-year medical career in the military, my patients who are veterans have taught me a crucial lesson: I rarely cure them of chronic disease. Instead, I must find a way to make them a partner in their own healing. This is especially true when treating veterans with complex health conditions. They require special attention and treatment approaches that provide relief both in the short term and healing for the rest of their lives.
Health care in America, as currently delivered, is not producing health nor helping to heal. Studies show that only 15- to 20% of health, for individuals or for entire populations, comes from medical care. Nearly 80 percent arises from other factors rarely addressed in doctors’ offices; factors such as the behavioral and lifestyle choices that people make every day in their nutrition, exercise and movement, sleep, stress management, substance use, and coping with the social and economic environments in which they live. Veterans, in particular, face unique challenges aligned with these health factors.
Improving Veterans’ Health by Embracing a New Model
The Veterans Health Administration has launched an exciting and innovative Whole Health model, an integrative approach that emphasizes patient engagement and the promotion of non-drug and self-care initiatives, alongside standard medical treatment.
I had the honor of serving as the lead medical member on the Congressionally mandated Creating Options for Veterans’ Expedited Recovery (COVER) Commission, which carefully assessed this new model and issued its report last year. I can confidently and enthusiastically report that the VA’s two-year pilot launch of its Whole Health approach holds new promise, not only for veterans, but for all health care providers and for the entire US health care system.
Our report included recommendations that would help each of the 9 million veterans served by the VA to create their own personal health plan. In this model, every veteran is assigned a designated “health partner” as part of a team of professionals including physicians, nurses, nurse practitioners, social workers, health coaches, health navigators, and mental health providers who provide direct care and, significantly, encourage and support self-care.
If the government, payers, and the public fully embraced such a model for the broader population, this could ultimately have far greater impact on America’s health than any incremental refinements or expansions in Medicare or the Affordable Care Act.
That’s because we know it works.
We know that many of the most common chronic conditions, such as hypertension, diabetes, obesity, chronic pain, anxiety, and depression can be mitigated and effectively treated with behavioral and integrative health approaches that are evidence-based. These approaches employ tactics such as diet, movement, stress management, therapeutic yoga, acupuncture, and massage therapy. They are safe, effective, and--if employed in a timely manner--far less expensive than drugs and surgery.
For two years, the VA has partially implemented this model at 18 “Whole Health Centers of Excellence” across the country. Indications are that these pilot sites have improved care while significantly reducing costs by an average of nearly $5,000 per veteran in the first year and a half. Quality of care is improving too. For example, pain patients using Whole Health services report a 38% drop in opioid use.
The VA model provides veterans with access to a suite of these proven, non-drug approaches. All patients still receive conventional medical treatments—but only when necessary.
Putting Whole-Person Care Into Action
To truly offer healing to our veteran population, we must shift to a person-centered model stressing self-care, rather than our traditional medical-centered focus that relies heavily on pills and procedures. Our nation needs to provide this type of care for everyone.
But how can we do that as physicians?
Before seeing my patients at the Fort Belvoir Community Hospital Pain Clinic in Northern Virginia, I have them fill out a two-page Personal Health Inventory that starts by asking him or her to consider not just what ailments they might have, but to assess themselves in terms of their body, behavior, lifestyle, social, financial, emotional, and even spiritual life.
By assessing these key aspects of each patient’s life, I’m no longer simply asking them “What’s the matter?” but rather “What really matters to you?”
This long-term approach is the most critical for veterans who are often grappling with consequences of war and exposure to experiences that many of us can’t even imagine. For their healing journey to be successful, it requires the patient’s belief in the provider, the treatment and finding a feeling of hope and empowerment that the process encourages.
From my experiences, I believe that practitioners can become more effective healers if we can learn to ask our patients the right questions, listen more closely to their answers, and guide them more surehandedly on a path to self-care.
As a provider, this often means looking at non-pharmacological approaches for chronic conditions or seeking to integrate new modalities into our treatment plans. We need to look for opportunities to grow in how we provide care. For example, a newly released self-directed course on pain management helps to explore these new approaches to helping patients with chronic pain, with the goal of finding alternatives or additions to treating with opioids. It’s our duty as providers to look into options like these and learn how to embrace and use them.
Our veterans want to be full participants in their own recovery, not passive recipients of treatment. They want to work as full partners with their providers. They want to feel that they are still accomplishing their new mission, which is now the mission of healing.
Wayne Jonas, MD, is a practicing family physician, an expert in integrative health and health care delivery, and a widely published scientific investigator. He is currently the Executive Director of Integrative Health Programs at the Samueli Foundation. A retired Lieutenant Colonel in the Medical Corps of the United States Army, he also served as director of the National Institute of Health’s Office of Alternative Medicine. From 2001-2016, he was President and Chief Executive Officer of the Samueli Institute, a non-profit medical research organization supporting the scientific investigation of healing processes in the areas of stress, pain and resilience.