plant the seed 2020 header
Incorporating Wellness and Integrative Health into Your Practice
From the moment a patient steps into a doctor’s office, we’re trained to ask one question: “What is this patient’s primary problem?” Rebecca Wilson Zingg, Doctor of Osteopathic Medicine and Assistant Professor in the Physical Medicine and Rehabilitation Division, shares how a lens on integrative health and wellness can supplement conventional medical practice and this problem-based approach.

ur current medical model often revolves around treating symptoms such as pain through pharmaceutical and surgical approaches, without addressing underlying causes through less invasive means. When patients present with pain, we may inadvertantly guide them deeper into the tunnel of their discomfort through our questioning. We ask: How high would you rate your pain? What does your pain feel like? Where is it, and what makes it better or worse? 

While important in addressing the patient’s presenting concern, it is essential to expand our treatment focus to include approaches that optimize and reconnect patients with their sense of wholeness, embodiment, health, and structural integrity. In the words of Andrew Taylor Still, MD, DO: “To find health should be the object of the doctor. Anyone can find disease.”

Examining health through a different lens

Mindfulness research has shown that people have the ability to develop control over where they place their attention. This can have tremendous impact on managing pain and stress.

Through singular focus on pain, doctors may unconsciously further channel their patients’ attention toward what’s going wrong with their bodies and towards their sense of dis-integration and dis-ease, rather than ultimately supporting and facilitating connection to positive sensation and healthful empowerment. People can wind up feeling like they are their diagnoses.

Integrative health and wellness offers an expanded approach to treatment that both addresses the patient’s primary concern while also dilating the focus to include supporting patients’ overall wellbeing. Through lifestyle emphasis, mindfulness, and hands-on treatment, we can equip our patients with tools to augment positive transformation; to broaden attentional focus and liberate them from the anchor of pain; and to restore a sense of integrity and wholeness.

My goal with my patients is to unite the different facets of more conventional and integrative care in addressing musculoskeletal issues. By actively engaging with patients through a health-centered approach, I can provide guidance in specific elements of preventative and integrative health that will be significant for their rehabilitation and pain management. Hands-on modalities (like osteopathic manipulation, acupuncture, and massage), rehab therapies, guidance in aerobic conditioning and strengthening, mindfulness, and nutrition are often overlooked in favor of other interventions such as medications, injections, and surgeries. Yet these practices can drastically reduce patients’ inflammation, pain, and risk of chronic diseases. Importantly, we can use this broader approach as a springboard into daily patterns for greater health.

Finding balance between two practices

While wellness and integrative health is a growing topic of interest, developing provider education and clinical space in this health-centered model is ever evolving.

One way we’re working on incorporating more training in this domain is through a program for medical students that examines the elements of wellness and integrative health. We focus on how sleep, exercise, and nutrition influence patient health. Students also learn how different modalities can serve as alternatives or adjuncts to more commonly implemented treatments and procedures. We also emphasize resiliency and team-based collaboration. We’ve found that our approach to whole-body healing isn’t just good for the patients—it’s good for providers too. Integrative health practices, such as mindfulness, have shown higher retention rates and reduced burnout among providers.

In regards to clinical models for health-centered care, I have had the tremendous fortune to work at the Wellness and Integrative Health Center at Huntsman Cancer Institute. We provide nutritional and exercise guidance, hands-on modalities (osteopathic manipulation, acupuncture, and massage), and creative modalities (through art, music, and writing) in conjunction with more conventional treatment for patients and caregivers impacted by cancer. Centralized on the first floor at a NCI-designated Comprehensive Cancer Center, this clinic exemplifies the power of imbedding services focused on wellness and integrative health with other outpatient clinics and inpatient units.

Obstacles to change

The largest obstacle to integrative health care has been insurance coverage. Health-centered measures should be at the heart of all patient care. We need coverage for lifestyle-based interventions like exercise guidance (for aerobic conditioning, strengthening, and balance) and nutrition as well as hands-on modalities for symptom management. In my own practice, in addition to lifestyle guidance, I utilize osteopathic manipulative treatment to address structural restrictions and support how the patient’s body functions to clear disease and facilitate their sense of wholeness and health.

We also need to promote a collaborative learning environment that is structured around teamwork. The traditional, pyramidal structure of power, with one physician shouldering all of the elements of a patient’s health during an annual appointment, often leads to symptom-based treatment plans rather than whole-body care. Integrative health practices that incorporate a team-based approach can optimize the continuum in care to support patients in reaching their wellness goals, as well as maximize provider fulfillment through a more collaborative approach to patient education and treatment.

Finally, we need to shift towards a more motivational model of patient empowerment. In our current system, the provider is often viewed as the “fixer” rather than the “facilitator” of change in addressing patient concerns. When I’m with my patients, I educate them, provide them with resources and recommendations, and discuss different modalities. When the patient realizes that they are in the driver’s seat in regards to their daily lifestyle choices, outlook, and attentional focus, they reclaim their power over their own lives and capacity for fulfilling change through daily transformation.

Key elements for collaborating with wellness and integrative health practitioners

Incorporating wellness and integrative health into more traditional, clinical and hospital-based models continues to evolve. Consider these key elements for successful collaboration.

Get curious. One of the best ways to learn about different care practices is to experience them and learn what kind of impact they can have. Understanding the benefits of integrative treatments will help you provide relevant information to your patients. If a certain area interests you, there are CMEs and workshops that can help you develop your skills.

Connect with existing specialists. We often feel that if we’re interested in something we should become experts, but that’s not necessarily true. Expand your team by establishing connections with specialists in your area, and refer your patients to them for further guidance.

Engage with your patients. One of the quickest ways to implement integrative health is to ask your patients questions that bring awareness to where they are health-wise, and where they want to be. You can continue to revisit these questions during each visit to see how they’re progressing. You may also consider introducing your patients to tools for self-care and empowerment through teaching a class or creating video content.

Toward a more empowered patient

There are over 23 other hours left in your patient’s day after an appointment, where they have their own habits, relationships, and patterns. Helping them take control of their health means more than ordering a daily prescription, it’s about showing them activities they can explore every day that will impact their health on a more fulfilling level. Incorporating integrative health approaches into practice fosters whole-body care by planting seeds of confidence in our patients.

*Originally published August 2020


Rebecca Wilson Zingg

D.O., Assistant Professor, Division of Physical Medicine and Rehabilitation, University of Utah Health

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