Dr. Lauri Medina: Whole Person Health & New CME Course

In this episode, Dr. Lauri Medina joins the program to discuss her path to integrative health and whole person care as a surgeon in rural Colorado. She always knew there was more to health. As one of the instructors of our new CME Course: Introducing Whole Person Care Into Your Practice, she strongly urges all clinicians and clinical teams to explore the course. She shares how she incorporates the HOPE note and the Personal Health Inventory into her practice using it not only with her patients, but with her whole team. Listen as she describes what she gained by being one of the CME instructors and taking the course herself. “For most of us, we'd like to contribute and make the world a better place, and we know that one of the key components of wellbeing is having a sense of purpose. So if we can re-identify with this sense of purpose and then use the tools that are provided with this course, help use these tools to facilitate this sense of purpose that improves our own wellbeing. Begin by taking the personal health inventory ourselves and sharing it with our team members.” 

Watch the full interview here: https://vimeo.com/828070275?share=copy  

Below are links to topics discussed in this episode.

CME Course: Introducing Whole Person Care Into Your Practice www.integrativehealthcme.org

Annals of Family Medicine Article https://www.annfammed.org/content/21/2/188 

Check out the book: "Healing and Cancer: A Guide to Whole Person Care"
Visit https://www.healingandcancerbook.com/ for more information.

Connect:
Twitter: @DrWayneJonas
Facebook: Dr. Wayne Jonas
Instagram: @drwaynejonas
LinkedIn: Dr. Wayne Jonas
LinkedIn: Alyssa McManamon

Visit Healing Works Foundation www.healingworksfoundation.org for more information.

Dr. Wayne Jonas is a board-certified physician and Dr. Alyssa McManamon is a triple-board certified hematologist/oncologist. The opinions expressed on this show are those of the hosts and guests and do not necessarily represent the views and opinions of their places of employment, the Department of Veterans Affairs, or the United States government. The opinions expressed on this podcast are meant for entertainment and education and should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Wayne Jonas and Dr. Alyssa McManamon have no relevant financial disclosures.

Transcript

Please note that this transcript is produced electronically and may not be an accurate representation of what was said. It may not be reproduced, edited, altered or modified in any way without prior written permission. Any use of quotes or excerpts from this interview requires explicit permission from Healing Works Foundation. Please contact us at healing@healingworksfoundation.org if you would like to use any part of this transcript for quotes or other purposes.

“How Healing Works with Dr. Wayne Jonas”

Interview with Dr. Lauri Medina--Whole Person Health & New CME Course

Wayne Jonas, MD (00:07):

So welcome everyone to our next installment of How Healing Works. It is a great pleasure to introduce my guest today, Dr. Lauri Medina to the program. Dr. Medina is director of the University of New Mexico Center for Life and Integrative Medicine, and she does other things too as we'll hear about in Albuquerque and in rural hospitals in Colorado. She's board certified in Integrative Medicine and in General Surgery, an interesting combination. That we'll also explore. Recently, in conjunction with Tufts University, we helped produce a new and free CME course released called Hope for Change, which applies tools to introduce Whole Person Care into your practice. Dr. Medina participated in that and her expertise and experience in developing the course, and so we'll ask her a little bit about the course and how it's best used. So welcome to the show.

Lauri Medina, MD, FACS, ABOIM (01:14):

Thank you.

Wayne Jonas, MD (01:14):

So Lauri, if I can call you that, you've got a very interesting background that we'll get into a bit, but before we do that, can you tell our listeners a little bit about yourself? How did you get into medicine? How did you get into surgery? How did you then get into integrative and Whole Person Care? What drove you there?

Lauri Medina, MD, FACS, ABOIM (01:34):

Well, I came from a very strong medical family, and my father was a very passionate cardiologist and certainly following in his footsteps was something that seemed fairly natural. And along the way it was interesting, there were always little questions that popped up about, "Is this really bringing people to a state of health?" Because I was always passionate about the outdoors, always passionate about just being healthy and I started seeing that people weren't necessarily healthy when they went into medicine, but be that as they may, the excitement and the adrenaline of doing surgery certainly caught my interest and that's really why I went into it. It just was a lot. I was probably one of the few people that actually had fun in my General Surgical residency. So that's how I got into General Surgery.
(02:34)
And despite having a better than most experience within the residency program, this little voice kept saying, "Is there something more?" and having worked as a general surgeon for a few years and then starting my family, I had the opportunity to become trained as a yoga teacher and a personal trainer, and was living up in the mountains in Colorado, and continued to realize that there really is more to health than simply removing an appendix or doing some other technical procedure. At that point in time, I'd become familiar with some of the work of Dr. Weil, and began exploring the different training programs available and found the Academy of Integrative Health and Medicine which worked with my family at the time. And so I enrolled in that program because it was online, and there was some wonderful and continued to be some amazing teachers and mentors there. So that was how I ended up in Integrative Medicine.

Wayne Jonas, MD (03:42):

It's interesting that healthcare as a profession is not a very healthy profession, isn't it? It's not conducive to the health of providers and the physicians that are in it. And you were going into that, fortunately you weren't dissuaded from your father's work, but the exposure to nature and the interest and exposure to activity and healthy activities allowed you to do that even in a profession that is not known to be good for your mental health. Burnout is, we'll talk about in a minute, pretty high among physicians and surgery especially. I mean, people don't think of surgery and whole person, or integrative care together. Usually you say, "Well, I've got to take your appendix out and that's my focus and you do the rest," but I don't think you think of it that way, do you? Can you tell us a little bit about how you've brought these two professions together in your own practice?

Lauri Medina, MD, FACS, ABOIM (04:51):

Well, I've always been fortunate to practice in rural areas in Colorado, and as such we would follow the patient from even prior to a diagnosis at times throughout the procedure needed to make a diagnosis and into their aftercare. I also quickly learned about survivorship for individuals that had been diagnosed with cancer, and certainly survivorship is a multidimensional specialty, really looking at all the different social determinants of health that we know so impact all of us on a daily basis. So those pieces of being a general surgeon were really what began calling to me more and more. And there's also studies out there as we know that even if you do have say a hip replacement, if your bed is the one by the window, you will require less pain medicine and go home sooner than the person whose bed isn't by the window.
(05:52)
And likewise, we know and there's been other studies, some published and some not yet, saying that doing some of the mind body practices in the perioperative area can also decrease pain medication use, length of stay and things like that, and it can be as simple as listening to a recording before you go into surgery. Likewise, when I interact with my patients, I really try and see them as an individual in terms of softening the corners of what is typically prescribed in terms of let's say the length a drain has to be inside somebody and if they really want to get home for Christmas Eve with their grandkids, maybe bending the rules a little to help them do the things that really matter to them. But as long as it doesn't hurt their overall care, I think we have a lot more wiggle room than we used to think we did.

Wayne Jonas, MD (06:56):

Yeah, it's amazing. You've mentioned several things that are very simple that can be brought in conjunction with surgery if you need surgery that can improve the outcomes. My team and I did a study several years ago in which we had a simple kit that we handed to people as they were preparing for surgery that had little acupuncture bands to help with nausea and a little MP3 player at that time, you do it differently now with a cell phone, which educated them about what they were about to get as well as took them through some mind body practices, relaxation practices and some imagery practices in which almost self-hypnosis where they were told they were going to have little bleeding, they were going to rapidly heal, et cetera. And we randomized people to either get this kit or not get this kit, and not only did they have less bleeding, they healed faster. And we also measured inflammatory markers postoperatively and even a month later, those who had used the kit had lower inflammatory markers and healed faster, just that simple intervention.
(08:08)
So that's an example of an integrative approach along with surgery. And then of course, if you're healthier going in, you're more likely to be healthier coming out. So the very reason you went in and needed the surgery is going to be better in those areas. I know there are surgical programs such as yours around the country which are holistic in that sense. The Dell Medical School in Austin, Texas has embedded a joint surgery and pain management program that is truly holistic mind body, psychological, nutritional components, and they get much better outcomes when they do their knee and hip replacements than those who don't do that. So I'm glad that you went into this and glad that you're doing this out in the west where it's a little difficult to access these things. I mean, rural areas especially have suffered even before COVID, but especially after COVID in terms of access to basic medical care. And I know you've been involved in trying to make that access more available wider in that. Can you tell us a little bit about that work?

Lauri Medina, MD, FACS, ABOIM (09:26):

Yes. I think one of my goals throughout COVID has always been to look at the silver lining and what have we learned, and what lessons can we take moving forward, and I think a real big one is the use of telehealth. States out west tend to have one, at most two large regional referral centers that can provide some of these high-tech services. And then the question is, what happens to these individuals once the tech part is done and they're returned home to their rural communities? So right now I'm deeply involved with the ECHO Survivorship program at the University of New Mexico, and they actually have worldwide presence there from the survivorship program.
(10:10)
Likewise, there's some research studies ongoing, again through the cancer center that I'm working to support, promote and help create additional ones about bringing different practices such as healing gardens, pairing cancer survivors with master gardeners in different communities that have these outreach programs, that a 4-H type situation, but for gardening that in the pilot program done by a woman named Cindy Blair has shown to increase consumption of fruits and vegetables and improve quality of life for these individuals that have been paired. And so since these are some programs that exist throughout these smaller communities, making these accessible to whether it's cancer survivors or patients of any sort throughout the west is really important.
(11:05)
Likewise, providing telehealth services in the form of integrative health consultations and helping people connect with the resources in their area, because even a lot of the smaller communities will have things like a Silver Sneakers program. I've lived in places that were very small that had extremely well-trained acupuncturists and massage therapists that actually took people's insurance. So there really are some resources. Some of it might take a little bit of digging. However, I think just helping people connect and even, perhaps, starting their own group, a coffee walk and talk program, creating support within the community.

Wayne Jonas, MD (11:49):

Yeah, that's fantastic. Thank you for that. The access of it is easier if it's organized and especially now with telehealth than people think sometimes. And I know you participated in a telehealth training program called the Integrative Health Learning Network, and then out of that came a CME, Continuing Medical Education program that is free. It was produced by Tufts University to train people how to do whole person and integrative care, and to embed it into their practice wherever they are. And it is online and it is a virtual, and you are one of the contributors to that, and so it's possible to actually do this. Can you tell us a little bit about that and that course and why clinicians and clinics ought to take a look at it? It was just released a few months ago.

Lauri Medina, MD, FACS, ABOIM (12:50):

Well, I think one of the exciting things about the course is that it doesn't just tell you the benefits of beginning with an integrative approach as well as the tools such as the HOPE note that facilitate doing this, but it tells you the cost benefits associated with it, things that you can bring to administration to help promote and create support for this, ways to speak with your peers about it and what to do on Monday morning once you're convinced that this really is a good thing to do. There's so many different position statements that are great and well-meaning, but the question is really, "Okay, that's wonderful. I'm inspired. What do I do on Monday morning?" And the way this course is presented in a, "This is what we think is good to do, this is why we think it's important, and this is how you can go about doing it," it's presented in a very digestible way and it's actually very quick to do. I know everyone is time pressed, but it can be done in a very quick and meaningful fashion.

Wayne Jonas, MD (14:04):

That's great. Thank you. So it really provides some practical tools and actually a lot of resources to say, "Here's how you do it." And beyond that it's like how do you do it in your team? How do you do it with your clinic? How do you get it embedded on very practical things? How do you put it into the electronic health record? How do you bill for it? Those types of things are part of that. Some of the people who look at it say, "Oh, just another thing. I've got to do another thing. I'm already burnt out," and we know that even before the pandemic, burnout was a major problem during and after the pandemic, it's even worse.
(14:42)
20% of healthcare providers have left. And the recent, I think, surveys show that in primary care a good 60% or more actually meet the criteria for burnout, which means they're not really functioning that well in those areas. I mean, that's a crisis, isn't it? I mean, how can our healers be healers if they're not healthy and function themselves? So how do people take this course and not just make it another thing, but actually help their teams and themselves feel better about what they're doing and alleviate some of these stresses and strains? Is it possible to use this for that?

Lauri Medina, MD, FACS, ABOIM (15:25):

I think if you step back and look at what is all our intentions for doing what we do, what is our why for why we get up in the morning? And for most of us is we'd like to contribute and make the world a better place, and we know that one of the key components of wellbeing is having a sense of purpose. So if we can re-identify with this sense of purpose and then using the tools that are provided with this course, help use these tools to facilitate this sense of purpose that improves our own wellbeing. And beginning maybe by taking the personal health inventory ourselves and sharing it with our team members, and for a lot of patients that come in, they might come in with a very "simple complaint", and I put that in quotes because we don't really talk about that as much as how they are and who they are.
(16:21)
But if they come in with that and they fill out the personal health inventory, they really learn a lot about themselves, so I think incorporating this both for ourselves, into our teams that we work with, can really create these healing oriented practices and environments within our own practices, whatever that looks like. Supporting each other in needed time off, supporting each other when a family emergency comes up, helping promote healthy food being brought for staff meetings. It's really the beginnings of creating this sense of community and connection which again, we know is one of the other key factors in wellbeing for all of us, but particularly in these days when so many healthcare providers do feel very isolated and at odds with everyone from their colleagues to administrators, I think it's a great place to start moving towards something other than the pervasive burnout.

Wayne Jonas, MD (17:21):

Yeah. No, thank you for that. So basically turn the lens on yourself and use it first for yourself and your team in this area. Now, it's interesting, we were teaching this at a large safety net hospital in New York prior to the pandemic, and this hospital system got smashed with the pandemic. They were at one of the epicenters of the peak time. And so after the waves, actually it had two waves of COVID that swept through there, they said, "We need some help here. We need to recover ourselves."
(17:57)
So we took these same tools that are in the CME course, the HOPE note, the Personal Health Inventory, the resources for facilitating health and healing, and they just turned it back on themselves and their residents. Their residents had a huge challenge with burnout even though they were in the early part of their career, and I know that's something you've looked at and started to address too. And so starting with that, starting with, "Okay, let's just look at how it applies to ourselves," can be a great boost in getting us into the practice and getting it in for your patients.

Lauri Medina, MD, FACS, ABOIM (18:37):

I think it is exciting as we see that more and more medical schools have moved to supporting their learners throughout their career. I know I certainly didn't have anything like that. It was the stiff upper lip approach, and I know within the University of New Mexico, there are several supports out there. And even with that being said, we do have some learners rotating with us and they certainly do speak to some of the challenges of having to be in a variety of different clinics and all the different challenges there. So anybody that comes and works with me sees a HOPE note applied not just to the patients we're working with, but also to themselves. And they also are shown that different resources available, and several that are going out into private practice within the community are taking note of those and looking to apply those within their practice. So I think we are starting to move the wheel of change forward there.

Wayne Jonas, MD (19:36):

That's great. And for listeners that don't know what the HOPE note is, it is the healing oriented practices and environments note. It is the way you sit down and actually talk with patients about how to enhance their health and wellbeing. After you've made the diagnosis, after you've done the SOAP note, then turn to the HOPE note and help them get well. Empathy goes down during medical school, that's been shown over and over again. Compassion is a key aspect of providing high quality healthcare, improving the health of patients, even lowering costs in those areas. And so the hope is that this will actually help people to maintain their empathy and compassion, even in the midst of busy, busy practices.
(20:29)
You do a lot with survivorship, and I know cancer and cancer care is another area where there's a huge amount of stressors. Just the word cancer itself hits people in the face and often makes it difficult for them to make decisions. They often rush in and try to kill everything, and in the process produce sometimes a lot of side effects and have health problems with that, and then when the cancer's gone, they've got to live the rest of their lives. And so you do a lot with cancer survivorship. Have you found Integrative Health and Whole Person Care, these HOPE tools to be useful in that field?

Lauri Medina, MD, FACS, ABOIM (21:12):

I think it's the core of survivorship, quite honestly. If you look at the challenges that individuals with cancer face either during treatment or the rest of their life, it involves all the different aspects on the HOPE note. It certainly takes a huge financial stress on people to obtain their cancer treatment. Oftentimes, it changes their social connections. Even those closest a spouse, family members, what they're able to do, it can certainly impact their ability to move in terms of cancer related fatigue is huge whether it's because of surgical changes that are needed to treat a cancer or chemotherapies, or simply the anxiety and depression. People's ability to nourish themselves is often challenged as well too. So to me, survivorship and integrative medicine are really almost one and the same, quite honestly.

Wayne Jonas, MD (22:19):

Yeah. .

Lauri Medina, MD, FACS, ABOIM (22:19):

So I'm very fortunate to work very closely with the director of Survivorship at the cancer center.

Wayne Jonas, MD (22:26):

Now, that's fantastic. Yes, I think we should change the word survivorship. What we're really looking for is thrivership. We want people not simply to go beyond the cancer, but want them to live healthy, functional and high quality lives, and so that's part of what this is doing. So this course came out and you participated in a learning collaborative called the Integrative Health Learning Collaborative. A summary of that and these tools was also just published a few days ago in the Annals of Family Medicine, and so we'll put the little link to that at the bottom of this interview.
(23:02)
We just finished a similar thing with cancer leadership and cancer leaders around the country, and are taking the tools that you so kindly help to develop and talk about in the course and bringing them into cancer care, adapting them specifically to cancer care. So maybe we'll have you back at some point, and you can talk about that too in these areas. So any last things you'd like to mention to our listeners around this, and what's the next step? What do they do on Monday and how do they find out more about this?

Lauri Medina, MD, FACS, ABOIM (23:41):

Well, one of the things that the course addresses is what are the challenges to implementing this new way of caring for patients? And I think one of the challenges that I frequently hear is, "Oh, my gosh. Isn't it going to take more time? How am I going to do this in addition to the other intake forms and so on and so forth." So I think one of the things I would say to people toying with the idea of beginning to implement this in their practice is, number one, become familiar with the HOPE note and don't necessarily think that it's going to take more time. My MAs will oftentimes give the HOPE note actually to all my patients. And certainly if I'm running just a couple of minutes behind, the patient will have already completed it before I even walk in the room, and even if they haven't, the tool is simple and quick enough to complete with the patient, and you can explore it further as you're completing it.
(24:47)
Similarly, sometimes if the MAs forget to give it to them, I've done it enough that we can explore the different elements of it together. And so it really becomes something that is embedded and done either beforehand, during or after whether or not you have the piece of paper there. And the other thing that's really exciting is having created it as part of our electronic medical record. If I am making a couple notes, as most of us do when we're in the room with the patient, most of my documentation is quickly done while I'm in the room with the patient, and they are part of the creation of this, and we identify goals. One of the things on the HOPE note is their readiness for change.
(25:33)
And sometimes people will just flat out tell you, "I'm not ready to do that, but I am ready to do this," and then that breeds success for the patient. And as we all know, success brings on more success. They walk in and they say, "Hey, I was able to do this. Now, I'm ready to tackle that." And so I think circling back to the question about burnout, seeing that we can be effective agents of change helps us feel like our work is meaningful as well too.
(26:07)
In terms of Monday morning, I would just encourage people to go to your website and just poke around at some of the different resources that are there. Maybe some of them fit in your practice, maybe some of them don't, but just take a little bit of time poking through there. And certainly, and this is not a plug for your book, but it is, just reading through that and having how healing happens and being able to talk to colleagues about that. I find a lot of colleagues get very excited when they hear that. So I think there's a lot that can be done in a very quick and dirty way on Monday morning.

Wayne Jonas, MD (26:45):

Thank you very much. I appreciate all your contribution to this, and there's even some information and resources about how to bill for this. You can actually get it paid for if you set it up right. Well, one of the things that we try to do, and this is built into the tools of HOPE and the PHI that you just mentioned, is asking the patient what matters to them in life, what brings them joy. And most clinicians, if you asked them and they looked back on what was satisfying in their practice, it was the relationships that they had, and so this gets right at relationships.
(27:24)
You get to know them better by hearing about what it is that they want to have health for in their life, what's the meaning and purpose that they have. And so I want to thank you, Lauri, for being part of this and helping us as practicing physicians and clinicians, and helping patients who would like to develop a deeper relationship by addressing what matters to us all. So thank you very much. We really appreciate you, and we will have you back when we talk about cancer and whole person cancer care in the future.

Lauri Medina, MD, FACS, ABOIM (28:01):

Awesome. Thank you very much. It's just been such a treat and I've learned so much, and it's always exciting to be a part of this, so thank you.

Wayne Jonas, MD (28:08):

Okay. Bye-bye.

Lauri Medina, MD, FACS, ABOIM (28:09):

Bye.