How Should Doctors Define Wellness?

The healthcare industry is shifting its focus from treating illness to promoting wellness. But what does wellness actually mean? For some, it’s a new age mix of alternative medicines. For others, it’s about nutrition and fitness. For wellness researchers, the scope expands dramatically to include choices far beyond a physician’s control. Housing safety, spiritual practices, and environmental surroundings are drivers in their wellness metrics.

In 1964, the World Health Organization defined health as “a state of physical, mental, and social well-being, not merely the absence of disease.” Neither “health” nor “well-being” is the same as wellness. Health status is determined by the presence of disease. Well-being is a holistic approach to living a satisfying and happy life. It includes factors outside the reach of healthcare.

What clinical guidelines should a doctor use to define wellness? There doesn’t appear to be one.

National Standards for Wellness

CMS has rolled out the value-based care (VBC) initiative, changing how doctors are paid for services. The goal is to focus on the deliverables from care, not the number of procedures delivered. 

One of the measures in VBC is patient outcomes. But there are no criteria for what determines a “good patient outcomes.” CMS does have a ranking system for hospitals’ receiving VBC reimbursements. 

This is the list of measures and their weight in determining the outcome: 

  1. Mortality (22%)
  2. Safety of care (22 %)
  3. Readmissions (22 percent)
  4. Patient experience (22 percent)
  5. Effectiveness of care (4 percent)
  6. Timeliness of care (4 percent)
  7. Efficient use of medical imaging (4 percent)

Can these be applied to patient outcomes? It’s a given that patients receiving treatment aren’t dead.  But these statistics are designed to measure facilities, not patients. Once again, we’re left with no measures of patient health outcomes. If the definition of wellness was defined and standardized, could it be the metric CMS is missing?

The Many Definitions of Wellness

From New Heritage Dictionary:
“The condition of good physical and mental health, especially when actively maintained by proper diet, exercise, and avoidance of risky behavior.”

From the Medical Wellness Association:
“An approach to delivering health care that considers many influences on a person’s health and consequently multiple modalities for treating and preventing disease as well as promoting optimal well-being.”

From the Farlex Free Medical Dictionary:
“A philosophy of life and personal hygiene that views health not merely as the absence of illness but the full realization of one’s physical and mental potential. 

From the Global Wellness Institute:
“The active pursuit of activities, choices, and lifestyles that lead to a state of holistic health…Wellness is not a passive or static state. Rather, wellness is associated with an active process of being aware and making choices that lead toward an outcome of optimal holistic health and wellbeing.” 

At the AMA: 
The American Medical Association has no definition of wellness. The most common use of the term is related to doctor stress and burnout.

At CMS:
There is no wellness guidance at CMS. The closest they come is to clarify a “wellness visit” under the ACA. One major concern for doctors about VBC has been around how patient outcomes are measured. The reimbursement model does not allow for variations in patient severity or complexity. 

For doctors, defining wellness is important. The cost of healthcare is going through the roof. People are demanding patient-centric care. Traditional medical protocols don’t always suffice when it comes to patient outcomes. It doesn’t make sense to sit around and wait for some outside organization to set a standard.

Doctors can and should start to explore what wellness looks like for their patients. Once it’s defined, see how wellness is incorporated to improve patient outcomes and quality of care.

Making Wellness A Part of Your Practice

Wellness can be looked at as an expansion of traditional medicine. It goes beyond a medical exam. Wellness includes multiple influencers that can affect a person’s health. Not all of them fall within a doctor’s control but they can be an indicator of how to direct treatment.

The standard influencers of wellness are:

  1. Physical: Nutrition, exercise, and sleep
  2. Mental: Cognitive capability, critical thinking, creativity
  3. Emotional: Self-awareness, compassion, empathy
  4. Social: Interacting with family and friends, a sense of belonging
  5. Spiritual: Core beliefs, a sense of purpose in life
  6. Environmental: Minimizing hazards, supporting the natural environment

The first three are aligned with traditional medical practices. The bottom three have a huge impact on wellness but aren’t always discussed in a patient consult. 

Doctors need to ignore stereotypes and consider how wellness can benefit their patients and their practice. It’s a way to create a cross-disciplinary approach that can improve patient care.

1. Definition

The first step is to define what wellness means for your practice. It doesn’t need to be elaborate, just a way to communicate with patients and staff.

“Wellness is more than the absence of disease. We encourage patients to create a balanced lifestyle. Wellness supports their physical, mental, and emotional health.”

You can write the statement specific to your specialty – geriatrics in the example below.

“Wellness is a combination of mental, emotional, social, and physical health. We commit to offering all the resources we can to helping our patients to have satisfying lives.  

Pediatrics here:

“Wellness is key to healthy development. From infants to the teens, we help parents and children learn and practice physical, emotional, social, and mental health.”

It’s not necessary to make this a plan – it’s a statement. Keep it simple and hit the high priorities.

2. Be a Coach, Not A Boss

Wellness is a collaboration. Doctors and patients are partners to create the best health outcomes. Unfortunately, not all partners are created equal. Doctors are used to being in charge. They have staff that respond to requests. 

Patients are not always cooperative. If treatments or medications are discretionary, they don’t always follow directions. Sometimes they say will (or did) when they haven’t or don’t. When it comes to wellness, the patient is the decision-maker. It’s frustrating (we know -preaching to the choir), but patience is the touchstone of your bedside or “webside” manner. 

Keep your consults impartial. Too often patients will “mislead” doctors on their intentions or actions. They want approval. This is particularly true when it comes to sensitive issues, like weight or loneliness or cognitive issues. If the patient hasn’t taken or acted on wellness suggestions, there’s only so much you can do. 

Whenever possible use remote monitoring devices to capture results. Try to build a relationship with the patient that affirms honest intentions – even when it’s “Hell no, I’m not giving up bacon.” You can expect more resistance early on. When you can acknowledge that some things are their call, they may get more open-minded.

3. Broaden Your Provider Network

It is doubtful most doctors have a spa on speed dial. But maybe they should. There are all types of wellness practitioners in the community that can add to your practice. More than half of U.S. patients use some form of alternative medicine.

Massage therapists, acupuncturists, and chiropractors add options for your patients. Nutritionists and fitness coaches are partners in wellness. Senior centers offer social interactions that fight loneliness and depression. Many churches, temples, and mosques offer outreach and counseling. 

These resources might not feel like medicine, but they address components of wellness.

They are other non-invasive treatments that are popular. Hypnosis can be effective for behavioral change. Ancient Chinese medicine looks at meridians which carry energy through the body. Clearing the blockages is the premise for reflexology, EFT (tapping) and chakra cleansing. If there are herbalists in your area, they’re also a connection you can make. 

We’re not saying you don’t need to vet these providers. We’re saying it doesn’t hurt to know what’s available. Make sure your patients know you’re just sharing the information, not endorsing.

4. Incorporate Your Interests

Many doctors are passionate about healthy lifestyles. Wellness is a great way to incorporate your interests into your practice. If you’re a runner, create some videos of your training routine. Put them on your website and use social media (Instagram Stories) to share them. 

Introduce them to your meditation routines by posting the videos or audio files you use. Blog about how yoga has helped you physically, mentally, and emotionally. Speak to issues you see in the community and thoughts on solutions. Look at obstacles to wellness – air pollution, lack of clean water, and food insecurity. 

The issues that are important to you can play a part in how you communicate with your patients. Contributing to your community increases the sense of belonging. No matter how small the gesture, it feels good to do good. Being an example of that is important. Helping other people to be one too – priceless.

5. Explore and Share Resources

Create a Wellness Resources page on your website. Pull together the information most relevant to your wellness statement. There is so much information out there. Start by deciding a list of high-level topics. Get feedback from patients on social media. Either offer a list for comments or ask patients for suggestions.

Once you’ve got a list, start gathering articles, videos, infographics, and podcasts. Look for free online courses. Make sure the content is geared for your patients, not your colleagues. If you need help, contract with a curator to vet a list of links. Then hand them over to your web designer. Send out an email to your patients, explaining your wellness initiative and introducing the new resource page.

6. Make Wellness a Side Gig

Forget the spa on speed dial – plenty of doctors are opening up their own. Plastic surgeons and dermatologists have embraced the cosmetic side of wellness. They offer non-invasive treatments and products in secondary spaces outside their offices.

Developing wellness products is becoming a sideline for physicians. Don’t limit yourself to skin products. Many doctors are working with vitamin companies with supplements. Dr. Andrew Weil, a pioneer in wellness and integrated care, has an entire store of products, books, and courses.

Give some thought to your interests and expertise. Jot down the ideas as they come to you. And if you need some inspiration, here’s a list of top-selling wellness products on Amazon.

Summing Up Wellness

Wellness can add to your practice. Whatever initial doubts you might have, step back and take a fresh look. Complementary medicine has gone mainstream. Alternative treatments are much more popular. Consumers are doing their research and taking charge of their health.

Traditional medicine can’t address all the issues that affect patients. Here’s that wellness list one more time:

  1. Physical: Nutrition, exercise, and sleep
  2. Mental: Cognitive capability, critical thinking, creativity
  3. Emotional: Self-awareness, compassion, empathy
  4. Social: Interacting with family and friends, a sense of belonging
  5. Spiritual: Core beliefs, a sense of purpose in life
  6. Environmental: Minimizing hazards, supporting the natural environment

Patients will be much better off when we encourage wellness instead of merely  treat disease. 

 

 

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