Now I’m going to play psychologist for a minute.”
Those were the words of my primary-care doctor, Eduardo Bermudez, M.D., of Kaiser Permanente Sacramento, during our first, getting-to-know-you appointment some 17 years ago. It goes a long way toward explaining why I’ve stayed with him all these years: He demonstrates real interest in me as a human—and doesn’t pooh-pooh my woo-woo ideas, like when I suggested my tailbone pain was a manifestation of grief.
Though Bermudez is an internist working within the context of conventional medicine, he nonetheless acknowledges the mind-body-spirit connection and looks at the larger picture—key components of whole-person health, a growing movement. Approaches vary, but the premise of whole-person health, according to the National Center for Complementary and Integrative Health’s website, involves “looking at the whole person—not just separate organs or body systems—and considering multiple factors that promote either health or disease.” That list may include everything from the obvious (diet, activity level, stressors, genetics, environment, mental health) to things you might not expect, such as relationships, social support, work, personal beliefs and values—even economics.
Rooted in integrative medicine, which combines conventional and complementary therapies and emphasizes the patient-practitioner partnership, whole-person care is the wave of the future, according to some local experts—and it’s the patients, they say, who are demanding it.
MORE THAN TREATING SYMPTOMS: CONNECTING THE DOTS—The compartmentalization of medicine—treating symptoms separately and in isolation—is what’s gotten us in trouble and created gaps in care, says Revée Barbour (aka “Dr. Ray”), N.D., M.S., of Naturopathic Concierge Primary Care in Sacramento. Barbour says such approaches run counter to whole-person health, in which practitioners attempt to connect the dots in order to treat the person, not the disease.
“Treating the whole person recognizes that many factors impact wellness, and we cannot afford to oversimplify health care for the sake of time and money,” she says. “Protocols to ‘do this’ and ‘do that’ don’t always lead to the best outcomes.” While Barbour’s own protocols include both Western and Eastern interventions, natural medicine is her first line of treatment whenever possible.
When she’s working with an individual, Barbour says, it’s with an understanding that “physical symptoms are a manifestation of, and related to, imbalances in their mental and spiritual bodies.” For example, if a patient has symptoms suggestive of IBS (irritable bowel syndrome), “I would ask about that person’s stress level, diet and lifestyle, to find potential triggers for their symptoms. So I wouldn’t just be treating the gut symptoms, but also seeing if there are ways we can calm down the stress and anxiety.”
As a naturopathic doctor, Barbour also works on the principle that we are all energetic beings. “We’re all emitting energy from our bodies, all the time,” she says. “This is science; this is fact.” When treating a patient, Barbour says, “I’m addressing not just the physical issues, but the energetic disturbances, including the psyche—the mental health piece.” This, she asserts, is where conventional medicine has largely failed.
MAINSTREAMERS GETTING ON BOARD—But don’t count the mainstreamers out. A surprising number of behemoth organizations, including governmental entities, are jumping on the bandwagon with innovative new whole-health programs. In 2018, the U.S. Department of Veterans Affairs launched one of the biggest with its Whole Health initiative, representing a sweeping overhaul of its health care system and offering a patient-driven approach emphasizing personal values, needs, preferences and priorities. The U.S. Department of Defense’s Total Force Fitness program, initially launched in 2009 and reintroduced in 2021, integrates into a single framework multiple dimensions of health beyond the physical, including psychological, spiritual, social and economic.
On the local front, even the mammoth mainstream medical groups are forging ahead with cutting-edge integrative medicine programs. Sutter Health has long been a leader in this arena, offering personalized care and complementary therapies ranging from Chinese and Ayurvedic medicine to bodywork at its Institute for Health & Healing clinics, two of them local (Roseville and Sacramento). In spring 2021, UC Davis followed suit by opening its first-ever Integrative Medicine Clinic, located at the Point West Clinic in Sacramento.
The UC Davis clinic had been in the works for a while, according to its medical director, Michelle Dossett, M.D., Ph.D., M.P.H., a general internist who specializes in integrative medicine and provides consults at the clinic. “Before I came onboard, there were other physicians here who had been working for several years to build it,” says Dossett, whose clinical interests include mind-body approaches for stress reduction. “It’s often the big academic centers that have been at the leading edge of this movement.” That movement is building steam, Dossett says, pointing to the recent growth in the number of academic health centers (currently more than 75) joining the Academic Consortium for Integrative Medicine and Health, whose mission is to advance integrative medicine and transform health care.
This paradigm shift is primarily patient driven, according to Dossett. “Integrative care is seen as something patients are looking for,” she says. “If you build it, they will come, so to speak.”
At the UC Davis clinic, first-time patients are asked to complete a 10-page intake form providing a comprehensive picture of their eating habits, activity level, quality of sleep, stressors and more. But beyond what’s on the page, Dossett says, the key is in getting to know patients as people, and to meet them where they are.
“At its most basic level, whole-person care is really about understanding not only what the medical issues are, but who is this person in front of me?” she says. “What’s important to them?”
IT TAKES TIME—Such a comprehensive approach takes time—a luxury many doctors don’t have. In the United States, most patients get about 18 minutes per visit with their primary care doctor, according to a study published in 2021 in the journal Medical Care. But in the world of whole-person medicine, where personalization is paramount, visits are typically longer. At the UC Davis clinic, an hour is allotted for first-time appointments, according to Dossett.
“It really gives me time to really hear a patient’s story and to ask questions,” she says.
Dossett says she often opens with a broad or general question and then lets people talk for a while without interrupting. “Being present and really hearing people is a big part of integrative medicine,” says Dossett. “It’s not only the details of what they’re saying, but how they say it and how they frame it that tells you so much.”
Doctors in conventional settings with tight schedules and cumbersome caseloads face real challenges in providing this kind of in-depth care. But Kaiser’s Bermudez somehow finds a way, bringing to the table 31-plus years of practice and an understanding that the best way to treat a patient is as a person.
“Sometimes in Western medicine we just look at things like your blood pressure, your heart, your diabetes—but that’s not really what an individual’s about,” says Bermudez, who also serves as medical service director of Kaiser Downtown Commons (on J Street). “It’s much more than that, because there’s health and then there’s wellness. To me, health means your physical well-being, and wellness is your whole-person well-being, which is why it’s important to do whole-person care.” Bermudez will also step outside the Western medicine box when the occasion calls for it. When my frozen shoulder wasn’t responding to the anti-inflammatories and physical therapy he initially prescribed, he offered a referral to an acupuncturist.
Getting a handle on a patient’s complex web of unique circumstances means digging deep, Bermudez says.
“You have to look at things like the intellect of the individual, their social strata, and also how the environment affects them, the kind of work they do—many dimensions,” he says. “That’s why I ask questions deeply. I want to know who you are.”
When interacting with a patient, Bermudez takes special care to maintain focus on the person, not the computer. “I want to be present, ask about your life,” he says. “I think that environment and friendliness when I open those doors helps the patient share things with me they haven’t even thought about.” Bilingual in Spanish and English and of Mexican- American descent, Bermudez says he believes his cultural upbringing has
largely shaped his style of interacting. “For me, every individual who comes to me is an individual, and a family member,” he says. “It’s beyond the doctor-patient relationship.”
MENTAL HEALTH IN THE COVID ERA: “SYMPTOMS OF THE SPIRIT”—Whole-person care arguably takes on heightened importance in an era when mental-health issues may be at an all-time peak. According to a scientific brief released by the World Health Organization in March, global prevalence of anxiety and depression increased by 25 percent in the first year of the COVID-19 pandemic alone. But most of us need look no further than our own circle of family and friends to measure the toll the pandemic has exacted on our collective psyches. While a number of factors fueled this fire, including fear of infection, work constraints and financial concerns, one of the hardest hitting, according to the WHO brief, was social isolation.
Barbour calls these “symptoms of the spirit” and says they, too, speak to the need for whole-person care.
“When there was a lockdown of our usual communal spaces, I think it led to an imbalance in a lot of people’s spirits,” she says. “The body cannot heal if the spirit is broken.”
True healing can happen only when people are empowered to speak and express what they’re experiencing in their spirit, Barbour says. Education also helps to empower, she adds, and is a critical piece of the whole-person approach, which seeks not just to reverse disease but to prevent it.
“Teaching patients how to live healthy, to empower them in healing and disease prevention—this is patient-centered care at its core,” says Barbour, who uses her website (drraynd.com) and social media to educate and provide tips for healthier living.
UC Davis’s Dossett also sees herself as an educator and facilitator in helping patients on the path to healing. While it’s a partnership first and foremost, she says, the onus is ultimately on the patients to do the work. “Eighty percent of chronic disease is related to lifestyle factors,” she says. “By changing a few things—diet, physical activity, reducing stress, social support, sleep—you can dramatically impact your well-being.”
In an ideal world, all doctors would consider such factors and tailor treatment accordingly. But that’s just not the reality, Dossett says. “If you had a heart attack, you’d hope your cardiologist would address diet, stress and physical activity,” she says. “It doesn’t always happen, though it happens more than it did 10 years ago.”
But it would “absolutely” happen, she says, at an integrative physician’s office.
BENEFITS OF WHOLE-PERSON CARE—Beyond providing patients with more personalized care, research suggests whole-person health has the potential to yield other big benefits. In a review of 125 studies of whole-person care in the United States, published in June 2021 in the journal Medicina, the authors routinely found reports of improved clinical outcomes and patient experience—and, importantly, a reduction in costs and provider burnout.
But at the end of the day, maybe what matters most is that it’s meeting a human need, says Barbour.
Often, she says, patients seek her services because conventional treatments have failed or they don’t feel heard by their doctors—or both.
“People are craving a more customized approach to health care, and they’re seeking new options,” says Barbour. “The people, the community, more than ever are demanding it. There’s a great need out there.”
LOCAL OPTIONS FOR WHOLE-PERSON CARE
The good news? Locals seeking whole-person care in the form of integrative medicine and complementary treatments can easily find it, whether from a holistic doctor in private practice (we’ve got many) or one of the region’s “big four” medical groups.
In the Sacramento region, Sutter Health was the first to open dedicated integrative medicine clinics (in Roseville and Sacramento), part of its Institute for Health & Healing, founded in 1994. Last year, UC Davis Health unveiled its own new Integrative Medicine Clinic, located at its Point West Clinic in Sacramento. At Sutter and UC Davis clinics, teams of integrative medicine experts offer a mix of evidence-based conventional and complementary therapies and a personalized approach.
Dignity Health and Kaiser Permanente also offer complementary care services. At Kaiser, the list includes acupuncture and chiropractic (coverage is dependent on the member’s health plan), classes in mindfulness and meditation, and a plethora of podcasts, guided imagery programs and more, on its website and app. Dignity Health’s approach to holistic medicine includes palliative and spiritual care (including professional chaplains) and a range of supports for chronic-care patients.