Bringing SELF care reform into HEALTH care reform

"How are things at home?"

My first experience shadowing a real practicing physician was in 1996, when I spent my spring break week staying in the home of a Radcliffe alumna and saw a glimpse into "a week in the life of..." someone in the real world. I thought, if I wanted to have a credible story about wanting to go to medical school (which my essential self really didn't want to do), I should at least see what one does. I shadowed a family physician in Philadelphia, who had a beautiful family of her own and a fun group of colleagues. At the time, I was naive to many of the challenges of having a small medical practice affiliated with a teaching hospital system, but I was keenly focused on how she interacted with her patients. I noticed that every time a patient came in, she would ask, "How are things at home?"

It almost became a running joke between us, because no matter how "mechanical" the problem seemed to be at first - an annual school physical, or a follow-up visit for a broken arm - she always asked this question. And it always opened people up to some long-awaited discussion about a lingering source of stress in their lives. They seemed so relieved to be able to talk about what was going on at home. Often there was nothing more she had to do except listen to the patient for a few minutes, giving them a space to be heard. Amongst us doctors, we used to call these "psychosocial" issues or "supratentorial" problems (a medical insider's term for implying "it's all in their head"). I returned from that trip with a profound respect for the job of a family physician - in the way she had taken it on - and also a desire to find some way to play an important role in people's lives through my work.

Self care isn't as sexy as medical care

When I actually got to medical school, I quickly learned the hierarchy of "sexiness" among the medical specialties - the unspoken but pervasively understood ranking based on how "challenging" or "prestigious" or "difficult to get into" they were. Family medicine pretty much ranked at the bottom. In contrast to the people who were "really" doing important things like surgeries, intensive care, and (oooh la la!) minimally invasive procedures, family physicians were the glorified "social workers" in the pecking order of traditional western medicine. At least that's how I learned it at the time.

When I rotated onto the primary care services and saw patients in the outpatient clinics, I was struck by how little time could be devoted to asking, "How are things at home?" within the structure of our medical training. We're taught to find out what's wrong, and have a plan of action - involving writing orders for diagnostic tests, referrals to specialists, or a prescription for a pill - to address the problem. Never were we told to inquire about what might be the underlying cause of the complaint or symptom. Never were we allowed to ask what really brought the patient in to see the doctor.

I can't blame modern western medicine for getting to this point. As we've become more and more disconnected from our bodies, and as our lives have become more and more complex and demanding, our physical problems have become more severe. Naturally, our tendency toward innovation has led to the creation of more and more sophisticated technologies for dealing with those escalating problems.

But what no one seemed to care about - at least when I was in medical school - was health and wellness. In other words, doctors played no active role in promoting their patient's SELF care by asking, "How are things at home?". Some of the most basic questions and observations were left out of our assessments of "normal" patients - like posture, breathing, diet, exercise, work-related stress, quality of relationships, and emotional coping mechanisms.

I've heard all the arguments about doctors "not having the time" to ask these questions. I believe those pressures are real. But I also believe that the intention to maintain and restore health to the whole person is not at the forefront of our medical training or even our health care paradigm in this country.

Self care is simply not part of our health care system.

I had to learn this myself, outside the system. I've always lived my life with an underlying belief that if there was a heap, I would find my way to the top of it somehow. Luckily, through a sensitivity I was born with and also cultivated through years of musical practice and listening, I also had the ability to "check in" with myself and set limits for the amount of work and stress I would sign up for. I didn't like being around the crowds of medical students who got together in groups to hype up their own stress by studying together for exams. I didn't drown my sorrows in alcohol at the end of each week either. I found other outlets - playing music with people who managed to live on a different setpoint for stress was one, and exercising was another. Both of these gave me a chance to surround myself with different kinds of people, who spoke a different language, and would not allow my particular stresses to spiral and escalate through constant storytelling.

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Moving into balance

Later on, I discovered yoga, which started out as a pure fitness activity and has slowly evolved into a deep personal self-care practice for my mind-body connection. After ten years of practice, I can "drop in" to my own body and consciousness each time I get on the mat. By repeating many of the same poses each time, I can sense subtle differences from day to day, and from the beginning to the end of practice. Now that I include chanting, meditation, and breath work in my practice, I can also tell immediately when my mind is racing or wandering, and when it is quiet and receptive.

As I look back, it has been during the most "busy" and "stressful" years of my life that I have chosen to neglect yoga in favor of more "active" exercise like going to the gym and doing more "efficient" cardiovascular activities. I think at the time I believed that the more vigorously I worked, both in my life and in my exercise, the better I would perform. I thought that constant activity would protect me from things. I didn't want to think about what might happen if I actually slowed down and took a few deep breaths.

In every case, I learned from my own body that breathing is the only option. The opposite of what I believed was actually true - if I didn't slow down and take a few deep breaths, I would not have come into contact with the restorative power of my body's own energy, or quieted down enough to listen to the tangled web of outdated thoughts that were keeping me stuck in old patterns. Becoming aware of these things enabled me to take specific actions to improve my own experience of life, and consciously create my own state of well-being.

How's your mind-body hygiene?

I just read a fascinating article in this month's Yoga Journal about a Harvard University neuroscientist at Brigham and Women's Hospital whose lifelong mission has been to scientifically prove the health benefits of yoga. After twenty years of being unsuccessful in raising funding (while he worked on research in the field of insomnia and Circadian rhythms), Sat Bir Khalsa, PhD, a yoga practitioner for over thirty years, finally received a grant in 2001 from the National Center for Complementary and Alternative Medicine. His far-reaching vision is for yoga to become the preferred "medicine" in America, by promoting it as a "toothbrush for body and mind". Says Khalsa:

"I think of this as hygiene. We have dental hygiene, which is a well-accepted part of American culture. Schools teach it, doctors recommend it, parents reinforce it. Imagine if people didn't routinely brush their teeth. That would be unheard of in this country! But what about mind-body hygiene? We have nothing for that."

"The American lifestyle generates an enormous number of sick people, and there's a huge cost to repair them. We're constantly looking for high-tech solutions - a new magic pill, a new surgical procedure. But what if we went low tech instead, giving people yoga strategies? It would be the biggest bang for the buck in terms of making an impact on the world."

Why is yoga as SELF care perceived as such a "soft" approach - like family medicine compared to neurosurgery? Part of our distrust of yoga as a therapeutic activity is that it includes spiritual or sacred elements and isn't a "pure" physical activity. We seem to feel more comfortable separating mind from body in our culture. We want to "isolate" a problem and "solve" it, once and for all. And oh, the technologies we've created that give us the illusion that we're doing that!

By the way, my mentor in Philadelphia ended up going back to pursue her psychiatry residency at the age of 50. She's diving deeper into those questions about "How are things at home?". In a way, I've taken my own deep dive into these questions by devoting myself to holistic wellness education and self-empowerment.

I believe we need to develop a vocabulary and practice of SELF care in our culture, starting one person at a time. When we see examples of exquisite self care - the energy and vitality of someone who is joyful, powerful and at ease - we know it. It's undeniable.

But how many times do we use a limiting belief like, "I don't have time!" or "Some people are just born that way...", to keep us in our comfort zones and safe from the risk of learning?

Sure, changing your behavior may seem "hard".

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But haven't we gotten to the point where we've seen that our old ways of thinking, the systems we have come to rely upon, just don't make it any easier?

If you want to keep beating up your body and waiting until you get a diagnosis before you start caring about your health, be my guest. The new "reformed" health care system will be right there waiting for you.

But if you want to learn - for yourself - some ways to care for your SELF, you can start right now.

I'm going to be bringing all kinds of ideas and practices your way. You can join me, too, either here in cyberspace (hopefully I'll get you away from your computer for a few minutes a day!) or in the real world, face to face. I would LOVE to help you learn how to care more deeply for your SELF.