Family Medicine Vital Signs

     By Victoria Prince, MD, PhD

Nature is beautiful.  This is not only my opinion, but also, it seems, a truth.  There is a great TED talk on beauty:

You can jump straight to the information on beautiful nature at 6:55 if you want.

While our modern lives seem to set most of us outside of nature, with frustrating commutes and the ability to adjust our indoor environment without reference to season or location, we remain a part of nature. Our ancestors evolved in a world of woods and plains, oceans and rivers, not in a world of offices and condos. It should be no surprise that the outdoors satisfies a deep need in our psyche, probably because it was our original evolutionary niche. Consciously and subconsciously, people recognize this- at least when it comes to recreation. We “get away”: camping, hiking, climbing, skiing, and boating.

Nature can also play a therapeutic role in medicine.

One of the most frequently referenced papers on this subject was published in Science in 1984 by Roger Ulrich[1]. He showed that patients recovering from surgery with a view of “a small stand of deciduous trees” had shorter postoperative hospitalizations, took fewer strong pain medications, and had fewer negative nursing notes (such as notes saying that patients were upset or crying) than patients with a view of a brick wall.

Some architects and healthcare institutions have taken this to heart. New facilities are being built with a “healing environment”- often incorporating nature or views of nature [2]. Obviously many institutions can’t physically incorporate nature because of their urban location, but even they can make efforts to improve natural light (which one study showed may decrease stress, pain, and pain medication use [3]), select artwork depicting nature, or ensure a decent number of large healthy indoor plants such as trees.

What about the family medicine setting?

Certainly it would be nice if new clinical buildings incorporated nature, but older construction, and buildings built in places without the ability to incorporate nature, could be decorated with nature artwork. “Healing Gardens” can be incorporated in and around clinical settings [5], and as advocates for public health, family doctors can support public parks and community gardens where their patients live and work. When we counsel patients to exercise, we can encourage them to find something outdoors that will benefit them both physically and mentally. Take a walk. Take the family. Go somewhere beautiful and unwind and give yourself some time to heal.

Beyond patient and population health, nature is also important for health-care-provider health.

We frequently hear of “Provider burnout”, and there is a lot of research to understand the phenomenon, and to try and find ways to counteract it.  We hear “work-life balance” a lot in this field, but for some physicians, myself included, I think a major part of mental wellbeing comes from a work-nature balance.

I knew residency training was going to be one of the most stressful times of my life. With that in mind, I wanted a residency program that provided an excellent clinical training where I could also tend to my need-for-nature. One of the questions I routinely asked on the interview trail was- “If I have a couple hours of downtime after work, where can I go hiking?”

For work-nature balance, I really think I won the jackpot. The clinical training I’m receiving at the University of Utah is excellent and I am incredibly glad that I am training in this program. I am also grateful that the opportunities to experience nature in Salt Lake City are world class- even as a busy resident, nature is at my fingertips.

I am certainly not alone in seeking activity, adventure, and peace in the wilderness around Salt Lake.  Colleagues and mentors agree on just how important this “nature outlet” is to our mental wellbeing and professional job-satisfaction. In Salt Lake City we are poised to take advantage of all the amazing things that Utah has to offer; the beautiful mountains and canyons of the Wasatch are a short drive from campus, the Bonneville Shoreline Trail is within a stone’s throw of University Hospital, and the Uintas are easily accessible. The deserts of Utah are a little further away, but are perfect for one-day, “micro adventures” or extended exploration with more time. Utah’s great outdoors is accessible, even for busy interns and residents with very limited time off.

Nature heals us- as health care providers, patients, and communities. It’s not always an easy principle to practice, but when we do, primitive synapses in our brain fire and our health says “thank you”.

1. Ulrich, R.S., View through a window may influence recovery from surgery. Science, 1984. 224(4647): p. 420-1.
2. Landro, L., A Treatment Room With a View, in The Wall Street Journal. 2008.
3. Walch, J.M., B.S. Rabin, R. Day, J.N. Williams, K. Choi, and J.D. Kang, The effect of sunlight on postoperative analgesic medication use: a prospective study of patients undergoing spinal surgery. Psychosom Med, 2005. 67(1): p. 156-63.
4. Diette, G.B., N. Lechtzin, E. Haponik, A. Devrotes, and H.R. Rubin, Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia. Chest, 2003. 123(3): p. 941-8.
5. Mitrione, S., Therapeutic responses to natural environments: using gardens to improve health care. Minn Med, 2008. 91(3): p. 31-4.

Victoria Prince is a 2nd year Family Medicine Resident at the University of Utah, School of Medicine.