by Mauli Dalal, MD
In family medicine, we are in a unique position to take care of someone’s whole health. This may mean different things to everyone. This could mean listening to someone’s life story and holding space for them. This could mean asking directed questions to assess someone’s lifestyle. This could mean just being present for someone and seeing them as a whole person. My goal in medicine is to help improve quality of life and prevent future disease. So to me, whole person health includes all of the above but also digging deeper into lifestyle practices if given the chance. At each new patient, physical, or wellness visit, I use the following prompts/questions which I have continued to refine through learning from various integrative and functional medicine providers and educational courses.
- Work/Typical Day: What is your typical day like? How many hours is work or school? What do you do with the rest of your time? Who lives at home?
- Exercise: What type of physical activity do you get? How often? Duration and activity?
- Nutrition: mostly home cooked or whole foods? Balance of protein and veggies at each meal? Healthy fats? Snacking concerns? What exactly do you eat for breakfast? Lunch? Dinner? In-between meals?
- Sleep: fall asleep easily? Stay asleep? # of hours? feel rested in am?
- Mental Health concerns: any mood concerns? Any depression or anxiety or other mental health concerns that you have dealt with in the past?
- Stressors: Any major stressors right now?
- Coping Mechanisms: What are your coping mechanisms for stressful situations?
- Support: Who are your main supporters?
One or two of the following, whatever seems fitting:
- What brings you joy?
- What do you do to nurture your soul? Or What do you do to keep your soul alive?
- Where do you find meaning and purpose in your life (and how are you going to pursue this)?
- When do you really feel alive or when in the past have you felt the most alive (and how are you going to cultivate this)?
For me, this approach allows me to see the big picture of someone’s whole health and future health risk. I sometimes explain what I am doing and say this is my approach to get a picture of the patient’s health; nutrition, exercise, and sleep being part of your physical health, and mood, stressors, and support being part of their mental health. The last few questions are a part of your spiritual health, and they are more to assess how content is the soul with its journey through life: although they can be connected to religion or beliefs, they don’t necessarily need to be. And of course, all of these areas overlap significantly.
I look for areas where we can make small changes in both physical and mental health, offering suggestions, and setting specific goals with my patients. I also listen for areas the patient would like to tackle first. I often find the last few questions about spiritual health the most impactful and often the ones that surprise the patient a little. I chose these questions after learning about spirituality in healthcare through modules by Frederic Craigie in University of Arizona’s Integrative Medicine curriculum as well as reading Craigie’s book Positive Spirituality in Healthcare as a part of my medical school’s Physician Healer Track. I quickly learned this is an area that is often missing when we are thinking about someone’s whole health. For example, one of my patients in his 70s came in for a routine wellness visit. I was meeting him for the first time, and with those questions I learned that he feels bored with day to day life all the time. He wouldn’t really call himself depressed or feel like he had issues with his mood— he just was not content. So probing deeper I asked when in the past did he feel the most alive and is there anything from that time that he could bring to his day to day life. He said he used to love camping and hiking and somehow hasn’t been able to fit it into his life lately. We made a plan to slowly start reincorporating this back into his life with maybe starting with going on one hike each month. The next time I saw him he seemed happier and overall more content. He had started to incorporate some more hiking back into his life. If I had not asked those questions, I would not have known that he was struggling. This allowed me to see a missing piece of his whole health. It’s not a perfect approach and one I continue to refine as I grow as a physician, but this approach gives me some hope that discussing small lifestyle changes at initial visits can impact someone’s whole health.
Dr. Dalal is from Lake Jackson, TX. She completed her undergraduate degree at the University of North Texas and her medical degree at The University of Texas Medical Branch. Her medical interests include lifestyle medicine, integrative medicine, behavioral health, patient-centered counseling, and functional medicine. She enjoys being outdoors, hiking, cooking, running, dancing, reading, meditation, yoga, and functional strength training. She chose the University of Utah because of exemplary primary care training, kind-hearted supportive residents and faculty, and the opportunity to train in a beautiful setting.