Advancing Skills in the Delivery of Personalized, Proactive, Patient-Driven Walking the Circle of Health: How Are You Doing? Clinical Tool This document has been written for clinicians. The content was developed by the Integrative Medicine Program, Department of Family Medicine, University of Wisconsin-Madison School of Medicine and Public Health in cooperation with Pacific Institute for Research and Evaluation, under contract to the Office of Patient Centered and Cultural Transformation, Veterans Health Administration. Information is organized according to the diagram above, the Components of Proactive Health and Well-Being. While conventional treatments may be covered to some degree, the focus is on other areas of Whole Health that are less likely to be covered elsewhere and may be less familiar to most readers. There is no intention to dismiss what conventional care has to offer. Rather, you are encouraged to learn more about other approaches and how they may be used to complement conventional care. The ultimate decision to use a given approach should be based on many factors, including patient preferences, clinician comfort level, efficacy data, safety, and accessibility. No one approach is right for everyone; personalizing care is of fundamental importance.
WHOLE HEALTH: CHANGE THE CONVERSTAION Walking the Circle of Health: How Are You Doing? Clinical Tool This survey is designed to get you thinking about how you take care of yourself in terms of the different Components of Proactive Health and Well-Being (the items on the Circle of Health). Definitions of Whole Health vary from person to person; this survey will help you define it for yourself in greater depth. Keep these general questions in mind as you work your way through the questions: 1. What are you doing well? What are your assets when it comes to your health? 2. Where would you like to make improvements? 3. Are there any areas that had not occurred to you were part of Whole Health? 4. Are there areas not covered here that you think should be? This questionnaire covers many areas of health and wellbeing, but it is by no means comprehensive. It takes about 20 minutes to complete. Note that there is a Mindful Awareness Moment at the end of this clinical tool as well. Review the following questions, and put a check mark next to the questions where the answer is yes. VHA Office of Patient Centered and Cultural Transformation Page 1 of 7
Me at the Center I know what really matters to me and focus my behaviors accordingly. I take enough time to think about my health. I advocate for my own health needs. I give myself the time and attention I need. I have a good sense of what is best for my health and am not negatively influenced by the expectations of others. I am kind to myself. It is clear to others that my self-care is important to me. Me Mindful Awareness I spend enough time engaged in mindful awareness. I am aware of signals from my body. I am aware of my emotional state. I have an awareness of my level of fatigue or alertness. I note when I need breaks and take them. I am fully aware when I am doing routine tasks, such as driving, showering, or eating. Self : Personal Development I am fulfilled by my work (or being retired). I try new activities and experiences. My finances are in order and do not cause me stress. I engage in hobbies and creative pursuits (art, music, etc.) I avoid substance misuse (alcohol, caffeine, medications, illegal drugs, etc.). I am attentive to hygiene and grooming. I have a healthy level of self-esteem. I use my talents and skills. I do volunteer or charity work. I take time to be creative. I feel good about my physical appearance. VHA Office of Patient Centered and Cultural Transformation Page 2 of 7
Self : Surroundings I feel comfortable where I live. My living space is uncluttered. I like my work environment. I spend time in nature. I feel safe from violence, from physical, emotional, sexual, and other types of abuse. I have minimal exposure to toxic chemicals. I take time to enjoy sensual pleasures (good food, flowers, art, natural beauty, massages, music, etc.). I have clean water, outdoor air, indoor air, and physical surroundings. I live in a way that is attuned to ecological/environmental health. Self : Working the Body (and Overall Physical Health) I feel physically healthy. I feel good about my level of fitness. I am pain-free. I feel at home in my body. Each day I engage in physical activity not related to work for at least 20 minutes. I do stretching exercises (e.g., yoga, Pilates, Feldenkrais, others). Self : Food and Drink Overall, I have a healthy diet. I drink adequate amounts of fluid (at least 1 cup of water for every 16 pounds of body weight). I eat five or more servings of fruits and vegetables in a day. I avoid potentially harmful foods. I am at the appropriate weight for someone my height. I am emotionally at peace with my weight/body size. I have a healthy digestive system (normal bowel movements, no heartburn, no food intolerances, etc.). I avoid smoking or chewing tobacco. Self : Recharge I get 7-8 hours of sleep. I am free of bad dreams. I take breaks. I take leisure time and/or vacation time. I feel rested when I awaken in the morning. I am free of fatigue during the day. I have humor in my life. I laugh. VHA Office of Patient Centered and Cultural Transformation Page 3 of 7
Self : Family, Friends, and Coworkers I spend time with people I care about. I experience romantic love My relationships with my family are healthy. I relate well to my coworkers. I relate well to my neighbors. I focus on maintaining and enjoying friendships. I feel compassion. I am satisfied with the level of physical intimacy in my life. I avoid unproductive or negative encounters with other people. Self : Spirit and Soul I have a sense of meaning and purpose in my life. I take time to focus on what really matters to me. I experience joy. I experience gratitude. I experience unconditional love/platonic love I feel inspired by events, people, and/or experiences in my life. I spend time doing things that really matter to me. I take part in activities I would describe as spiritual based on my belief system. I am able to let it go when someone offends, criticizes, or hurts me in some way (without saying that their behavior was in any way acceptable). I learn and grow from my negative experiences. I feel connected with the world around me. I am comfortable with death and dying. Self : Power of the Mind I feel emotionally healthy (free of depression, anxiety, anger, etc.) ***I am not affected by stress. I have inner peace/tranquility/peace of mind. I take deep, abdominal breaths. I use a mind-body practice to help myself relax. I engage in meditation, contemplation, counseling, journaling, or other activities to help me explore my thoughts and feelings. I keep my mind active and stimulated. I have a good memory. I concentrate well. I am optimistic. VHA Office of Patient Centered and Cultural Transformation Page 4 of 7
Professional : Prevention and Treatment I have a professional team that helps me with my health. I am pleased with my health-care team. I avoid acute health problems (colds, injuries, etc.). I appropriately seek out medical care when needed. I am good about getting screening tests done/discussing them with my primary care provider, and they are up to date. I have a professional care team I trust. I avoid high-risk sexual practices. Professional I am free of symptoms of chronic illness. (If I have chronic illnesses, I manage them well.) Professional : Conventional and Complementary I explore my health care from many different perspectives. I know as much as I would like about complementary approaches to care. I receive as much care using complementary medicine as I would like. I take time for a massage, an acupuncture session, a yoga class, or some other, similar experiences as often as I would like. Professional Community I feel that I am part of a community or neighborhood. I attend community events (e.g., civic celebrations, arts performances, Community fundraisers, sporting events) as often as I would like. I am involved with directing or organizing events in my community (e.g., member of a committee or board) I participate in group religious/spiritual activities in an amount that feels good to me. I am involved in regional, state, or national organizations. I am involved in support groups or other groups with a mutual interest. VHA Office of Patient Centered and Cultural Transformation Page 5 of 7
Working with Your Responses WHOLE HEALTH: CHANGE THE CONVERSATION Take a moment to go back over your responses for each section: 1. Which sections had the most check marks? 2. If you were to choose 3 areas to be your health priorities for your Personal Health Plan based on your answers, what would they be? 1) 2) 3) 3. Which areas had the fewest checkmarks? 4. Based on your answers, if you were to choose three areas as your greatest Whole Health assets, what would they be? 1) 2) 3) Take a few moments to complete the Mindful Awareness Moment on the next page as well. VHA Office of Patient Centered and Cultural Transformation Page 6 of 7
Mindful Awareness Moment Taking the Whole Health Survey Consider the following? How did you feel while taking this survey? Why? Where in your body did those feelings arise? Was there a particular component of Whole Health where you scored relatively high on the questions? What about one where your scores were relatively low? Why might that be? Did taking this survey seem overwhelming? Can you take just one of the questions and give it your full attention for a day or a week? Does working with the areas where you identified necessarily have to be based on making them par of your to do list, or might you focus on them in another way? For example, some people or groups will focus on a different part of the Circle of Health each day, or each week, or even each month. This doesn t mean you neglect the other components; you simply choose one to emphasize for a given period of time. Do you agree that the items listed in the questionnaire are important? Why or why not? Was anything missing that you think should be added? How can you overcome any obstacles to accomplishing your Whole Health goals? If you cannot necessarily overcome them, what steps can you take, despite their existence? Whole Health: Change the Conversation Website Interested in learning more about Whole Health? Browse our website for information on personal and professional care. http://projects.hsl.wisc.edu/service/index.php This clinical tool was written by J. Adam Rindfleisch, MPhil, MD, Associate Professor and Director of the Academic Integrative Medicine Fellowship Program, Department of Family Medicine, University of Wisconsin-Madison School of Medicine and Public Health, and Assistant Director and faculty for the VHA Whole Health: Change the Conversation clinical program. VHA Office of Patient Centered and Cultural Transformation Page 7 of 7