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Visionary Tracy Gaudet, MD, Explains Whole Health Care Within the VA

“We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival, but really it is larger than that. It is to enable well-being, and well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when disability comes, but all along the way.” – Atul Gawande, MD, American surgeon, writer, and public health researcher

“How do we design for that?” asks Tracy Gaudet, MD, who presented this quote from Dr. Gawande during the 2018 End Well Symposium where she delivered a lecture titled, “The Frontline of Health Care Transformation.”1 Dr. Gaudet is the past executive director of the Veterans Health Administration’s (VHA) National Office of Patient Centered Care and Cultural Transformation and a recognized leader in the evolution of health care. Her office was charged with leading the VHA’s evolution to Whole Health, a unique and visionary approach to wellness that delivers personalized, proactive, and patient-centered care to US veterans.2

“Whole Health is an approach to health care that both empowers and equips patients to really take charge of their health and well-being,” explains Dr. Gaudet.1 “For what purpose? [For patients] to live their life to the fullest. What does that look like? The person is at the center—their mission, their aspiration, their purpose—is at the very center of this model… It address areas of self-care together with clinical care.”1

This undertaking represents a fundamental re-envisioning and redesign in the philosophy and practice of healthcare delivery for US veterans. It evolves the traditional disease-based model into a new model for the 21st century based on patient-centered health care. The VHA’s transition to a Whole Health System in 2018 was initially deployed at 18 flagship VA facilities around the nation. As the largest healthcare provider in the country, the VHA attends to eight million veterans, ranging from WWII and Korean War vets to soldiers coming home from our wars in Iraq and Afghanistan.3 This unique structure allows for innovations often difficult to realize in the private sector and allows for the potential for radical systemic change.2

Key to the Whole Health approach is to start with what matters most to the patient, explains Dr. Gaudet.1 For example, even when living with a difficult condition such as chronic pain, would the person like to return to a favorite sport or hobby? To play on the floor with their children or grandchildren? To feel and function better at work?2

“Our healthcare system is designed to start with the problem—the circumstances we don’t like,” explains Dr. Gaudet.1 “If you come and see somebody that’s trained in the [traditional] medical model [as I was], we are going to write down your chief complaint. That’s how I start. I make a ‘problem list,’ and I have a plan for your problems. And I thought… We need to stop starting from what’s wrong and begin to totally change the conversation, saying, ‘What do you want your life for? Whether you have a moment or a decade, what do you want to live for? What really matters?’ And if we started from that place, imagine what could happen.”1

This approach is turning peoples’ lives around, and the clinical outcomes are better.

                                                                                            – Dr. Tracy Gaudet1

In an interview with Integrative Medicine, Dr. Gaudet says that the impact of Whole Health has been far greater than she had anticipated.4 “It is because a lot of people who choose to practice medicine in the VA choose to do it for a variety of reasons, one of which is that the VA is very mission driven—the most mission-driven organization I’ve even been a part of,” she says. “They want to help veterans. In this environment, they don’t have to be worried about managing the business of a practice, so they have more freedom, in a lot of ways, to do the right thing for their patients.”4

Dr. Gaudet explains that the number-one strategic priority of the VA is to empower veterans to improve their health and well-being. “Particularly I think that the veterans who are dealing with complex kinds of conditions like PTSD, {and others} those men and women just want help,” she says.4 “They want to heal. They want relief from the suffering, and because they are dealing with those kinds of conditions and issues, I think they are really very receptive to other approaches.”

“As I was trained as a physician, my own views are that modern medicine starts with the body rather than the soul and the mind rather than the heart. And yet we know that the soul and the heart are the doorways to healing, and the health of the body and the mind. So now we’re at this amazing place in the history of health care to design for that. And lead the way.”1

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References

  1. Gaudet T. “The Frontline of Health Care Transformation.” End Well Symposium. Published March 13, 2018. Accessed December 18, 2019. https://www.youtube.com/watch?v=azbz79kc34M
  2. National Center for Complementary and Integrative Health. Dr. Tracy Gaudet to speak on health care transformation in the VA’s patient-centered model. Published October 25, 2018. Accessed December 12, 2019. https://nccih.nih.gov/research/blog/Tracy-Gaudet-Health-Care-Transformation-in-the-VA
  3. US Department of Veterans Affairs. VA History. Published August 6, 2018. Accessed December 18, 2019. https://www.va.gov/about_va/vahistory.asp
  4. Benda B. Tracy Gaudet, MD: being an agent of health care transformation. Integr Med. 2016;15(5):68-72.

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