The Case for Whole-Person Integrative Care

Abstract

Rationale: There is a need for medicine to deliver more whole-person care. This is a narrative review of several models of whole-person care and studies that illustrate the business case for whole-person models in primary care. Objectives: To provide an overview of what whole-person care models exist and explore evidence to support these models. Study Selection: Representative whole-person care models widely used in the United States are summarized and evaluated. Selected studies focused on outpatient primary care with examples from programs that integrate the delivery of conventional medical care, complementary and alternative medicine, and self-care within the context of social and cultural environments. Methods: Pubmed search conducted December 2020–February 2021. Two iterative searches using terms for “Whole Health Veterans Administration,” “integrative medicine,” “integrative health,” “complementary and alternative medicine,” and, as they related to the outcomes, of “health outcomes,” “cost-effectiveness,” “cost reduction,” “patient satisfaction,” and “physician satisfaction.” Additional studies were identified from an initial search and the authors’ experience of over 50 years. We looked for studies of whole-person care used in general primary care, those not using a single modality and only from United States practices. Results: A total of 125 (out of 1746) studies were found and met our inclusion criteria. We found that whole-person models of primary care exist, are quite heterogeneous in their approaches, and routinely report substantial benefits for improving the patient experience, clinical outcomes and in reducing costs. Conclusions: Evidence for the benefit of whole-person care models exist but definitions are quite heterogenous and unfocused. There is a need for more standardization of whole-person models and more research using whole systems approaches rather than reductionistic attempts using isolated components.

The Future of Medicine: Frontiers in Integrative Health and Medicine

“…Jonas and Rosenbaum shared their perspective on the need for standardization of whole-person models and research using whole systems approaches [43]. Whole person medicine includes dimensions of health that consider behavior and lifestyle, social and emotional dimensions, and an individual's mental and spiritual dimensions.…”

Towards Whole Health Toxicology: In-Silico Prediction of Diseases Sensitive to Multi-Chemical Exposures

“…Traditional approach to healthcare is based on a reductionist ideology that divides a person into smaller components that are then used individually as subjects of diagnostics and therapeutic interventions [1,2]. This approach contradicts the modern understanding of the integrated nature of biological systems and health.…”

“…The concept of wholeperson health was suggested recently to overcome the drawbacks of prevailing reductionism [3]. This concept suggests that global health problems are not independent of each other and calls for a multidimensional and integrated approach to care to encompass internal (body) and external factors that play a role in the general well-being of an individual [1,3].…”

Returning Wholeness to Health

“… 13 , 14 Gita Vaid, MD discusses the value of using psychedelics in the psychotherapy setting, which she sees as an opportunity to build connection to the patient’s trans-personal nature, that is, “building wholeness through connection.” 15 Together, these efforts are wholly congruent with prior work emphasizing the need to include the spiritual domain of the whole person. 16 , 17 Other authors emphasize the psychosocial, economic, and environmental aspects of what constitutes, and is needed for caring for, the whole person. 18 , 19 …”

“…More broadly, we must consider what constitutes the Whole Health approach. 17 , 19 Dr Kligler’s VHA’s program defines Whole Health as “an approach to care that empowers and equips a person to take charge of their health and well-being and live their life to the fullest.” 6 He continues, “that the emphasis of Whole Health is on the person, not the healthcare provider,” a movement away from a perspective of what’s the matter with the person to what matters to the person. 6 …”