In 2011, our burgeoning palliative care team had the unique experience to spend a week learning from the palliative care teams of McGill University. During that week we learned about the Whole Person Care Program and subsequently invited the Director of Whole Person Care, Dr. Tom Hutchinson to Mayo Clinic to lead a workshop on Whole Person Care. It was my pleasure to interview Dr. Hutchinson about the Whole Person Care (WPC) program at McGill.
Cory: Please share with us, Dr. Hutchinson how the whole person care program at McGill got started.
Tom: This history is important because WPC grew out of an insight from Palliative Care that subjective quality of life (QOL) could improve at a time when people are objectively becoming more ill. That change to improved QOL during periods of worsening incurable illness is the process of healing.
Cory: Tell me more about the relationship of WPC to Palliative Care (PC).
Tom: What PC did in taking care of incurable people was that they rediscovered the process of healing. Dr. Mount and Dr. Kearney are largely responsible for this rediscovery.
In 1999, they set out to reincorporate the process of healing into the medical mandate. It had been lost track of. We need both the medical science and the healing relationship; whole person care. The approach has been through transforming our approach to training our medical students and faculty and our relationship with the people of Montreal.
We have two main approaches. First with medical students they have a mandatory WPC curriculum that aims at teaching them tactics to provide a space for healing. Our hope is that McGill is producing physicians better able to incorporate a healing approach into their medical practice. Courses in the existential aspects of medical care are taught and mindfulness and meditation are offered as vehicles to facilitate a healing presence.
We also train our faculty so that there is an environment that is receptive to a healing approach where students can grow and develop.
Students are partnered with their faculty mentor for a mentorship process called physician apprenticeship. There are six students for one faculty for the entirety of medical school. Burnout is a significant entity in medicine. We have started to teach mindfulness for self-care and presence with patients.
We have engaged the public as we recognize the yearning of the general public for WPC. They are essential allies in the promotion of WPC. To capture their interest we have developed two forums to explore healing. Firstly, we have developed a film series in which films illustrating the process of healing are viewed and a dialogue is held after the film. The films are well attended.
We also offer a seminar series with a similar purpose. These are invited lectures on topics like empathy, hope, or other topics related to WPC.
Cory: I understand you are going to expand your influence to host the first ever international congress on WPC starting in the fall of 2013.
Tom: That is right. This conference will be held every other year in Montreal. The focus of the conference is to address how we can change the medical mandate to incorporate WPC. This will be a full breadth academic conference to cover topics such as mindfulness, narrative medicine, and methodology to change systems to incorporate WPC in to the standard practice of medicine.
Cory: This last spring you edited the first textbook on WPC. Can you tell us about the book?
Tom: The book attempts to put together the contributors to WPC from McGill and around the globe. It attempts to develop through 18 chapters the concept of WPC from different aspects and approaches. It covers topics from genetics to medical teaching, and concludes on professionalism at McGill. The last chapter lifts the veil and peeks at the future of WPC as a renewed focus on the relationship between the doctor and the patient. That relationship has both an empathic component and includes medical expertise that the patient doesn’t have. Along with that is the mutual respectful relationship and mutual vulnerability to treat them as a whole human being.
I think this is going to happen because this is what doctors really want and why many went into medicine. And it is what patients really want. Medicine is more effective than ever before but somewhat less attractive due to the loss of the approach to healing. A rediscovery of what is important to doctor and patient and gives satisfaction to both parties within the relationship.
Cory: Since WPC grew from lessons learned from PC, how will WPC and PC relate to each other going forward?
Tom: PC remains the best model for WPC that we have. PC is important as an exemplar of WPC. There is a risk that PC may become a more fixing, curing discipline and forget the healing aspect. PC has to remain the model for healing. PC needs to represent WPC for the rest of medicine. PC is a new way of looking at medicine that can change the rest of medicine. It will have a strong relationship with WPC. PC is a beacon for a different type of care.
Cory: How does PC maintain their skill, role and time in the changing health care landscape?
Tom: Not a simple solution. The more we turn medicine into an enterprise that is financially driven and primarily an industrial model of efficiency and cost effectiveness this will be unhelpful for medical practice. What these approaches do is focus on products and forget the reasons for what we do. A model that focuses on efficiency has different effects that particularly may divert away from processes that lead to healing. There is a momentum to the industrial model.
After speaking with Dr. Hutchinson, I can’t help but wish my medical school had had a similar curriculum with attention to WPC. Fortunately, there are ongoing opportunities to learn from the wealth of experience at McGill. I hope to attend the 2013 first international conference on whole person care. I have already read the book and given a copy to each palliative care team at Mayo within the Midwest.
Cory Ingram, M.D.
Assistant Professor of Family Medicine and Palliative Medicine
Mayo Clinic, College of Medicine
Medical Director – Palliative Medicine
Chair of the Palliative Medicine Specialty Council
Mayo Clinic Health System