“Lifestyle medicine is part of regular medicine but stands apart in that it is health care that directly benefits patients through the restoration of vitality and health, primarily by lifestyle interventions.

And its healing capacity does not stop there. Because it unlocks the door to health and well-being, its effects reach well beyond patient care, to entire families, communities, and indeed to the lives of health care providers themselves.

Changing the health care system within which physicians work will have positive ripple effects throughout all of health care. It will not only improve their wellness in the workplace — but also optimize patient care. And it will get us closer to the quintuple aim because a rising tide lifts all the boats.”

Iris Schrijver is a lifestyle medicine physician.

She shares her story and discusses her KevinMD article, “Healthy patients and healthy physicians: Is it possible?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Iris Schrijver. She is a lifestyle medicine physician. Her KevinMD article is titled “Healthy patients and healthy physicians: Is it possible?” Iris, welcome to the show.

Iris Schrijver: Thank you so much for having me, Kevin.

Kevin Pho: We’ll get to the article in a little bit, but first off, just briefly share your story and journey to where you are today.

Iris Schrijver: I’d be happy to. So I was born and raised in the Netherlands, where I also went to medical school, and then I did a postdoctoral fellowship in genetics at Stanford and ultimately became a clinical molecular geneticist. Then I wanted to learn more about laboratory medicine as a whole and completed a residency in clinical pathology. I was then hired on the faculty of the pathology department, also at Stanford, and there I wore many different hats.

I was director of the molecular genetic pathology lab, which is a diagnostic laboratory where, in the beginning of my career, we were primarily focused on the diagnosis of inherited genetic diseases. As the years went on, of course, with the advent of high-throughput methods and with genomics, we were able to diagnose cancers but also provide prognosis, therapy predictions, and molecular minimal residual disease testing. So it was a great sandbox to play in. I also directed the clinical pathology residency program and helped develop one of the first molecular genetic pathology fellowship programs, and I had a research lab.

So as you know, academic medicine can be very rewarding, but it can also be kind of all-consuming and demanding. So a few years ago, my husband and I simultaneously decided to step away from employment and embark on new adventures. But I still remain very happily affiliated with Stanford as an adjunct clinical professor, and that allows me to be involved in teaching and mentoring, both of which I tremendously enjoy.

We moved from California to Oregon and pursued a very different lifestyle, with more attention to personal quality of life. It allowed me to engage with Clackamas Volunteers in Medicine, which is a free clinic in our large county for uninsured individuals, and it also gave me time to write my book. The seed of that had actually started during a sabbatical at Stanford, but of course, I never had the time to complete it. That book is On the Path to Health, Wellbeing, and Fulfilment, and it was recently published. Through the writing of the book, I also discovered lifestyle medicine and became a certified lifestyle medicine physician. So it’s quite a change.

It may seem ironic that a pathologist, where the emphasis is so much on disease, writes a book about health and well-being. But I think that we’re beginning to see a shift in medicine away from only disease management to also more of a focus on how we can sustain health, how we can improve health and increase well-being. We have a chronic disease epidemic in this country, right? So it’s very much needed that we are redirecting our attention. And as a geneticist, it was kind of interesting to discover that maybe 30 to 40 percent of our happiness is determined by genes, and only a quarter of our longevity. So I think at the moment, lifestyle medicine really is a great tool for all of us.

Kevin Pho: So as a lifestyle medicine physician, walk me through a typical day and some of the typical cases that you would see.

Iris Schrijver: Oh, a lifestyle medicine physician would basically help individuals and their families adopt and sustain healthy lifestyles so that they can improve their quality of life. It is a medical specialty that uses evidence-based lifestyle therapeutic approaches, and it uses them primarily to prevent, treat, and, if used intensively enough, also reverse chronic diseases like heart disease, like diabetes, and so on. So that’s basically what a lifestyle medicine physician does.

It’s usually practiced in a team, with nutritionists, with nurses, and physical therapy as needed. It’s really looking at the whole person, right? I think that’s different, and that also creates a ripple effect because we’re looking at health restoration and a return to vitality. You can do that in the context of patient care, their families, and ultimately the community. But as somebody who practices this, you also directly see how it affects health care providers themselves. And lifestyle medicine has six pillars. Maybe I can talk about that.

Kevin Pho: Yeah, you talk more about that in your article, right? So, “Healthy patients and healthy physicians: Is it possible?” So yes, talk more about your article for those who didn’t get a chance to read it.

Iris Schrijver: Absolutely. So this article came out of the work in my book, because in the book I take a good look at the mind, the body, and the world by which they are influenced. Basically, I take a look at the scientific basis of what we think we know about healthy living. I also wrote it to highlight the issues with the status quo in health and health care and to provide a path forward.

So in that sense, it’s very relevant to us as health care providers, because as I write in my article, if we want to achieve this very ambitious quintuple aim of better health outcomes, a better patient experience in health care, and lower cost, all of that in an environment of health equity and clinician well-being, then we need a whole new health ecosystem. We really need to have a change, and the incentives at the moment are very misaligned, right? So in lifestyle medicine, there is that change in practice.

The six pillars of lifestyle medicine, as I described in my article, are, first, a nutrient-dense, whole-foods, plant-strong way of eating. We all know that we need to increase our fruit and vegetable intake, and it’s the same for our physicians, because we have many obese physicians or physicians who don’t exercise. At the moment, more than 72 percent of people in America are either overweight or obese, and that includes physicians. If you are a physician who is obese, you’re much less likely to counsel on weight loss and nutrition, and the same goes for exercise. So this is very important. And we, of course, all know that more fruits and vegetables protect us against chronic diseases and some cancers as well, and improve our mood.

The second pillar is optimizing and individualizing physical activity plans. There, too, we know it’s a powerful lifter of mood. It creates positive emotions, supports our health, and supports longevity.

The third pillar is to improve restorative sleep. I always say every good day starts with a good night’s sleep. If you don’t sleep well, you’re likely to eat 300 more calories the next day, and in the long term, you’re at risk for weight gain as well as several cancers, actually. So it’s very important, and of course, it also reduces anxiety and stress and reduces the risk for depression.

The fourth pillar is to stop smoking and tobacco use and also reduce exposure to harmful substances. There, I’ll be very brief, because we all know about that one, except that we often frame it in the way that we have the freedom to do something, and it can be so much more liberating to have freedom.

Then the fifth pillar is making and maintaining good, positive connections, good social relationships. You probably know about the Grant Study, which is the longest study of health and well-being and longevity. It has gone on for more than 75 years now, and it clearly showed that at the heart of a happy, healthy, long life are social connections. So that’s something we need to pay attention to as well.

And then finally, especially for physicians, managing stress with healthy coping strategies. There, I really like the concept of positive health, where we take the six pillars of lifestyle medicine and combine them with positive psychology, because stress management can bolster resilience, but it doesn’t quite get us to this point of flourishing and thriving. That’s what I wanted to highlight in my article: Sometimes we feel like we’re in a storm where our boats are overturned, but with lifestyle medicine, we can all lift our boats with the rising tide.

Kevin Pho: Now, take us into your exam room. When you talk to individuals about these pillars of lifestyle medicine, what are some of the obstacles and challenges that you face in having these individuals adopt some of these pillars, and how do you overcome those challenges?

Iris Schrijver: Well, I’m currently building a lifestyle medicine program for the clinic for Clackamas Volunteers in Medicine, so I can only comment on that in a general way. There are many barriers. There are many barriers in our minds. There are also very practical barriers for the patient population that we deal with in this clinic. For some of these patients, it’s a matter of choosing between food on the table and medical care, so that’s why they come to our clinic. And I think we need to really realize that this equality of disease that we have right now in the health care system, but also in society at large, affects individuals as well and how they can take care of themselves.

So with lifestyle medicine, we use techniques like motivational interviewing, but also very practical approaches like SMART goals and frequent follow-up. The appointments are typically longer and more comprehensive. There is a lot of support to make these changes and roll them out step by step, at the pace with which the patient is comfortable. It needs to be a dance, not a top-down approach, but rather figuring out what is important to the patient and then making those improvements step by step.

Kevin Pho: And for the clinicians listening to this podcast, they may take a look at your six pillars and want to make some changes in their own life. Clinicians, as you know, are under a tremendous amount of stress and pressure and don’t have a lot of time. What are some immediate next steps that these clinicians should take if they want to integrate more of a lifestyle medicine approach into their lifestyle?

Iris Schrijver: Yes. So I would encourage them to read my book, of course, and then I would also encourage them to do a few things immediately. First of all, I would like them to evaluate their own health. Which part of their own health and well-being can use a boost? That requires some introspection, that requires some time, but we usually all know where it’s at and what we would really like to change.

I think that on the path to health, well-being, and fulfillment, we need to assess where we’ve come from and where we find ourselves at present, and then envision a compelling future. In medicine especially, we see so many physicians right now who are running from or moving from a bad situation. What I would like to see more, because we have so many opportunities in medicine, is more physicians moving to that compelling vision of a future that they can create for themselves.

And I’d like them to be curious, curious about the power of the science we have today to really restore their patients’ health but also their own health. So be curious. Be critical also. There is so much information, and that’s great. It’s true for patients and physicians that we have a lot of information at our fingertips, and that can be exciting and helpful, but there’s also a lot to wade through, and it can be confusing because so many of our sources of information contradict each other. So be discerning about that. Nourish your health and well-being with what we know is based on validity.

And then I’d like everybody to become an advocate for health, well-being, and fulfillment, because it protects us against chronic diseases and it helps our patients. And even with COVID, we’ve seen that any new health challenge that we face, and our patients face, will be improved by these pretty straightforward approaches.

Kevin Pho: We’re talking to Iris Schrijver. She’s a lifestyle medicine physician. We’re talking about her KevinMD article, “Healthy patients and healthy physicians: Is it possible?” Iris, how does one go about finding a certified lifestyle medicine physician?

Iris Schrijver: I think a quick internet search will do the trick. Also, the American College of Lifestyle Medicine has resources for physicians and for patients, and that’s also a place where you can find practicing lifestyle medicine physicians. And of course, you can reach me at lifestyleforhealthandwellness.com or just through my email, [email protected].

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Iris Schrijver: Well, the take-home messages really are that doctors, managers, and institutional leaders need to focus more on what optimizes health and well-being in the workplace. We now see an increased emphasis on self-care because everybody realizes the tremendous personal, institutional, and societal cost of burnout and disability. We need to be well in order to do well. So that requires a reorientation of our mindset and of our health care system, and only that way will we ultimately, hopefully, arrive at affordable, accessible, and sustainable health care.

Kevin Pho: Iris, thank you so much for sharing your time and insight, and thanks again for being on the show.

Iris Schrijver: Thank you so much, Kevin.