By Amy Phariss

Each year, many of us travel to our doctor’s office for our annual checkup. We expect the usual suspects: blood work, heart exam, lung exam, head & neck exam and assorted screenings to include colonoscopies and mammograms. But what happens after the annual physical exam? What happens if, for example, it turns out we have markers for prediabetes, depression or anxiety? What do we do if we realize our diet is no longer serving us (no pun intended), and we need to make different choices in the foods we eat or the ways we move? 

Where do we go next? 

A growing number of medical clinics are embracing a holistic view of medicine and patient health and offering wellness teams: teams of professionals who can assist and guide patients to get and stay healthy. Pinehurst Medical Clinic is one such clinic. Medicare-eligible patients may have an Annual Wellness Visit with one of their health coaches to further explore a patient’s wellness needs, both physical and mental, to ensure the patient is on the best possible path toward health and wellness. Although the Annual Wellness Visit must meet standard requirements, the Wellness Team explains, each visit is tailored for the individual. This is the opposite of cookie-cutter medicine. This is individualized support that meets each patient where they are on their own road to feeling their best. 

I sat with the entire Wellness Team and spoke with them about what a wellness visit actually means, what they do on an individual basis to help patients thrive and live healthier lives and what a patient might expect when scheduling an appointment and utilizing their services. I learned a lot that afternoon, listened to each of the women describe her view on health, wellness and patient advocacy. 

Here is an overview of what you might expect in seeking out the services offered by the Wellness Team at Pinehurst Medical Clinic. Learn how you might overcome barriers and how your life might be positively impacted when reaching out for help from qualified, specially-trained staff. 

What is a Wellness Team?

The Wellness Team consists of team members trained in different disciplines, all of which are focused on enhancing overall health and well-being including registered dieticians, counselors and therapists, registered nurses, social workers and health coaches. Teams are individualized to meet each person’s needs which might include weight loss, diabetes education and treatment, tobacco cessation, caregiver support, and depression management, to name a few. A Wellness Team is a lot like a sports team. There are different coaches on a sports team. There is an offensive coach or a defensive coach or a special teams coach. If you need to work on defense, you see the defense coach, for example. The Wellness Team is exactly like this. Whatever you need to work on, the Team has a coach to help you. 

What is a Health Coach? Is it like a personal trainer? 

A health coach engages patients in behavior change with evidenced-based recommendations. This means they encourage and recommend programs and ideas that have been researched and proven effective. These recommendations help facilitate lifestyle changes for better physical, emotional, environmental, occupational and social wellbeing. Sometimes we know we ‘should’ make a change in our lives, but we don’t know how to make that change, or we need support in order to develop a plan. This is how a Health Coach can help. The Health Coach does not determine what the patient should do or what the patient values; that is up to the patient. The patient sets the goals based on his or her values and needs, and the Health Coach helps the patient brainstorm ideas, develop a plan and supports the patient as he or she moves through the steps necessary to move through that plan. Many patients find that small changes can yield big results, and gradual, small changes tend to ‘stick.’ The Health Coaches look at what the patient can do at that time and go from there. There is no shoulda, coulda, woulda here. There’s just a focus on what is possible right now, right here, with what we’ve got. 

What are the biggest barriers to healthy lifestyle changes? What keeps people from coming to see a Health Coach or taking steps to become healthier?

Finances. Schedules. Social Support. Time – if you’re a caregiver, for example, you may not have time to make an appointment for yourself. Distance is another barrier, and transportation can be an issue for some people. Lack of confidence is sometimes a problem, but the Wellness Team likes to remind patients that focus is more about the effort than the outcome. 

Another important barrier for many people is plain old guilt and shame. 

People feel ashamed of weight gain or blood sugar numbers. Any behavior can induce shame including lack of exercise, over-eating, emotional eating or failing to take medication, and with shame comes guilt. The Wellness Team encourages patients to try to let go of these feelings and continue to reach out and come to appointments, being open and honest about their progress. The Wellness Clinic is a judgement-free zone, a place of support not criticism. It’s a safe space where patients can come with their own goals and discuss issues they meet along the way, problems they face and barriers that may have derailed progress. 

The Wellness Team helps patients with both physical and mental health issues. What is the day-to-day connection between physical and mental health? How do they depend on each other and interact with each other in ways that may not readily come to mind?

Mental and physical health are often interconnected. For example, doing something physically good for us (going for a walk, going outside in the sunshine, getting a good night’s sleep) will actually improve our mood, our feelings. Often mental health and emotional health can depend on physical health and vice versa. When we work to improve one area, which might be physical, it will also improve other areas. For example, appropriate weight loss may increase one’s confidence and physical ability to do different activities that were previously a challenge. Finally, the Wellness Team notes how important it is to remember: feelings are not facts. We may not feel like doing something good for us, but we can do it anyway. We may feel something, but that doesn’t make it true. Learning to distinguish between feelings and facts is an important lifestyle skill. 

What are the best and simplest acts we can do to be physically healthier?

  • Move more and sit less. 
  • Eat less processed foods and more whole foods. 
  • Socialize. 
  • Get adequate sleep. 
  • Manage stress. 

What are the best and simplest acts we can do to be mentally healthier?

  • Get adequate sleep. 
  • Practice gratitude. 
  • Breathe. 
  • Step outside – sunny or not. 
  • Think mindfully. 
  • Take a break from judgment, especially for yourself. 
  • Have a good support system. 
  • Name your emotions. 

Many patients who utilize the services of the Wellness Clinic are managing chronic illnesses. What are some priorities in managing chronic illness beyond medical intervention? 

Education. Learning about and understanding your illness are key in being able to manage it. Support is also a huge component in managing chronic illness. You might need social support to remind yourself to take medication or to go for a walk. You might need social support for socialization and getting to appointments. Priorities are also important, and you will need to set these priorities and goals for yourself. Planning and goal setting are key to developing a path for managing an illness. Finally, resources are incredibly helpful. From medical resources like doctors or wellness teams to social services and even community resources like church families and friends, the more help we can get, the better off we are in taking care of our whole selves. Often, through support, education and resources, you can meet your personal health goals. 

How can behavioral counseling help patients with physical issues or chronic pain/illness?

The first and perhaps most important way is to deal with expectation management. Many patients come in with expectations regarding their pain. They may expect to have no pain, or they may expect to have life-long pain. Counselors and coaches can help them explore beliefs and expectations. When their pain is not entirely gone, they are disappointed and upset. The Wellness Team can help them manage those expectations, develop a plan going forward and help them stop comparisons that can be damaging. Behavioral counseling can also help change emotional responses to pain sensation and help people identify the pain rather than having the pain identify the patient. Pain can be managed with mindfulness therapies as well, which has been proved effective for many people. Finally, adjusting to new realities is important. The Wellness Team helps patients practice acceptance and explore the mind-body connection, which can be healing in and of itself. 

Finally, the question so many readers may be asking themselves is: how do we pay for these fabulous services? 

All of these services are covered by insurance, some covered at 100%, others with a copay. Annual Wellness Visits are specific to Medicare and Medicare Advantage plans. Once a referral is received, coverage will be verified and communicated with the patient. 

Editor’s note: 

I am grateful to the Wellness Team of Pinehurst Medical Clinic for letting me crash their annual retreat and for their willingness to so openly answer my questions. Years ago I read the book God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine (Victoria Sweet, 2013) about a doctor who worked at the last almshouse in the United States. Of all the messages the book left me with (there were many), the greatest is that there is incredible power in treating the entire person rather than the specific illness or condition. Pinehurst Medical Clinic’s Wellness Team’s approach takes this idea and makes it a reality.