The Rise of Lifestyle Medicine and Its Impact on Modern Practice with Dr. Iris Schrijver

“If we are serious about this quintuple aim, this lofty goal of improved health outcomes at lower cost with better experiences for our patients, all of that in an environment of equity and physician wellbeing, then we really need a shift in health and healthcare. Because what I see is that patients are disenchanted with healthcare. They don’t feel that their physicians have time for them. They don’t feel heard. And I see physicians leaving healthcare because the system is really not conducive to either group.”
– Dr. Iris Schrijver

Dr. Iris Schrijver is a certified lifestyle medicine physician who also specializes in clinical pathology and molecular genetics. She’s an adjunct clinical professor of pathology at Stanford University School of Medicine and a past president of the Association for Molecular Pathology. Dr. Schrijver has served as the medical director for a volunteers in medicine organization because she believes that health care is a basic human right. Together with her husband, an astrophysicist, she wrote Living with the Stars, a popular science book about connections between the human body and the universe. And more recently, she has written On the Path to Health, Wellbeing and Fulfillment.

Originally from the Netherlands, Dr. Schrijver eventually landed at Stanford to be trained in clinical molecular genetics and clinical pathology, or laboratory medicine. She then became a faculty member in the pathology department where her main purpose was to direct the diagnostic molecular genetic pathology lab. After a long and rewarding career there, she and her husband made a joint decision to step away and pursue new adventures. They moved from California to Oregon where Dr. Schrijver became involved in a free clinic and ultimately became its medical director. She also discovered lifestyle medicine and was so impressed with its urgency and the science behind it that it inspired her to become certified in it herself. Her experience also inspired her to write her latest book.

Dr. Schrijver shares just how important lifestyle medicine is and that it has a solid base in science. She explains the six pillars of health, well-being, and fulfillment and what they mean for both physicians and their patients. We discuss how to sift through all of the information that is out there and how small shifts add up to big, lasting changes. It can be challenging for physicians to “walk the walk” when it comes to lifestyle medicine, and Dr. Schrijver offers her advice. She also shares practical ways for physicians to integrate lifestyle medicine principles into their daily practice.

What’s Inside:

• How Dr. Schrijver became involved in lifestyle medicine.
• The six pillars of health, well-being, and fulfillment.
• How to integrate lifestyle medicine into your personal life and professional practice.

Mentioned In This Episode:

• DocWorking.com
• American College of Lifestyle Medicine
• LifestyleForHealthandWellness.com
• [email protected]
• On the Path to Health, Wellbeing, and Fulfilment: To Your Health

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Please enjoy the full transcript below

 

Dr. Schrijver:  If we are serious about this quintuple aim, right, this lofty goal of improved health outcomes at lower cost with better experiences for our patients, all of that in an environment of equity and physician wellbeing, then we really need a shift in health and healthcare, because what I see is that patients are disenchanted with healthcare. They don’t feel that their physicians have time for them. They don’t feel heard. And I see physicians leaving healthcare because the system is really not conducive to either group.

Jill: Hi everyone and welcome to DocWorking: The Whole Physician Podcast. I’m Jill Farmer, co-host of the podcast and lead coach at DocWorking. And as always, this is brought to you by DocWorking THRIVE. Go to DocWorking.com today to find out how we can support you as a physician and healthcare professional on your road to thriving. Today, you’re in for a treat. We are joined by Dr. Iris Schrijver. She is a certified lifestyle medicine physician who also specializes in clinical pathology and molecular genetics. She’s an adjunct clinical professor of pathology at Stanford University School of Medicine and a past president of the Association for Molecular Pathology. She served as medical director for a volunteers in medicine organization because she believes that healthcare is a basic human right. Together with her husband, an astrophysicist, she wrote Living with the Stars, a popular science book about connections between the human body and the universe. And more recently, she has written On the Path to Health, Wellbeing and Fulfillment to your health. And that’s what we’re going to talk about today is your most recent book, Dr. Schrijver, and how that can help support the work that so many of our physician and healthcare professional listeners are doing. So thanks so much for joining us today. 

Dr. Schrijver: Oh, I’m delighted to be here, Jill. Thank you. 

Jill: So tell us a little bit about your personal journey and what led you to write this most recent book. 

Dr. Schrijver: Yeah, so I’m originally from the Netherlands and eventually I came to Stanford to be trained in clinical molecular genetics, ultimately also in clinical pathology, which is laboratory medicine. And I became a faculty member in the pathology department where my main purpose was to direct the diagnostic molecular genetic pathology lab, where we diagnose inherited genetic diseases and provide a diagnosis, prognosis, therapy predictions and minimal residual disease testing in acquired genetic disorders and cancers. And I’ve had a long and rewarding career there, but eventually my husband and I decided together to step away and to pursue new adventures. So we moved from California to Oregon. And, you know, as a physician, you have so many different possibilities to make a difference, right? So I became involved in this free clinic and ultimately became its medical director. I also discovered lifestyle medicine, and I was so impressed with its urgency and with the science behind it that I decided to become certified in it myself. So that was a newfound love. And I finally had time to write my book, On the Path to Health, Wellbeing and Fulfillment. And it may seem ironic that a pathologist writes a book on health and wellbeing, but I do think that we see a shift in medicine where, of course, we still need to diagnose diseases and take care of our patients. But there’s also a greater interest now in prevention and in optimizing health, in looking what serves our patients best and us in that setting, and to not just look at what’s wrong with patients. 

Jill: So let’s back up a little bit because it’s really become more common, the understanding of what lifestyle medicine is and the practice of lifestyle medicine has become more widespread over the last few years. But I’m not sure all physicians or all healthcare professionals are totally familiar with what we’re talking about when we talk about the discipline of lifestyle medicine. So can you give us kind of in broad strokes what that definition is and what it means to be a lifestyle medicine practitioner? 

Dr. Schrijver: So lifestyle medicine is the medical specialty that uses evidence based lifestyle therapeutic interventions as a primary approach to prevent, treat and actually often reverse the conditions that cause the most disease and deaths in our time. And it does that by addressing the root causes so, so often in medicine we’re managing disease. But this actually looks at the whole person and enables people to adopt and sustain healthy lifestyles so that we can get back to an area of health restoration where we can actually really feed that energy and vitality that we all so often miss. And that has a ripple effect because we’re treating our patients and their families. But this also, you know, has a positive effect on their communities and certainly also on healthcare providers and healthcare leaders themselves. Now, lifestyle medicine has six pillars, and maybe I can go through those real quick. The first pillar is an emphasis on a whole foods, plant-strong way of eating, because that way of eating is supported by science to be just very conducive to optimizing health and longevity. Then also the second pillar is optimizing and individualizing physical activity plans because that lifts mood, increases health and longevity as well. And third, improving restful sleep. That’s certainly something that we as physicians can use more of often. The fourth is stopping tobacco and other harmful substances. The fifth, making and maintaining good social relationships, that is so profoundly important. And then managing stress with healthy coping strategies. And that’s the emphasis, healthy coping strategies. But as you well know, managing stress increases resilience. It is not the same thing as thriving. But those pillars together can certainly help prevent burnout or address burnout when it has happened. And what I love about it the most is that this is solidly based on science. 

Jill: So let’s talk a little bit about what are the factors that undermine either any of these six pillars or just generally health, well-being and fulfillment for physicians and for healthcare providers, in your experience? I know you write about that in the book.

Dr. Schrijver: Yeah, I do. And you know, if we are serious about this quintuple aim, right, this lofty goal of improved health outcomes at lower cost with better experiences for our patients, all of that in an environment of equity and physician wellbeing, then we really need a shift in health and healthcare, because what I see is that patients are disenchanted with healthcare. They don’t feel that their physicians have time for them. They don’t feel heard. And I see physicians leaving healthcare because the system is really not conducive to either group. So physicians are working under such high pressures. I mean, there’s the workload, that’s one, but also time pressures. And I describe in my book this anecdote of a study that shows that the mean time to interrupt by a physician when the patient comes to see them is 11 seconds. And of course, there’s a wide range. It was a relatively small study. It’s certainly not necessarily the norm, but it is telling, I think, that there is a reason why patients don’t feel heard. And the problem then is that they seek sources where they do feel that people have time for them, where they do feel heard. And what they often don’t realize is that they may be manipulated into trusting information that does more harm than good. And that’s one of the problems. There are so many contradictions in information sources these days, and we as physicians also have trouble navigating that. 

Jill: And so how in lifestyle medicine, how do you navigate that? How do you make sure that what you are providing, so I hear you saying that a principle is listening to the patients more carefully so that you’re considering their whole health as part of the process and preventative health, looking for ways for preventative health. But how do you sort of sort through the morass of information that’s there as it relates to all of these pillars? I mean, sleep, everybody can agree we need more of that. And tobacco is not good for but in terms of especially around diet, health and some of the other mental health aspects of the pillars. 

Dr. Schrijver: Well, I think we need to go back to the art and science of medicine, and that is easily said and not so easily done because of those time pressures. And, you know, another example in my book is that statins are so widely used. For example, if I go back to our patients, then three out of four doctor’s visits end up with a prescription. And in any given month, every second person takes a prescription medication. And if you look at national guidelines, then it’s actually recommended in those guidelines that physicians discuss lifestyle changes with their patients first. But there is so little time and patients have come to expect a prescription when they go to the doctor that it is much easier for physicians to just write that prescription. But ultimately, that really doesn’t serve any of us. So what I would like to encourage physicians to do is to make small shifts. And when we think about what can actually make a difference, I think about the six pillars of medicine and combining them with the principles of positive psychology. So let’s say you want to make a change in exercising, then, you know, we all have good intentions and that motivation is great and it’s at the heart of any change. And it is something that needs to happen to get us going. But in order to keep us going, we need positive emotions and with positive emotions, so positive health, we can enforce the healthy habits that we try to establish and vice versa, because those healthy habits actually generate positive emotions, and that’s often lost. So then you get into a positive circle of really supporting our overall health. And that’s what I love about that combination. 

Jill: Yeah. And that works well for people, at least on the well side of the psychological scale, as Martin Seligman and all of his colleagues have identified. 

Dr. Schrijver: But it also I want to just add that it is a preventive measure for burnout and also can reverse burnout once it has been, you know, once it’s there. 

Jill: So you’ve talked beautifully about a lot of the amazing attributes of, as a physician, a better understanding of lifestyle medicine as a way to treat and support the health, wellness and longevity of your patients. What I hear from so, so, so many of my physician clients, whether it’s one on one, whether it’s in our small group sessions here at DocWorking where we’re supporting physicians is there’s this understanding of these six pillars and the data behind it and knowing how much healthier it can make patients. But they feel terrible because it doesn’t feel like there’s the time in their life that the system has sort of squeezed them out of being able to do what they want to do as it relates to their own personal health and wellness journey. So how do you speak to physicians who are like, it’s hard for me to preach at my, you know, not that they’re preaching, but to encourage my patients to do these six pillars when I know I’m not living that in my own life. And that makes it hard for me to emphasize that for them. How do you answer that? 

Dr. Schrijver: Yes, it is difficult. It is a challenge because I think the perception of busyness and of overwhelm is very real. You know, it’s not something that is easy to solve because it is a systematic issue and it is both because of our physician traits. I think we all have this deep-seated value of prioritizing work no matter what, and there’s this unspoken code of conduct that we need to show up for work and show up for our patients and do that at the detriment of showing up for ourselves. And of course, that’s not the whole story. Right. Research has shown that it is, in fact, also institutions themselves that generate a system in which it is very difficult for physicians to thrive. So it really doesn’t go back just to us as physicians. But what I would like to say to them directly is that there often is this misperception of all or nothing, and all or nothing works when you have a major health scare. Maybe then you become really motivated to throw your life around and to really look at all that’s going on. But I am a huge fan of baby steps. I think black and white thinking is generally not helpful, and small steps can generate a remarkable shift and make a difference in health and health outcomes and our quality of life. And what we need most perhaps is compassion. We need compassion for others. Certainly, we need compassion in the workplace because we need to give each other a break in order to have the time to be under the weather, support each other in that sense. If the system doesn’t support us, we need to wake up and support each other. But maybe most of all, we also need compassion for ourselves because that’s where it really starts and that’s where you can really take a step back and say, which aspect of my own health needs a boost today? How can I thrive? Because when you establish that, when you take a short time to create that space to breathe, then you can actually really meaningfully make small changes one at a time. And it doesn’t take that much time or effort to shift a little bit. And yet these little shifts can make a big difference over time. 

Jill: Yeah, I think that’s such an important reminder, and I don’t think we can say it enough here because we do know that when you’re in an activated stress state as a human being, not just a health care professional or a physician, then we are more likely to step into these maladaptive coping strategies. And one of them is that all or nothing thinking as you described, or that black or white thinking, you know. And the other thing is that we know that physicians tend to have a higher-than-average sense of compassion and empathy toward other people and also tend to have a much higher than average, when psychologists have looked at the way that they talk to themselves, they’re very hyper self-critical. And so the way that I like to think of this often is the most compassionate way that you would reach out to a patient about making small changes in order to support their health and longevity because you care so deeply about them as humans. If we could turn that on ourselves and if physicians could turn that on themselves, I wonder how much easier it would be to make changes instead of that harsh inner critic telling them that they’re lazy, that they just need to be more efficient, that they, or just rage against the machine of wishing things were different than they are. And I think I just really like how you stated that no step is too small in this journey. 

Dr. Schrijver: No, and it is a journey, you know, I generally don’t like the term, but our life and our health, they are a journey and our identity over a life span doesn’t stay the same. But we need to be very careful as physicians that we don’t just add years to life, but life to years, you know, we really want to be there for ourselves and be happy and feel good and support our own health in any phase of life so that we can do meaningful work. 

Jill: So for you personally, Dr. Schrijver, how has the both the study of lifestyle medicine and the integration of having a lifestyle medicine practice, how has it impacted your patients? What do you see happening with the people you work with and how has it impacted your own life as an individual? 

Dr. Schrijver: Well, I’m currently setting up a lifestyle medicine service for that free clinic, so I haven’t actually jumped into having this practice. But I hear from so many people how important it is to have support in making these changes. And for me personally, I think, you know, if you talk the talk, you have to walk the walk. And so it actually has been a great motivator for me personally to also have a good look at my health. And as a physician who has worked in nonprofit and academic medicine, I’m so impressed with the things that we can do in this sphere. I have this love of learning, this curiosity, and I’ve always looked at how I can do things better and how I can make things better for others and myself. And lifestyle medicine, I feel, is a very realistic way of doing that. Just because the perception of truth and validity and the perception of what is real and what is science based really affects our health and our happiness. And so it’s working at that behavior in small steps that can really get us to thriving. 

Jill: So just a couple of final questions here. First of all, if a physician has not become certified as a lifestyle medicine practitioner but hears this and says, you know, I know it’s got to be more about helping to sustain longer term health for my physicians through these pillars that you talked about, is it important for them to go study lifestyle medicine or get the certification before they integrate it into their practice? Or are there other ways that they can consider adding it as part of their medical practice, in your experience? 

Dr. Schrijver: I would encourage anybody to check out the American College of Lifestyle Medicine. There are lots of free resources there. There are also many lifestyle medicine physicians and other lifestyle medicine professionals that physicians can collaborate with, that they can team up with. And I say that because on the one hand, yes, everybody can incorporate lifestyle medicine into their practice. However, if I think about the fact that more than 75% of medical schools don’t teach even the minimum of recommended nutrition training, then physicians have a long way to go in terms of really being confident and being capable in conveying such aspects to their patients. So lifestyle medicine certification is added value. If a physician has an interest in that, they can find out more about it on the American College of Lifestyle Medicine website. But there are also many resources that they can use today. 

Jill: Yeah. Thank you so much for that insight into that. And finally, if you wanted to inspire a physician who says, oh, I heard you talk about those six pillars. I hear about you talking about how important it is for prevention of burnout, but also other diseases to be thinking about incorporating these pillars more into my life. How would you inspire them to begin today to make a positive change in their life? 

Dr. Schrijver: I would inspire them by saying, take a moment, take a step back and ask yourself, how can I thrive? Which aspect of my own health can use a boost today? And what can I start with? What is a step in the right direction? I think we so often ask about our general health; you know? Where does our food come from? For example, we think about our mental health, how what makes me happy. We also need to think about our mind health, what nourishes our mind in the sense of what information can be trusted. We need to be discerning so that we as physicians also don’t reach for things that are smoke and mirrors that are actually not helping us, but that actually help us make decisions that are based on science and nourish our wellbeing. So I would like to encourage physicians to take a pause, maybe to take some digital detox moment and just spend a few minutes, maybe a few minutes a day asking themselves this question. 

Jill: Thank you so much. If people want more information or want to find your new book to dive in a little more deeply to these principles, how can they do that? 

Dr. Schrijver: Yes, so they can find me on my website, LifestyleForHealthandWellness.com. And they can also email me, [email protected]. On my website, there is a discount code for the book. The book is now out as a hardcover, but also a paperback. And I’m very excited to say that it’s also available on Amazon as a Kindle and that edition has just come out as well. So people can find On the Path to Health, Wellbeing and Fulfillment right there. 

Jill: Dr. Iris Schrijver, thank you so much for taking the time to talk about this very important subject with us today, it was great having you. And thanks to all of you who tuned in. Please share this podcast with colleagues and friends who might benefit from it as well. And please go to DocWorking.com. We have all kinds of resources, including access to an incredible just minutes a week course that you can take to help you better process your stress and help you thrive. Until next time, for DocWorking: The Whole Physician Podcast, I’m Jill Farmer.