Episode 22 - Health Care and Spirituality, with Dr. John Welshofer
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Episode Summary
Imagine you suffer from a painful disc injury that prevents you from engaging in many of your daily activities. For most people, the obvious course of action is to go see your doctor, where it’s likely you’ll have a physical examination and be prescribed medications and/or surgery. At the end of this course of treatment, you hope to be pain-free and back to your daily routine. Many patients never stop to ask themselves, “is there anything else I could be doing to improve my circumstances?” Dr. John Welshofer would answer you with an emphatic “yes!,” and he’s here today to tell you why.
While the idea of spirituality can be off-putting for some, a growing number of physicians believe spirituality can play a significant role in our physical and emotional health. On this episode of Back Talk Doc, our host, Sanjiv Lakhia, speaks with Dr. John Welshofer, a physician that believes in integrating faith and spirituality into the healing process. Always a science-minded person, Dr. Welshofer became interested in medicine after a severe car accident left a close friend paralyzed from the waist down. (2:17) After his residency in physical medicine and rehabilitation, he regularly dedicated his time to medical mission trips, where he served in communities that lacked health care.
Wanting to give back and serve others, Dr. John Welshofer traveled with the Bless Back Worldwide organization to Haiti and Nicaragua to provide care for underserved communities. For Dr. Welshofer, this experience gave him perspective on how fortunate he was to live in the United States. “[I]t makes you very appreciative of what you have, but also sort of stokes the fires of trying to help others beyond just your own comfort zone.” (6:05) While Dr. Welshofer encountered some truly devastating cases, the positive metamorphosis he observed over the course of return trips showed him the power of the human spirit to make the most amazing things out of the most horrendous circumstances. (7:21)
Dr. Lakhia and Dr. Welshofer go on to explore the weighty question of whether doctors should discuss religious or spiritual beliefs with patients. Dr. Welshofer avoids spiritual questions, instead opting to approach the topic with subtlety. “I don’t really overtly do spiritual histories…I more just try to provide hope for people that don’t seem to have hope when day-to-day they’re going through significant difficulties. (11:52)
While a Doctor should avoid imposing their beliefs on patients, Dr. Welshofer encourages physicians to speak to their patients about their spiritual connections using open-ended questions, as it can help them maintain hope in desperate times, “don’t be afraid to ask a question, if it’s a benign question, you’re not forcing anything, just…how are you doing emotionally and spiritually with your problems?” (21:25)
Having treated thousands of patients in his career, Dr. Welshofer has identified two types of doctors, “You have doctors who treat the problems people have, and then you have doctors who treat people that have problems. If you're a problem treater, you get burned out. Because if all day long, you see 30, 40 patients…all day long it’s people bringing problems. As opposed to, if you're a people treater, then you get to know the patient and then the patient becomes personal to you. So, it's no longer ‘I'm treating the disc problem that Nancy has, I'm treating Nancy that has a disc problem,’ and there's a huge difference. (19:20)
Resources mentioned in this episode:
To contact Dr. Welshofer and Dr. Lakhia’s or to learn more about their practice, visit cnsa.com.
If you enjoyed this episode of Back Talk Doc, check out our episode The Recommended Diet to Reduce Inflammation.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Imagine you suffer from a painful disc injury that prevents you from engaging in many of your daily activities. For most people, the obvious course of action is to go see your doctor, where it’s likely you’ll have a physical examination and be prescribed medications and/or surgery. At the end of this course of treatment, you hope to be pain-free and back to your daily routine. Many patients never stop to ask themselves, “is there anything else I could be doing to improve my circumstances?” Dr. John Welshofer would answer you with an emphatic “yes!,” and he’s here today to tell you why.
While the idea of spirituality can be off-putting for some, a growing number of physicians believe spirituality can play a significant role in our physical and emotional health. On this episode of Back Talk Doc, our host, Sanjiv Lakhia, speaks with Dr. John Welshofer, a physician that believes in integrating faith and spirituality into the healing process. Always a science-minded person, Dr. Welshofer became interested in medicine after a severe car accident left a close friend paralyzed from the waist down. (2:17) After his residency in physical medicine and rehabilitation, he regularly dedicated his time to medical mission trips, where he served in communities that lacked health care.
Wanting to give back and serve others, Dr. John Welshofer traveled with the Bless Back Worldwide organization to Haiti and Nicaragua to provide care for underserved communities. For Dr. Welshofer, this experience gave him perspective on how fortunate he was to live in the United States. “[I]t makes you very appreciative of what you have, but also sort of stokes the fires of trying to help others beyond just your own comfort zone.” (6:05) While Dr. Welshofer encountered some truly devastating cases, the positive metamorphosis he observed over the course of return trips showed him the power of the human spirit to make the most amazing things out of the most horrendous circumstances. (7:21)
Dr. Lakhia and Dr. Welshofer go on to explore the weighty question of whether doctors should discuss religious or spiritual beliefs with patients. Dr. Welshofer avoids spiritual questions, instead opting to approach the topic with subtlety. “I don’t really overtly do spiritual histories…I more just try to provide hope for people that don’t seem to have hope when day-to-day they’re going through significant difficulties. (11:52)
While a Doctor should avoid imposing their beliefs on patients, Dr. Welshofer encourages physicians to speak to their patients about their spiritual connections using open-ended questions, as it can help them maintain hope in desperate times, “don’t be afraid to ask a question, if it’s a benign question, you’re not forcing anything, just…how are you doing emotionally and spiritually with your problems?” (21:25)
Having treated thousands of patients in his career, Dr. Welshofer has identified two types of doctors, “You have doctors who treat the problems people have, and then you have doctors who treat people that have problems. If you're a problem treater, you get burned out. Because if all day long, you see 30, 40 patients…all day long it’s people bringing problems. As opposed to, if you're a people treater, then you get to know the patient and then the patient becomes personal to you. So, it's no longer ‘I'm treating the disc problem that Nancy has, I'm treating Nancy that has a disc problem,’ and there's a huge difference. (19:20)
Resources mentioned in this episode:
- BlessBackWorldwide.org
- The Nature of Suffering and the Goals of Medicine by Eric Cassell
- Discussing Spirituality with Patients: A Rational and Ethical Approach
- The Importance of Spirituality in Medicine and Its Application to Clinical Practice
- Spirituality and Medicine
- The Positive Spirituality in Health Care: Nine Practical Approaches to Pursuing Wholeness for Clinicians, Patients, and Health Care Organizations by Dr. Fred Craigie
- Goodness of Heart
To contact Dr. Welshofer and Dr. Lakhia’s or to learn more about their practice, visit cnsa.com.
If you enjoyed this episode of Back Talk Doc, check out our episode The Recommended Diet to Reduce Inflammation.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Intro: Welcome! You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health. Brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years.
[00:00:21] And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
[00:00:32] Sanjiv Lakhia: Thank you for tuning into this episode of Back Talk Doc. Today, we're going to hit on a topic that I think doesn't get enough traction and discussion in the field of healthcare and medicine, and that is spirituality in medicine, with my friend and colleague, Dr. John Welshofer.
[00:00:53] Spirituality in medicine is I think something that is worth the discussion today. And in particular, as it pertains to back pain, as you know, this is a podcast geared towards educating the public as well as healthcare professionals, really all about spine care, state-of-the-art spine care and best practices.
[00:01:14] And I think the two go hand in hand in particular, if you're a patient out there listening to the podcast today, undoubtedly, you're having some degree of pain and if you're a practitioner. You're also treating patients who have pain and using spirituality as a tool, can really help advance wellness. So, I want to welcome Dr. John Welshofer to the show today.
[00:01:37] John, thanks for taking time to speak with me today.
[00:01:40] John Welshofer: Thank you, Sanjiv. I'm delighted to be here.
[00:01:42] Sanjiv Lakhia: Now, John is he's really one of the more renowned physiatrists in the Charlotte area. He's been in practice for quite a while. Board certified in physical medicine and rehabilitation.
[00:01:53] He did medical school at the University of Cincinnati College of Medicine and residency and internship at the Medical College of Wisconsin. He's also a University of Dayton Flyer, like myself. So, he holds a special place in my heart.
[00:02:06] John, how long have you been with the group here?
[00:02:08] John Welshofer: Well, I've been practicing in Charlotte since 1994, but at Carolina Neurosurgery and Spine, since 2005.
[00:02:17]Sanjiv Lakhia: I think his depth of experience and just, I think your overall experience gives you a lens to look at this topic today about spirituality and just really help share with the listeners, your viewpoints.
[00:02:31] Before we dive into that topic though, can you give us just a little recap? So, people who don't really know much about you. Kind of give them a sense of who you are and what your path was into medicine and the field of spine care in particular?
[00:02:45] John Welshofer: Well, when I was in high school, I had a friend who had become a paraplegic after a severe car accident.
[00:02:54] He had a compression fracture and was paralyzed from the waist down. And that got me interested in thinking about medicine. I'd always been science-background oriented and I was not really great at math, so that kind of ruled out engineering and left medicine as a chance to be a scientist, but not have to worry about the math so much.
[00:03:14] And then I went to undergrad at the university of Dayton and yeah, like a lot of people you spend time shadowing and it just seemed to fit. So, I went off into a residency in physical medicine and rehabilitation, in part, and you as a osteopath doctor, the area that both of us practice is very holistic and this mind body. It's not just treating body parts, it's treating the whole body. And that kind of lent itself to sort of this topic today in terms of, you know, the spirituality part or of the mind body nature of things is, is to me as important as what we do in terms of assessing, imaging studies and lab work and things such as that.
[00:04:06] Sanjiv Lakhia: Yeah, I know. We've really gotten to know each other over the last five to six years, and I know that your faith is a big part of who you are. And, in particular, you dedicate time on a regular basis with mission trips, medical mission trips, where you go and serve in communities that really are lacking health care.
[00:04:27] I think it'd be worthwhile for the listeners to hear a little bit about some of the experiences that you've had as we kind of dive into this topic. So, do you mind sharing some of that?
[00:04:35] John Welshofer: No, not at all. When I first started practicing you, you know, I'm young, I'm married three kids, and so you kind of, you just do your time and then as time goes on and as people mature, not just personally, but also within your profession, you begin to understand how important it is to give back. And then obviously when you have the opportunity to serve others, not just in your own practice and in your own community, but in the outside greater world, I had always thought about it, but I always made excuses not to do it. And then I had an opportunity to work with a group of doctors and nurses and individuals through an organization called Bless Back Worldwide. And that group was formed by actually a physician's assistant here in Charlotte, after the Haiti earthquakes for relief for medical relief, but then it blossomed into regular mission type work. Medical mission work is non-denominational, it's probably, you know, Christian focused, but.
[00:05:45] We had all kinds of individuals who were not necessarily in that now, too, but go. And then I was one of the original groups when they expanded, going to Nicaragua. So, I've been to Nicaragua for medical missions stuff, probably at least five, six times serving the underserved there. And that gives you a very strong impression of the need that the world has beyond our, just our local communities.
[00:06:15] And it makes you very appreciative of what you have, but also sort of stokes the fires of trying to help others beyond just your own comfort zone.
[00:06:25] Sanjiv Lakhia: I haven't had the opportunity yet to go on a medical mission trip, but with my family background, I have visited India before. And you can definitely see another side of the world where we will take a lot for granted that we have here in the United States.
[00:06:41] And it can give you a perspective on how you approach healthcare in this country. And in particular, when you're dealing with patients in the office, I think just understanding their background and where they're from can really add to the kind of the care equation, so to speak. Is there anything in particular on your mission trips or any particular experiences with an individual that kind of comes to mind that would be kind of worthwhile in terms of how you're able to integrate not only providing the healthcare, but providing in a way that kind of serves or touches on the patient's purpose in life and where you've been able to integrate in kind of your background and your faith?
[00:07:21] John Welshofer: Probably the most memorable thing I can remember was the first trip I made. You'd go to these Nicaraguan, I call them burrows, but you can imagine shantytowns whereas basically homes that are made of leftover tin dirt floors and stuff like that. We saw a young lady, you know, we would just make cold calls.
[00:07:45] We would just walk up and down the street and who needed medical care. And we went into one of the little shanties. And when you went in, you kind of knew something wasn't right. And there was a young lady there. She was 14 at the time she had been paralyzed from a motorcycle accident. And so she's laying there in a cot and the degree to which, you know, it's hard to describe the smell, you know, there were chickens, you know, all inside their chickens, jumping up on the cot that she was on.
[00:08:17] She had had no care for a spinal cord injury, which means she had open wounds, etcetera. But she had the most beautiful sweet eyes and was the sweetest kid you'd ever meet, but we also knew something else wasn't right. And we were all concerned that maybe she was pregnant and come to find out we did go back later, administer a pregnancy test.
[00:08:43] Not only she was, was she pregnant, she was pregnant by her mother's boyfriend who was serially raping her. And also by her evil brothers who would take money from local kids there. Allow them to come in because she couldn't fight back cause she was paralyzed.
[00:09:02] And so it was probably the most devastating thing for us to absorb as a medical team but, you know, we prayed about it, we marshaled our resources and long story short, we went back on different mission trips. We managed to accomplish getting her food, we managed to get her out of that toxic environment. She actually went on to deliver a very healthy baby, that was then given up to an aunt to be raised.
[00:09:33] And she actually, now we placed her into this Bless Back organization. I was working with also have a local school and she was placed and is actually in school. She was just paralyzed from the chest down or the waist down. So, she, she, you know, so she had arm feeling her goal now is to become a nurse.
[00:09:55] And that probably, I will never forget that, I will never forget making return trips, seeing the metamorphosis. And you can do amazing things with the most horrendous situations you'd ever think of. If you give a group of dedicated people working on it. And it was that that to me is just, there's been some other amazing things, but that was by far and away was the most catastrophically bad that actually made a, made it turn out about as good as you can expect given the circumstances.
[00:10:29] Sanjiv Lakhia: Wow. That's very powerful. I really appreciate you sharing that experience. It's out of the depths of someone's pain, something beautiful was born through interaction, not just on a physical level. And I think a lot of times that's missed in medicine.
[00:10:45] We're not just here to fix a disc or fix a, a skin issue. But you, you went in there with your team, it sounds like, and really got the ball rolling on, not just physical healing, but it's almost like you started to heal and work on healing her soul and probably in the process, yours as well.
[00:11:03] John Welshofer: She would constantly refer to her faith and that she was going to be okay because her faith was going to help guide her through.
[00:11:11] And then when things started to improve for her, she would refer to our roving teams as that we were the answer to her prayers, which, you know, I'm a person of faith. And I, I believe that, but even for those who don't believe, for her, she believed it, and it was a very gratifying thing. It's like, you know, God will put certain people in your path during their life meant to help, you gotta be attuned to when that calling occurs.
[00:11:41] Sanjiv Lakhia: And I'm going to put a link in the show notes too. I'm just looking it up here while we're talking, I see blessbackworldwide.org. Is that the organization you're referring to?
[00:11:50] John Welshofer: Yes, it is.
[00:11:52] Sanjiv Lakhia: Okay. We'll definitely add that into the show notes. I want to read you something here.
[00:11:56] So in preparation for this, I was looking up some literature, medical literature on spirituality and medicine, and in fact, as many of the listeners know I'm currently a fellow in the, um, the Arizona Integrative Medicine Program. And we did a module on spirituality and health care maybe a month or two ago, but there's an article in PubMed and the title of it, it's the 2007 article.
[00:12:18] And it says the importance of spirituality and medicine and its application to clinical practice and just right in and willing to this article as well. But in the abstract itself, I'm still wanting to read you a little piece of it. It says that, and this was from 2007, which was a while ago, but it said at the time "a consensus panel of the American College of Physicians has suggested four simple questions that physicians could ask patients when taking a spiritual history."
[00:12:42] Then it goes on to say, "doctors and clinicians should not 'prescribe' religious beliefs or activities or impose their religious or spiritual beliefs on patients. The task of in depth, religious counseling of patients is best done by trained clergy. But in considering the spiritual dimension of the patient, the clinician is sending an important message that he or she is concerned about the whole person."
[00:13:07] I just want to get your response to that statement as well. Do you think that is kind of where we should be? Do you think that's a little bit off base of whereas practicing docs we should be with the topic of spirituality and medicine?
[00:13:19]John Welshofer: That's an interesting quote and I guess shows in my own personal practice.
[00:13:25] I don't really do a spiritual interview or questions. It's when I talk to patients, I'm aware that, in the world, you know, you have mean line denominations, of multiple religious persuasions, meaning a fairly large number of people who don't necessarily go to a particular, you know, Judaism, Christianity, Islam, Hinduism.
[00:13:52] They will self-describe themselves as spiritual. So, I think it would be hard to dispute that worldwide, that the vast majority of individuals either considers themselves spiritual and, or a part of an organized faith. And so, so with that, as the background, when I'm talking with patients, I am pretty subtle with it.
[00:14:12] I'm, I'm more, everybody who comes into your office, 99% of them in pain, they don't come there without some degree of some problem. And so, it becomes important to me, for them to understand that, you know, all their pain is bad and pain is difficult. How you handle pain and how you especially chronic pain, encompasses more than just treatment with medications or shots or, you know, therapy. There's a perspective to it as well. And every major world religion has discussion points about that. And this is this a question as old as time itself is "why is there pain in the world? Why do good people have bad things happen to them?"
[00:15:02] You know, is there a meaning behind pain? And I just will prod patients about, you know, that. About their pain is not good for them, you know, they it's, it's not pleasant, but, but sometimes through pain, it allows you to sometimes boil down into your spirituality. And I will tell patients that, you know, it's sometimes you don't really understand it, but there's meaning behind it.
[00:15:30] And certainly the Christian perspective, you know, what happened with Jesus. And the passion of that, but, but certainly through Judaism and other religions, it's a path that actually can help lead them to a closer relationship with God. And, and so, and I say sometimes, you know, you don't ask for it, but you have, for example, this cross to bear, but there, you know, sometimes you can make something good out of something that seems bad.
[00:15:58] And then if you get closer to your God, your spirit, whoever you may define that person through the physical discomfort or disorders that you have, then that is at least trying to make something good out of what's already kind of a tough situation.
[00:16:17] So, I don't really overtly do spiritual histories and stuff. But I, I more just try to, as much as I can provide, hope for people that at times it gets kind of tough for them because they don't seem to have hope when day after day they're going to significant difficulties.
[00:16:33] Sanjiv Lakhia: Yeah. That's excellent. If you're listening out there and you're uncomfortable with the idea of talking about specific religious denominations, I would kind of submit to you that still there's value in this conversation.
[00:16:47] So for example, what he said. I think it has real truth to it in my practice when I have patients that come in with pain, if the time is right and there's an opening, I personally believe that for many of us pain is somewhat of a metaphor, and it's a message. And for a lot of patients nowadays in this somewhat hectic overstressed world of pandemics and, and political strife, pain sometimes is a signal to just slow down and kind of recalibrate. What's going on in your life? What is your purpose? Are you living that purpose? And if not, what can you learn from this recent episode? Whether it's something as minor as a muscle pull or a major that is leading to back surgery or even worse. So that's kind of how I view it. And that's the lens that I look at these problems through.
[00:17:38] And that's where I think from a patient side of the equation, you can use your pain as I point to slow down and ask important questions. And then from a provider side of the equation, you can look at someone's pain and suffering as an opportunity to give them space to talk about what's going on in their lives.
[00:17:57] So at a minimum, they can open the door for more in depth and detailed questions. And then perhaps it does lead someone down a deeper path. As you just mentioned.
[00:18:06] John Welshofer: I think things I've seen is that when people, when they go to see a doctor, and so if you talked to enough patients and I've talked to thousands, they're already under the assumption that you are, you know, you have the medical skill or you wouldn't be a doctor, but so many patients, at times, you're just looking for validation that a) their pain is real, that they are struggling.
[00:18:33] And sometimes, especially with spine patients, you know, cause a lot of times the patients look okay, they may have a husband or a wife or family members, co-workers who don't really understand why, you know, they are not able to do what they would like to do and they, they get, they get down. And so, a lot of times I spend time validating their symptoms and so for the longest time I was just treating problems.
[00:19:02] But what has come across to me is, through my experiences now and made a world of difference in my practice and some of the comments and some of the feedback I get, and this would be something I would suggest, can the providers listening to this is, to me, there seems to be like two types of doctors in the world.
[00:19:20] You have doctors who treat the problems people have, and then you have doctors who treat people that have problems. And if you're a problem treater, you get burned out. Because if all day long, you see 30, 40 patients, if all day long, imagine if you have a job at nothing, but all day long, it's people bringing problems. As opposed to, if you're a people treater, then you get to know the patient and then the patient becomes personal to you. So it's no longer I'm treating the disc problem that Nancy has, I'm treating Nancy that has a disc problem, and there's a huge difference.
[00:19:55] And so when you start looking at each patient that way, and then when you also bring into the importance of validation and then the final layer for, and it's not every patient that comes in, you know, you have a certain mother group and you just develop a sense where it's important to bring in the spiritual aspect of it.
[00:20:16] And that's sort of the deepest level that I may go with someone, but I don't do it with everyone. You get a sense to know, okay, who, who, who needs that degree of a you know, I don't know. Probing or, you know, validation. And so, it's, it's just something that's brought a world of meaning. And I just, I can't express enough that if you're a provider, don't be afraid to do it.
[00:20:43] And you don't, and you don't have to sit through. You're not, I don't sit there and get on a soap box. I don't, you know, push, you know, any religion on anybody. I'm more pushing you. You know, the old, you know, what was it, did the two great commandments, you know, love God and love your neighbor yourself. Well, to me, that's loving your neighbor as yourself.
[00:21:01] And that provides a lot of, you know, feedback to patients exudes that you care. And from that, you know, it may not make their pain necessarily any better, but it also provides them an opportunity where if everyone to feel like you are a good doctor, but also a good person and which is something we all strive to be.
[00:21:25] Sanjiv Lakhia: Yeah, that's very well said. I don't think I can elaborate on that very much. I'll just kind of let that sit there for people to digest. For me personally, I would tend to agree as I've, as I've opened up more in my practice and really gotten to know patients and be a little more vulnerable with patients with myself and my own personal relationships. I think the depth of the care I provide has just improved as have the outcomes. So, there's definitely that, that sense in medicine where I think people are coming to see us and they're looking for more than just a shot or an injection or a surgery. And I tell patients all the time, you know, we treat people not MRIs, and I think that's somewhat similar to what you just articulated there.
[00:22:11] So that's a really good tip. Do you have any other tips? For providers that are listening to this, and they're saying, you know what? I think that's an area that I could add value in my practice, but not sure how to get started. What would you say to a doc? Listen, who's just a little bit uncomfortable, but wants to break out of their box and start to sprinkle in a little of this type of discussion with their patients.
[00:22:33] John Welshofer: Wow. That's a great question because you know, for some individuals, that's, that's just a really big chasm for them to try to jump across. I think, the best suggestion I could make would be for someone or a provider out there too, just don't be afraid to ask a question and just, you know, if it's a benign question, you're not really, you're not forcing anything just to the fact that like, well, you know, how are you doing emotionally and spiritually with your problems?
[00:23:05] So you can sort of couch that spiritual aspect in another thing, or, you know, do you feel like this has tested your, your faith at all? And so, I'll, I'll ask open ended questions, but after a while, you'll get used to just, it'll just kind of flow out of your mouth naturally. And, but that's probably, to me is sort of a very generic sort of broad-based question about it.
[00:23:33] And, and then you'll be shocked when you make a crack in the door what will come out of people's mouths, because I think they're not used to medical providers, whether they're nurses, doctors, or whatever, cracking that door. And so you can do it in a very benign, non, you know, threatening way to anyone. And even if someone's not, you know, either spiritual, even if they were atheists, you know, I've never had anybody ever push back. And so, I don't know that to me would be the one suggestion I would make is just, don't be afraid to throw in that little question. And if they're interested, they'll jump right in. I guarantee you, you're not going to have the problem, but they're not interested in, they just pass it by then you just pass it by because you planted the seed and you get, and I've had patients, you know, you don't know.
[00:24:24] And then, you know, two or three appointments later, I've had him say, you know, you asked me a question about that, and I thought about it. And so, so you never know, you just plants seeds and just, I think you just make it be known that you are willing to discuss, beyond just what that MRI shows, you're willing to discuss not only how it affects them emotionally, but even their spirituality.
[00:24:48] And like I said, I don't, I think that that's about the end of it in terms of what I'll do, people, I just try to, you know, validate and also say that, you know, it's not unusual for these types of things, you know, to help can bring you actually to a more fullness in your spirituality, because these are issues that are known throughout the world that people struggle with.
[00:25:12] Sanjiv Lakhia: Yes. And there's a, a couple of resources that may benefit. I think healthcare providers, as well as non-healthcare providers, there's a book called The Nature of Suffering and the Goals of Medicine by Eric Cassell and, Cassell is a physician and he wrote this, he wrote a seminal article called The Nature of Suffering, and it was published in The New England Journal of Medicine, in 1982.
[00:25:37] And it's kind of the basis for his textbook. And really the crux of the book is that he argues that medical practice just kind of what you just said, medical practice focus is the sick person rather than the disease. So, he focus on the person, not the disease entity, and then he kind of goes through and gives an argument for why that should be in and kind of how that should evolve in medicine. So that's a really good book. If you haven't checked it out, you would likely enjoy it.
[00:26:04] The other resources, Dr. Fred Craigie and that's spelled C R A I G I E, and I may have mispronounced the name. So, I apologize, but he has a website called goodnessofheart.com and we'll link to this as well.
[00:26:19] And he's, he's put up a lot of information about spirituality and health care. And he's written a text called The Positive Spirituality in Health Care: Nine Practical Approaches to Pursuing Wholeness for Clinicians, Patients, and Health Care Organizations. And it's a really easy read and very, very powerful.
[00:26:37] And he'll go through case examples of, of how these, these topics can be integrated. So those are, again, if you're listening and you want to get a little bit more involved from the provider side, I think, educate yourself and just like Dr. Welshofer said even very simple, basic questions. And then the other thing I would say is listen more than talking.
[00:26:58] I mean, open the door and then close the mouth and you'll be surprised what can happen. One thing I'll tell you, I work in again, I worked down in the Rock Hill, South Carolina office for our practice and I share the clinic's face with Dr. Joe Cheadle. And if you are listening to our podcast for the first time, I encourage you to check out an interview I did with him earlier, but one of the things I noticed right away when he joined our group is almost every time when he's checking a patient out, he will say, God bless you.
[00:27:27] And when he first started saying that openly and in the hallway, it made me pause for a little bit. And, and I was like, Oh, well, how's this going to go? And now his patients just love it. Now we are in the South, we're in the Bible Belt, South Carolina. And for the most part, you know, people are very attuned to that, but I was really struck by two things.
[00:27:46] I was struck by how he would say that in such an unabashed way, in a very positive way. And then secondly, how it would make people feel and how it does make people feel day to day. I think whether you have a religious background or not someone extending the energy of a positive affirmation, is always going to be well received.
[00:28:07] So whether you're religious or just spiritual, but not religious, I think it can push the ball forward in a positive way towards healing.
[00:28:15] John Welshofer: Me too, Sanjiv, it really helps because patients, the vast majority, they will not initiate. So it needs to come from the provider. And then I think they are somewhat shocked when you do give them a little opening.
[00:28:31] And then they jump right in, because to be honest with you, I find that they're starved to talk about things that had meaning to their life and how this has affected it. And so they're just, most, it's just not in our medical training. We're so technical. We're so scientific that when you kind of lost the art of medicine, there's the science of medicine, but there's the art.
[00:28:56] And before we have all these fancy treatments and all this stuff, you know, it goes on in today's modern medical world. And there used to be the heart of the personal or interpersonal relationships that the doctor would have with their patient. And so my doing some of these smarter things, I think it brings back some of the art and the caring aspect, the emotional side, the side that, you know, I think too often has been sort of set aside in our busy schedules and I think it would behoove us to try to bring back a little of the art of just being, you know, what we need to be for our patients, not just as medical providers for the technical side, but it's every bit as important to have the side and the emotional and spiritual needs of our patients.
[00:29:47] Sanjiv Lakhia: I think that was an excellent review of this topic. When you approached me about it, I wasn't quite sure where we're going to go with it. And I just wanted to kind of leave it a bit open and we've covered quite a bit of material. We got to hear you reflect on your experiences doing the medical mission work.
[00:30:02] We've got to hear your thoughts with regards to how you just integrate your faith and spirituality as part of the healing equation with your patients. And then hopefully I've been, able to provide some references for those that are listening and want to learn more. So let's kind of wrap it up. I always like to close the interviews with some questions about just health and wellness in general.
[00:30:24] And I think this whole episode is about that, but do you have any kind of tricks or tips or just routines that you like to use, whether it's exercise routines, whether it's your favorite apps, books, tools, anything you want to share as a parting gift to the listeners that could help promote their own health and wellness.
[00:30:43] John Welshofer: I think it's very important for doctors to walk the walk, not just talk the talk. So number one, I'm a big fan of dietary things. So for example, increasing Omega three, decreasing Omega sixes. I think the role of anti-inflammatory diets, there's all kinds of great stuff on the internet of anti-inflammatory diets and using natural stock as opposed to, you know, fat stuff.
[00:31:12] So that's my number one dietary wellness recommendation is to look into anti-inflammatory diets and find something that you can work with. Number two, I exercise regularly. I swim, uh, although with the COVID-19 that's been cut off. But I tell patients and I try to do it myself, is that minimum three times a week, but more preferably I was doing six, but I would say four to five, some type of activity for at least 30 minutes, whether it's walking, exercise, bike, treadmill.
[00:31:44] So some type of aerobic conditioning. And, by aerobic, I mean, I mean, it gets your heart rate up a little, you sweat a little. And, just like the legs of a stool that has three legs. It's standing. The other two are some type of basic weight training, some type of low level for tone and muscle strength. So you don't have to work out at the gym and pump iron or something that puts a little strain on the muscles, hand weights and stuff.
[00:32:09] And then the final thing is flexibility. So I think people need to do stretching, you know, so to me, it's like three things, aerobics, stretching, and strength. You don't have to do it each every single day. Find it a way that makes them that you can do and are willing to do. But if you do those three things on a fairly regular basis, those three triads, I will often tell patients, you know, that to me is, will help keep you doing fairly well.
[00:32:37] And it's good for you, but you need to combine that with good dietary habits.
[00:32:41] Sanjiv Lakhia: Yeah. Very good. Very well said. And I've always emphasized on this podcast that, there is no exact right or wrong way to promote your own health and wellness. And everyone, I interview has a little bit of a different program that they're doing to maintain their fitness.
[00:32:59] So my goal is just to flood people's minds with options and ideas. And, you know, I know you love to swim and that's, that's a terrific exercise, low impact, enormous aerobic benefit, but it also keeps you kind of lean and muscular. I think the resistance training combined with the swimming could be, it's just a home run.
[00:33:19] No doubt about that. So thanks for sharing that. And if you want to learn more about the anti-inflammatory diet that he's speaking about, feel free to download episode 12 of my podcast, where I. And over the Mediterranean anti-inflammatory food plan in great detail over about a half hour episode. Um, it's definitely the foundation of my health plan and it should be a good starting point for many of you listening today.
[00:33:43] All right, John. Well, I really appreciate your time today. I think it was a meaningful episode. It was nice to take a break instead of focusing on the technical aspects of spine care and health care to really talk about more of the human side of health care again, it's called health care, not health treat.
[00:34:00] And when we start adding in discussions about spirituality and meaning and purpose in our interactions, I think it only leads to not only happier patients, but frankly, healthier and happier practicing physicians. So thank you for your time.
[00:34:16] John Welshofer: Yes, sir. I appreciate you being willing to go with that topic. Appreciate that a lot.
[00:34:21] Sanjiv Lakhia: Very good. Have a great day. And I look forward to talking with you soon.
[00:34:24] John Welshofer: Alright, take care.
[00:34:27] Outro: Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
[00:00:21] And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
[00:00:32] Sanjiv Lakhia: Thank you for tuning into this episode of Back Talk Doc. Today, we're going to hit on a topic that I think doesn't get enough traction and discussion in the field of healthcare and medicine, and that is spirituality in medicine, with my friend and colleague, Dr. John Welshofer.
[00:00:53] Spirituality in medicine is I think something that is worth the discussion today. And in particular, as it pertains to back pain, as you know, this is a podcast geared towards educating the public as well as healthcare professionals, really all about spine care, state-of-the-art spine care and best practices.
[00:01:14] And I think the two go hand in hand in particular, if you're a patient out there listening to the podcast today, undoubtedly, you're having some degree of pain and if you're a practitioner. You're also treating patients who have pain and using spirituality as a tool, can really help advance wellness. So, I want to welcome Dr. John Welshofer to the show today.
[00:01:37] John, thanks for taking time to speak with me today.
[00:01:40] John Welshofer: Thank you, Sanjiv. I'm delighted to be here.
[00:01:42] Sanjiv Lakhia: Now, John is he's really one of the more renowned physiatrists in the Charlotte area. He's been in practice for quite a while. Board certified in physical medicine and rehabilitation.
[00:01:53] He did medical school at the University of Cincinnati College of Medicine and residency and internship at the Medical College of Wisconsin. He's also a University of Dayton Flyer, like myself. So, he holds a special place in my heart.
[00:02:06] John, how long have you been with the group here?
[00:02:08] John Welshofer: Well, I've been practicing in Charlotte since 1994, but at Carolina Neurosurgery and Spine, since 2005.
[00:02:17]Sanjiv Lakhia: I think his depth of experience and just, I think your overall experience gives you a lens to look at this topic today about spirituality and just really help share with the listeners, your viewpoints.
[00:02:31] Before we dive into that topic though, can you give us just a little recap? So, people who don't really know much about you. Kind of give them a sense of who you are and what your path was into medicine and the field of spine care in particular?
[00:02:45] John Welshofer: Well, when I was in high school, I had a friend who had become a paraplegic after a severe car accident.
[00:02:54] He had a compression fracture and was paralyzed from the waist down. And that got me interested in thinking about medicine. I'd always been science-background oriented and I was not really great at math, so that kind of ruled out engineering and left medicine as a chance to be a scientist, but not have to worry about the math so much.
[00:03:14] And then I went to undergrad at the university of Dayton and yeah, like a lot of people you spend time shadowing and it just seemed to fit. So, I went off into a residency in physical medicine and rehabilitation, in part, and you as a osteopath doctor, the area that both of us practice is very holistic and this mind body. It's not just treating body parts, it's treating the whole body. And that kind of lent itself to sort of this topic today in terms of, you know, the spirituality part or of the mind body nature of things is, is to me as important as what we do in terms of assessing, imaging studies and lab work and things such as that.
[00:04:06] Sanjiv Lakhia: Yeah, I know. We've really gotten to know each other over the last five to six years, and I know that your faith is a big part of who you are. And, in particular, you dedicate time on a regular basis with mission trips, medical mission trips, where you go and serve in communities that really are lacking health care.
[00:04:27] I think it'd be worthwhile for the listeners to hear a little bit about some of the experiences that you've had as we kind of dive into this topic. So, do you mind sharing some of that?
[00:04:35] John Welshofer: No, not at all. When I first started practicing you, you know, I'm young, I'm married three kids, and so you kind of, you just do your time and then as time goes on and as people mature, not just personally, but also within your profession, you begin to understand how important it is to give back. And then obviously when you have the opportunity to serve others, not just in your own practice and in your own community, but in the outside greater world, I had always thought about it, but I always made excuses not to do it. And then I had an opportunity to work with a group of doctors and nurses and individuals through an organization called Bless Back Worldwide. And that group was formed by actually a physician's assistant here in Charlotte, after the Haiti earthquakes for relief for medical relief, but then it blossomed into regular mission type work. Medical mission work is non-denominational, it's probably, you know, Christian focused, but.
[00:05:45] We had all kinds of individuals who were not necessarily in that now, too, but go. And then I was one of the original groups when they expanded, going to Nicaragua. So, I've been to Nicaragua for medical missions stuff, probably at least five, six times serving the underserved there. And that gives you a very strong impression of the need that the world has beyond our, just our local communities.
[00:06:15] And it makes you very appreciative of what you have, but also sort of stokes the fires of trying to help others beyond just your own comfort zone.
[00:06:25] Sanjiv Lakhia: I haven't had the opportunity yet to go on a medical mission trip, but with my family background, I have visited India before. And you can definitely see another side of the world where we will take a lot for granted that we have here in the United States.
[00:06:41] And it can give you a perspective on how you approach healthcare in this country. And in particular, when you're dealing with patients in the office, I think just understanding their background and where they're from can really add to the kind of the care equation, so to speak. Is there anything in particular on your mission trips or any particular experiences with an individual that kind of comes to mind that would be kind of worthwhile in terms of how you're able to integrate not only providing the healthcare, but providing in a way that kind of serves or touches on the patient's purpose in life and where you've been able to integrate in kind of your background and your faith?
[00:07:21] John Welshofer: Probably the most memorable thing I can remember was the first trip I made. You'd go to these Nicaraguan, I call them burrows, but you can imagine shantytowns whereas basically homes that are made of leftover tin dirt floors and stuff like that. We saw a young lady, you know, we would just make cold calls.
[00:07:45] We would just walk up and down the street and who needed medical care. And we went into one of the little shanties. And when you went in, you kind of knew something wasn't right. And there was a young lady there. She was 14 at the time she had been paralyzed from a motorcycle accident. And so she's laying there in a cot and the degree to which, you know, it's hard to describe the smell, you know, there were chickens, you know, all inside their chickens, jumping up on the cot that she was on.
[00:08:17] She had had no care for a spinal cord injury, which means she had open wounds, etcetera. But she had the most beautiful sweet eyes and was the sweetest kid you'd ever meet, but we also knew something else wasn't right. And we were all concerned that maybe she was pregnant and come to find out we did go back later, administer a pregnancy test.
[00:08:43] Not only she was, was she pregnant, she was pregnant by her mother's boyfriend who was serially raping her. And also by her evil brothers who would take money from local kids there. Allow them to come in because she couldn't fight back cause she was paralyzed.
[00:09:02] And so it was probably the most devastating thing for us to absorb as a medical team but, you know, we prayed about it, we marshaled our resources and long story short, we went back on different mission trips. We managed to accomplish getting her food, we managed to get her out of that toxic environment. She actually went on to deliver a very healthy baby, that was then given up to an aunt to be raised.
[00:09:33] And she actually, now we placed her into this Bless Back organization. I was working with also have a local school and she was placed and is actually in school. She was just paralyzed from the chest down or the waist down. So, she, she, you know, so she had arm feeling her goal now is to become a nurse.
[00:09:55] And that probably, I will never forget that, I will never forget making return trips, seeing the metamorphosis. And you can do amazing things with the most horrendous situations you'd ever think of. If you give a group of dedicated people working on it. And it was that that to me is just, there's been some other amazing things, but that was by far and away was the most catastrophically bad that actually made a, made it turn out about as good as you can expect given the circumstances.
[00:10:29] Sanjiv Lakhia: Wow. That's very powerful. I really appreciate you sharing that experience. It's out of the depths of someone's pain, something beautiful was born through interaction, not just on a physical level. And I think a lot of times that's missed in medicine.
[00:10:45] We're not just here to fix a disc or fix a, a skin issue. But you, you went in there with your team, it sounds like, and really got the ball rolling on, not just physical healing, but it's almost like you started to heal and work on healing her soul and probably in the process, yours as well.
[00:11:03] John Welshofer: She would constantly refer to her faith and that she was going to be okay because her faith was going to help guide her through.
[00:11:11] And then when things started to improve for her, she would refer to our roving teams as that we were the answer to her prayers, which, you know, I'm a person of faith. And I, I believe that, but even for those who don't believe, for her, she believed it, and it was a very gratifying thing. It's like, you know, God will put certain people in your path during their life meant to help, you gotta be attuned to when that calling occurs.
[00:11:41] Sanjiv Lakhia: And I'm going to put a link in the show notes too. I'm just looking it up here while we're talking, I see blessbackworldwide.org. Is that the organization you're referring to?
[00:11:50] John Welshofer: Yes, it is.
[00:11:52] Sanjiv Lakhia: Okay. We'll definitely add that into the show notes. I want to read you something here.
[00:11:56] So in preparation for this, I was looking up some literature, medical literature on spirituality and medicine, and in fact, as many of the listeners know I'm currently a fellow in the, um, the Arizona Integrative Medicine Program. And we did a module on spirituality and health care maybe a month or two ago, but there's an article in PubMed and the title of it, it's the 2007 article.
[00:12:18] And it says the importance of spirituality and medicine and its application to clinical practice and just right in and willing to this article as well. But in the abstract itself, I'm still wanting to read you a little piece of it. It says that, and this was from 2007, which was a while ago, but it said at the time "a consensus panel of the American College of Physicians has suggested four simple questions that physicians could ask patients when taking a spiritual history."
[00:12:42] Then it goes on to say, "doctors and clinicians should not 'prescribe' religious beliefs or activities or impose their religious or spiritual beliefs on patients. The task of in depth, religious counseling of patients is best done by trained clergy. But in considering the spiritual dimension of the patient, the clinician is sending an important message that he or she is concerned about the whole person."
[00:13:07] I just want to get your response to that statement as well. Do you think that is kind of where we should be? Do you think that's a little bit off base of whereas practicing docs we should be with the topic of spirituality and medicine?
[00:13:19]John Welshofer: That's an interesting quote and I guess shows in my own personal practice.
[00:13:25] I don't really do a spiritual interview or questions. It's when I talk to patients, I'm aware that, in the world, you know, you have mean line denominations, of multiple religious persuasions, meaning a fairly large number of people who don't necessarily go to a particular, you know, Judaism, Christianity, Islam, Hinduism.
[00:13:52] They will self-describe themselves as spiritual. So, I think it would be hard to dispute that worldwide, that the vast majority of individuals either considers themselves spiritual and, or a part of an organized faith. And so, so with that, as the background, when I'm talking with patients, I am pretty subtle with it.
[00:14:12] I'm, I'm more, everybody who comes into your office, 99% of them in pain, they don't come there without some degree of some problem. And so, it becomes important to me, for them to understand that, you know, all their pain is bad and pain is difficult. How you handle pain and how you especially chronic pain, encompasses more than just treatment with medications or shots or, you know, therapy. There's a perspective to it as well. And every major world religion has discussion points about that. And this is this a question as old as time itself is "why is there pain in the world? Why do good people have bad things happen to them?"
[00:15:02] You know, is there a meaning behind pain? And I just will prod patients about, you know, that. About their pain is not good for them, you know, they it's, it's not pleasant, but, but sometimes through pain, it allows you to sometimes boil down into your spirituality. And I will tell patients that, you know, it's sometimes you don't really understand it, but there's meaning behind it.
[00:15:30] And certainly the Christian perspective, you know, what happened with Jesus. And the passion of that, but, but certainly through Judaism and other religions, it's a path that actually can help lead them to a closer relationship with God. And, and so, and I say sometimes, you know, you don't ask for it, but you have, for example, this cross to bear, but there, you know, sometimes you can make something good out of something that seems bad.
[00:15:58] And then if you get closer to your God, your spirit, whoever you may define that person through the physical discomfort or disorders that you have, then that is at least trying to make something good out of what's already kind of a tough situation.
[00:16:17] So, I don't really overtly do spiritual histories and stuff. But I, I more just try to, as much as I can provide, hope for people that at times it gets kind of tough for them because they don't seem to have hope when day after day they're going to significant difficulties.
[00:16:33] Sanjiv Lakhia: Yeah. That's excellent. If you're listening out there and you're uncomfortable with the idea of talking about specific religious denominations, I would kind of submit to you that still there's value in this conversation.
[00:16:47] So for example, what he said. I think it has real truth to it in my practice when I have patients that come in with pain, if the time is right and there's an opening, I personally believe that for many of us pain is somewhat of a metaphor, and it's a message. And for a lot of patients nowadays in this somewhat hectic overstressed world of pandemics and, and political strife, pain sometimes is a signal to just slow down and kind of recalibrate. What's going on in your life? What is your purpose? Are you living that purpose? And if not, what can you learn from this recent episode? Whether it's something as minor as a muscle pull or a major that is leading to back surgery or even worse. So that's kind of how I view it. And that's the lens that I look at these problems through.
[00:17:38] And that's where I think from a patient side of the equation, you can use your pain as I point to slow down and ask important questions. And then from a provider side of the equation, you can look at someone's pain and suffering as an opportunity to give them space to talk about what's going on in their lives.
[00:17:57] So at a minimum, they can open the door for more in depth and detailed questions. And then perhaps it does lead someone down a deeper path. As you just mentioned.
[00:18:06] John Welshofer: I think things I've seen is that when people, when they go to see a doctor, and so if you talked to enough patients and I've talked to thousands, they're already under the assumption that you are, you know, you have the medical skill or you wouldn't be a doctor, but so many patients, at times, you're just looking for validation that a) their pain is real, that they are struggling.
[00:18:33] And sometimes, especially with spine patients, you know, cause a lot of times the patients look okay, they may have a husband or a wife or family members, co-workers who don't really understand why, you know, they are not able to do what they would like to do and they, they get, they get down. And so, a lot of times I spend time validating their symptoms and so for the longest time I was just treating problems.
[00:19:02] But what has come across to me is, through my experiences now and made a world of difference in my practice and some of the comments and some of the feedback I get, and this would be something I would suggest, can the providers listening to this is, to me, there seems to be like two types of doctors in the world.
[00:19:20] You have doctors who treat the problems people have, and then you have doctors who treat people that have problems. And if you're a problem treater, you get burned out. Because if all day long, you see 30, 40 patients, if all day long, imagine if you have a job at nothing, but all day long, it's people bringing problems. As opposed to, if you're a people treater, then you get to know the patient and then the patient becomes personal to you. So it's no longer I'm treating the disc problem that Nancy has, I'm treating Nancy that has a disc problem, and there's a huge difference.
[00:19:55] And so when you start looking at each patient that way, and then when you also bring into the importance of validation and then the final layer for, and it's not every patient that comes in, you know, you have a certain mother group and you just develop a sense where it's important to bring in the spiritual aspect of it.
[00:20:16] And that's sort of the deepest level that I may go with someone, but I don't do it with everyone. You get a sense to know, okay, who, who, who needs that degree of a you know, I don't know. Probing or, you know, validation. And so, it's, it's just something that's brought a world of meaning. And I just, I can't express enough that if you're a provider, don't be afraid to do it.
[00:20:43] And you don't, and you don't have to sit through. You're not, I don't sit there and get on a soap box. I don't, you know, push, you know, any religion on anybody. I'm more pushing you. You know, the old, you know, what was it, did the two great commandments, you know, love God and love your neighbor yourself. Well, to me, that's loving your neighbor as yourself.
[00:21:01] And that provides a lot of, you know, feedback to patients exudes that you care. And from that, you know, it may not make their pain necessarily any better, but it also provides them an opportunity where if everyone to feel like you are a good doctor, but also a good person and which is something we all strive to be.
[00:21:25] Sanjiv Lakhia: Yeah, that's very well said. I don't think I can elaborate on that very much. I'll just kind of let that sit there for people to digest. For me personally, I would tend to agree as I've, as I've opened up more in my practice and really gotten to know patients and be a little more vulnerable with patients with myself and my own personal relationships. I think the depth of the care I provide has just improved as have the outcomes. So, there's definitely that, that sense in medicine where I think people are coming to see us and they're looking for more than just a shot or an injection or a surgery. And I tell patients all the time, you know, we treat people not MRIs, and I think that's somewhat similar to what you just articulated there.
[00:22:11] So that's a really good tip. Do you have any other tips? For providers that are listening to this, and they're saying, you know what? I think that's an area that I could add value in my practice, but not sure how to get started. What would you say to a doc? Listen, who's just a little bit uncomfortable, but wants to break out of their box and start to sprinkle in a little of this type of discussion with their patients.
[00:22:33] John Welshofer: Wow. That's a great question because you know, for some individuals, that's, that's just a really big chasm for them to try to jump across. I think, the best suggestion I could make would be for someone or a provider out there too, just don't be afraid to ask a question and just, you know, if it's a benign question, you're not really, you're not forcing anything just to the fact that like, well, you know, how are you doing emotionally and spiritually with your problems?
[00:23:05] So you can sort of couch that spiritual aspect in another thing, or, you know, do you feel like this has tested your, your faith at all? And so, I'll, I'll ask open ended questions, but after a while, you'll get used to just, it'll just kind of flow out of your mouth naturally. And, but that's probably, to me is sort of a very generic sort of broad-based question about it.
[00:23:33] And, and then you'll be shocked when you make a crack in the door what will come out of people's mouths, because I think they're not used to medical providers, whether they're nurses, doctors, or whatever, cracking that door. And so you can do it in a very benign, non, you know, threatening way to anyone. And even if someone's not, you know, either spiritual, even if they were atheists, you know, I've never had anybody ever push back. And so, I don't know that to me would be the one suggestion I would make is just, don't be afraid to throw in that little question. And if they're interested, they'll jump right in. I guarantee you, you're not going to have the problem, but they're not interested in, they just pass it by then you just pass it by because you planted the seed and you get, and I've had patients, you know, you don't know.
[00:24:24] And then, you know, two or three appointments later, I've had him say, you know, you asked me a question about that, and I thought about it. And so, so you never know, you just plants seeds and just, I think you just make it be known that you are willing to discuss, beyond just what that MRI shows, you're willing to discuss not only how it affects them emotionally, but even their spirituality.
[00:24:48] And like I said, I don't, I think that that's about the end of it in terms of what I'll do, people, I just try to, you know, validate and also say that, you know, it's not unusual for these types of things, you know, to help can bring you actually to a more fullness in your spirituality, because these are issues that are known throughout the world that people struggle with.
[00:25:12] Sanjiv Lakhia: Yes. And there's a, a couple of resources that may benefit. I think healthcare providers, as well as non-healthcare providers, there's a book called The Nature of Suffering and the Goals of Medicine by Eric Cassell and, Cassell is a physician and he wrote this, he wrote a seminal article called The Nature of Suffering, and it was published in The New England Journal of Medicine, in 1982.
[00:25:37] And it's kind of the basis for his textbook. And really the crux of the book is that he argues that medical practice just kind of what you just said, medical practice focus is the sick person rather than the disease. So, he focus on the person, not the disease entity, and then he kind of goes through and gives an argument for why that should be in and kind of how that should evolve in medicine. So that's a really good book. If you haven't checked it out, you would likely enjoy it.
[00:26:04] The other resources, Dr. Fred Craigie and that's spelled C R A I G I E, and I may have mispronounced the name. So, I apologize, but he has a website called goodnessofheart.com and we'll link to this as well.
[00:26:19] And he's, he's put up a lot of information about spirituality and health care. And he's written a text called The Positive Spirituality in Health Care: Nine Practical Approaches to Pursuing Wholeness for Clinicians, Patients, and Health Care Organizations. And it's a really easy read and very, very powerful.
[00:26:37] And he'll go through case examples of, of how these, these topics can be integrated. So those are, again, if you're listening and you want to get a little bit more involved from the provider side, I think, educate yourself and just like Dr. Welshofer said even very simple, basic questions. And then the other thing I would say is listen more than talking.
[00:26:58] I mean, open the door and then close the mouth and you'll be surprised what can happen. One thing I'll tell you, I work in again, I worked down in the Rock Hill, South Carolina office for our practice and I share the clinic's face with Dr. Joe Cheadle. And if you are listening to our podcast for the first time, I encourage you to check out an interview I did with him earlier, but one of the things I noticed right away when he joined our group is almost every time when he's checking a patient out, he will say, God bless you.
[00:27:27] And when he first started saying that openly and in the hallway, it made me pause for a little bit. And, and I was like, Oh, well, how's this going to go? And now his patients just love it. Now we are in the South, we're in the Bible Belt, South Carolina. And for the most part, you know, people are very attuned to that, but I was really struck by two things.
[00:27:46] I was struck by how he would say that in such an unabashed way, in a very positive way. And then secondly, how it would make people feel and how it does make people feel day to day. I think whether you have a religious background or not someone extending the energy of a positive affirmation, is always going to be well received.
[00:28:07] So whether you're religious or just spiritual, but not religious, I think it can push the ball forward in a positive way towards healing.
[00:28:15] John Welshofer: Me too, Sanjiv, it really helps because patients, the vast majority, they will not initiate. So it needs to come from the provider. And then I think they are somewhat shocked when you do give them a little opening.
[00:28:31] And then they jump right in, because to be honest with you, I find that they're starved to talk about things that had meaning to their life and how this has affected it. And so they're just, most, it's just not in our medical training. We're so technical. We're so scientific that when you kind of lost the art of medicine, there's the science of medicine, but there's the art.
[00:28:56] And before we have all these fancy treatments and all this stuff, you know, it goes on in today's modern medical world. And there used to be the heart of the personal or interpersonal relationships that the doctor would have with their patient. And so my doing some of these smarter things, I think it brings back some of the art and the caring aspect, the emotional side, the side that, you know, I think too often has been sort of set aside in our busy schedules and I think it would behoove us to try to bring back a little of the art of just being, you know, what we need to be for our patients, not just as medical providers for the technical side, but it's every bit as important to have the side and the emotional and spiritual needs of our patients.
[00:29:47] Sanjiv Lakhia: I think that was an excellent review of this topic. When you approached me about it, I wasn't quite sure where we're going to go with it. And I just wanted to kind of leave it a bit open and we've covered quite a bit of material. We got to hear you reflect on your experiences doing the medical mission work.
[00:30:02] We've got to hear your thoughts with regards to how you just integrate your faith and spirituality as part of the healing equation with your patients. And then hopefully I've been, able to provide some references for those that are listening and want to learn more. So let's kind of wrap it up. I always like to close the interviews with some questions about just health and wellness in general.
[00:30:24] And I think this whole episode is about that, but do you have any kind of tricks or tips or just routines that you like to use, whether it's exercise routines, whether it's your favorite apps, books, tools, anything you want to share as a parting gift to the listeners that could help promote their own health and wellness.
[00:30:43] John Welshofer: I think it's very important for doctors to walk the walk, not just talk the talk. So number one, I'm a big fan of dietary things. So for example, increasing Omega three, decreasing Omega sixes. I think the role of anti-inflammatory diets, there's all kinds of great stuff on the internet of anti-inflammatory diets and using natural stock as opposed to, you know, fat stuff.
[00:31:12] So that's my number one dietary wellness recommendation is to look into anti-inflammatory diets and find something that you can work with. Number two, I exercise regularly. I swim, uh, although with the COVID-19 that's been cut off. But I tell patients and I try to do it myself, is that minimum three times a week, but more preferably I was doing six, but I would say four to five, some type of activity for at least 30 minutes, whether it's walking, exercise, bike, treadmill.
[00:31:44] So some type of aerobic conditioning. And, by aerobic, I mean, I mean, it gets your heart rate up a little, you sweat a little. And, just like the legs of a stool that has three legs. It's standing. The other two are some type of basic weight training, some type of low level for tone and muscle strength. So you don't have to work out at the gym and pump iron or something that puts a little strain on the muscles, hand weights and stuff.
[00:32:09] And then the final thing is flexibility. So I think people need to do stretching, you know, so to me, it's like three things, aerobics, stretching, and strength. You don't have to do it each every single day. Find it a way that makes them that you can do and are willing to do. But if you do those three things on a fairly regular basis, those three triads, I will often tell patients, you know, that to me is, will help keep you doing fairly well.
[00:32:37] And it's good for you, but you need to combine that with good dietary habits.
[00:32:41] Sanjiv Lakhia: Yeah. Very good. Very well said. And I've always emphasized on this podcast that, there is no exact right or wrong way to promote your own health and wellness. And everyone, I interview has a little bit of a different program that they're doing to maintain their fitness.
[00:32:59] So my goal is just to flood people's minds with options and ideas. And, you know, I know you love to swim and that's, that's a terrific exercise, low impact, enormous aerobic benefit, but it also keeps you kind of lean and muscular. I think the resistance training combined with the swimming could be, it's just a home run.
[00:33:19] No doubt about that. So thanks for sharing that. And if you want to learn more about the anti-inflammatory diet that he's speaking about, feel free to download episode 12 of my podcast, where I. And over the Mediterranean anti-inflammatory food plan in great detail over about a half hour episode. Um, it's definitely the foundation of my health plan and it should be a good starting point for many of you listening today.
[00:33:43] All right, John. Well, I really appreciate your time today. I think it was a meaningful episode. It was nice to take a break instead of focusing on the technical aspects of spine care and health care to really talk about more of the human side of health care again, it's called health care, not health treat.
[00:34:00] And when we start adding in discussions about spirituality and meaning and purpose in our interactions, I think it only leads to not only happier patients, but frankly, healthier and happier practicing physicians. So thank you for your time.
[00:34:16] John Welshofer: Yes, sir. I appreciate you being willing to go with that topic. Appreciate that a lot.
[00:34:21] Sanjiv Lakhia: Very good. Have a great day. And I look forward to talking with you soon.
[00:34:24] John Welshofer: Alright, take care.
[00:34:27] Outro: Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.