Dear Doctor: Kaylan Baban
The Chief Wellness Officer at George Washington University’s School of Medicine and Health Sciences on reclaiming the term “holistic” in evidence-based medicine.
A week before Thanksgiving in middle school, Dr. Kaylan Baban announced that she was a vegetarian. While her aunt who was hosting the holiday was less than thrilled, Dr. Baban’s commitment and passion for mind-body health and lifestyle medicine have remained steadfast. As Chief Wellness Officer, Director of the Lifestyle Medicine Program, and Assistant Professor of Medicine at George Washington University School of Medicine and Health Sciences, Dr. Baban is familiar with juggling important responsibilities and understands firsthand how critical lifestyle management is to one’s personal health and professional performance. As a clinician and educator, Dr. Baban believes that a personalized holistic approach to evidence-based medicine is the key to success, and she is working to redefine our approach to medical care to better the lives of patients and physicians alike.
Getting started in medicine
Finding my path within medicine has been a journey, and in some ways, my career has evolved alongside — and I hope has contributed to informing — the evolution of the field of medicine itself. None of the positions that I hold now existed even five years ago. They are a culmination not just of my own experiences and passions, but more importantly of a crucial movement in medicine towards the evidence-based pursuit of wellness and healthful lifestyles — something vital to healthcare that has been desperately missing. I use my own example to teach my students and residents the importance of not allowing themselves to be pigeon-holed — diverse skills, interests, and perspectives are critical in continuing the evolution of medicine and our healthcare system. Personally, the path of my own career is one that I could have never predicted but for which I am extremely grateful.
From an early age, I was interested in preventive medicine and mind-body practices. I loved science and found helping people directly to be incredibly rewarding. Beginning in middle school, I was a vegetarian who practiced mindfulness and ran track. Later on, I was an art history major working in an NIH basic science lab. My interests were pretty diverse and combined in unusual ways, but I quickly realized that they could lead me to some unique and intriguing niches.
When I was pre-med as an I. I. Rabi science scholar during my undergraduate studies at Columbia, for example, I co-ran a homeless outreach student organization called Advocacy Coalition (which is still active today). As the only pre-med student who was a part of that organization, I became the default point-person for anything medical that arose with our clients. Through that process, I learned that you can do everything you can to help one individual, but how far you’re able to assist them is limited substantially by the system in which you’re working. As a result, by the time I entered medical school I was also taking night classes to get my master’s in public health.
At this point, I was doing a lot of work abroad, including in northern Iraq where a lot of my family is from. I worked on many projects, including helping to build up their healthcare infrastructure. In school, I was feeling torn between my loves of prevention, public health, and close patient relationships on the one hand and surgery on the other. To me, the appeal of surgery was that you could really get to the root of the problem, which was massively appealing to me, but I didn’t see a good model for how to incorporate this with my passion for public health and holistic care. I didn’t know how to reconcile these until I met a group of patients in the dedicated care of Kurdish ophthalmologists in the town of Halabja, which was one of the villages that had been attacked with chemical gas by Saddam Hussein’s army. The preventive, medical, and surgical care they received, and that we helped create infrastructure to enable, made such a world of difference to their quality of life and that of the families for whom they could now care and support. It was in that setting that I came to love ophthalmology as a field that was able to engage all of my interests.
On finding mind-body and lifestyle medicine
During my ophthalmology residency, I focused in (so to speak) on ocular epidemiology with a prevention-based public health approach to glaucoma as my subspecialties. I had maintained my self-care throughout my training, but in my final year, a lot of competing demands and responsibilities came into play. Like many of us have at one point or another, I put my self-care on hold. I didn’t have time for sleeping or exercise and started getting all of my meals at the hospital (where mac and cheese was often the “vegetarian” option).
When things settled a bit and I finally returned to my passion for running a few months later, my joints were unstable from having been inactive for so long, and I ended up with nerve damage when my patella dislocated. I was unable to get a proper diagnosis for a while, and ended up taking call on crutches and operating with ice strapped to my knee for three months. Not surprisingly, this just made the damage worse. When I finally got a proper evaluation and diagnosis, I was told that I may not walk without assistance again. It turned out that what I needed was lots of procedures followed by intense rehabilitation and sustained lifestyle modifications (returning to my anti-inflammatory lifestyle with a vengeance), which inevitably changed the course of my medical training.
As you can imagine, the change this injury forced in my career was crushing at the time. I am glad to say, though, that there was a big silver lining, and another door opened. During that five year gap between finishing medical school and returning for my second residency, the culture of medicine had started to shift. During one of my many physical therapy workouts on the elliptical machine, I was introduced to Dr. Richard Davidson on Krista Tippett’s “On Being” podcast. Dr. Davidson is a cognitive neuroscientist at the University of Wisconsin who runs the Center for Healthy Minds in Madison and does a lot of research on mindfulness and meditation.
While listening to the podcast, I was fascinated to learn about how Dr. Davidson had found his career. He mentioned that he had always had an interest in mindfulness and was curious to see what goes on in the brain during meditation from a neurological perspective. At the time, he says his mentors cautioned him against making this research a part of his public-facing career, because no one would take him seriously. He followed this advice for several years but as his unpublished research findings in mindfulness mounted, he decided that it was worth the risk. He started to publish his research and in doing so revolutionized the perception of mindfulness in the scientific community. Some would say that he single-handedly created the scientific field of mindfulness and meditation (now with a literature base that is exponentially larger than these initial contributions).
It had never previously occurred to me that my life-long personal passions for prevention through lifestyle and mind-body could find a home in my medical career.
But given the growing evidence base and cultural shifts starting to take place in academic medicine at that point in time, I saw that there was now an opening for me to create a new type of medical career in this field — one that really took the whole person into account, and aimed for true wellness through treating the roots of health conditions, rather than managing symptoms.
So I returned and finished my training at Mount Sinai in preventive medicine, and also trained at then Beth-Israel in integrative medicine and began a resident clinic to manage patients through a rigorously evidence-based lifestyle and mind-body lens. I wasn’t sure how my patients would respond, especially with the older veterans at the Bronx VA where I was working at the time, but they really loved it. More importantly, they got better. It went so well that when I graduated and began my move down to DC, I was able to continue my practice here, where my clinic doubled in the first year. Now, all the internal medicine residents at GW rotate through the clinic and get exposed to lifestyle medicine — to benefit their patients as well as themselves — as part of their core clinical experience.
On defining holistic medicine
Though holistic care continues to grow in practice and scientific evidence across many disciplines, there’s still a widespread discrepancy between what the word means and what it’s come to be associated with. When we’re talking about holistic medicine and clinical care, it is, by definition, exactly what it sounds like: you take the whole person and their whole context fully into account. This means looking at conventional factors like diagnoses, symptoms, and medications, but also considering an individual’s living situation, stressors, maladaptive coping skills, diet, sleep, physical activity, environmental triggers, and more.
As an example, a practitioner can talk with a patient about their asthma or diabetes and prescribe appropriate medications, but unless they’re addressing the larger context, including issues like emotional eating or environmental triggers in the home, and the way the mind-body relationship can exacerbate these, they are not providing the full necessary scope of medical care to that patient. Talking about the bigger picture and addressing the root cause of a condition (which importantly also has a positive downstream effect on other areas of a patient’s health) is holistic care. For someone who has developed one lifestyle-related health condition and does not change their behaviors, it is very likely just a matter of time until they develop another and another. Unfortunately, in our existing system, patients are often not given the education and support they need to see the big picture and make these changes. We just wait until the next health condition develops, and add a new medication.
I often tell my patients that the beauty of the lifestyle-oriented or holistic approach is that we’re no longer limited to addressing each condition separately — we can use our scientific understanding of how lifestyle drives health and illness to reach positive, sustainable outcomes as a whole.
Unfortunately, what holistic medicine often gets associated with is not the patient-centered, evidence-based approach that we just discussed, but a group of practices that may not be evidence-based, could be harmful, and might even turn patients away from treatments that work well and that are in their best interests. It’s important to note that this perception is not fairly applied to all alternative practitioners, because I do believe there are excellent integrative health practitioners out there. But there are also providers, with MDs and without, who provide a type of care that I would not consider to be evidence-based, safe, or sometimes even ethical, that also use the word holistic. Given that this word “holistic” perfectly describes an approach that is desperately needed in our current healthcare system, I am on a mini-crusade to reclaim it.
On improving our current healthcare system
While there are many things we could improve upon, there are two big things that I would change in our current healthcare system. The first is the cost of healthcare. It’s clear that expenses are out of control. It is inexcusable that quality healthcare is unaffordable for a large portion of this country. But if all we do is make a broken system more affordable, it still costs too much.
For this reason, the first thing we really need to address, despite how pressing the financial issues are, is why the system is so broken. The answer to this question, I believe, goes back to the importance of a holistic approach. Both our patients and our providers need and deserve to have their full humanity and context considered when it comes to providing and receiving healthcare, and the benefits are synergistic. We have a very large body of literature that indicates that provider and patient wellness go hand-in-hand.
With that connection in mind, we can consider two epidemics in this country that are intimately related: chronic health conditions caused or exacerbated by lifestyle, and the rising burnout experienced by our providers. And what do both epidemics have in common? A culture that insufficiently promotes and supports wellness. That’s the lens through which I have developed our wellness initiatives at GW: with an explicit focus on lifestyle and the tenets of lifestyle medicine. The idea being that yes, medications and surgical procedures are important and we are lucky to have them when we need them, but we tend to go to them too quickly, and at the expense of addressing root causes. We do that in part because the training we receive as physicians includes very-little-to-no instruction on lifestyle medicine, and in part because providers and patients have very little time together.
Our current system of reimbursement often requires providers to see as many patients as possible in a single day. And when you can only spend ten minutes with a patient who has really complicated health conditions, trying to dive into a full understanding of who they are and what their life looks like will be challenging, to say the least. Not to mention, we have the data to prove that if a provider is able to engage in regular self-care, they are much more likely to counsel their patients on the importance of lifestyle, and those patients are more likely to make a change as a result of that counseling. It’s important to recognize that, as a provider, you can know the right thing to say to your patient, but if you’re not doing it yourself it won’t be as compelling, and you’ll be less likely to bring it up in the first place. We know that these are direct ways in which our providers’ healthier lifestyles benefit our patients. We also have the data to show that physicians who practice mindfulness not only experience less burnout and less stress, but also are perceived by their patients to be more empathic, and their patients are more likely to follow-through on treatment plans, experience fewer medical errors and have better outcomes.
On creating a culture of wellness at GW
For better and for worse, the lifestyle and wellness of the provider drive the wellness and lifestyle of the patient. And in order to support the wellness of both the patient and provider, we have to look at how the system and infrastructure can better promote these changes. Among the members of our GW community, we are taking a two-pronged approach: how can we support an individual’s lifestyle changes, and what can we do to support and promote healthy lifestyles on a systems-level? My mandate at GW is to focus on creating an environment that promotes and supports the wellness of all of the members of our enterprise, not just the clinicians or clinicians-in-training. We’re supporting everyone from physicians and nurse practitioners to graduate students, alumni, scientists and non-clinical staff (front desk, billing, building services, etc). This is unique to GW’s approach in my experience, and is vital; similarly to the drivers in favor of holistic care for an individual, I firmly believe that positively affecting the well-being of one sub-population of a community absolutely requires addressing and supporting the well-being of the whole community.
Vital Signs
My superhero name would be… I give a talk on Provider Wellness wherein I say that there are no superheroes in medicine. We are all humans doing our best, and there is no S on my chest! That being said, my personal superhero is probably Leslie Knope, from the TV show Parks & Recreation. She’s passionate, hardworking, and a collaborative, service-oriented leader.
Favorite podcast? I’ve referenced it once already, but I love “On Being” with Krista Tippett.
Next travel destination? I’m actually headed to Orlando soon to present a workshop on provider wellness at the American College of Lifestyle Medicine’s annual conference. Personally, I have a close friend who’s moving to Accra, Ghana, so I think that will be the perfect excuse to visit.
Best hangout in DC? My friend’s rooftop.
The best advice I’ve ever received was… “Dream big and don’t limit yourself to what is, when you can create your vision of what can be.”
You can learn more about Dr. Kaylan Baban by following her on Twitter here.
Know a great female doctor in NYC? We’d love to meet her, introduce us here!
