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“Yoga therapy differs from contemporary yoga in that the profession has a defined scope of practice based on educational standards and accreditation requirements for training schools and yoga therapists. In dealing with pain conditions, certified yoga therapists possess understanding and knowledge of pain theories and pain physiology and may collaborate with a patient’s health care team to develop an individualized care plan. While pain and musculoskeletal conditions represent the most common reasons for referral, yoga therapists may also see clients with chronic conditions, such as diabetes, heart disease, post-traumatic stress disorder, and addiction.”
Jaime Lewis is an internal medicine and palliative care physician.
She shares her story and discusses her KevinMD article, “Recommending yoga to your patients? Consider this first.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Jaime Lewis. She’s an internal medicine and palliative care physician, and she wrote the KevinMD article “Recommending yoga to your patients? Consider this first.” Jaime, welcome to the show.
Jaime Lewis: Hi. Thanks for having me.
Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?
Jaime Lewis: Yes, absolutely. I’ve been practicing palliative care at Rush University Medical Center for the past eight years now, but for the last couple of years I’ve been focusing on supportive oncology. So I see patients with cancer diagnoses and also sickle cell disease as well; they fall into that hematologic category. If you’re familiar with palliative care, you know that we focus on symptom management, whether symptoms are related to the disease itself or are treatment-related side effects. We also help counsel on advance care planning and support patients and families throughout the spectrum of a chronic illness.
I actually came to yoga through my own personal experience, starting it as a self-care practice my first year as an attending, just to help with getting thrown into the fire of attending life. It really helped me to manage stress and combat compassion fatigue. Overall, it was working pretty well, but I still hit a wall, probably a few years ago. So I actually left medicine for a while, about six months, and traveled the world. I call it my own little sabbatical. During that time, I really dove deep into my yoga practice and my meditation practice, and that actually inspired me to become certified as a yoga instructor.
So when I returned to my medical practice, news spread: “Oh, hey, you’re a yoga teacher. We’re trying to get some classes started.” Since then, I’ve been teaching staff and also patients in our cancer center, and the holistic benefits of yoga have really paired nicely with what I was already doing in palliative care.
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Kevin Pho: You took that mini sabbatical, six months, where you discovered yoga and became certified as a yoga instructor. So what were the reasons that you temporarily left medicine for those six months?
Jaime Lewis: I don’t know if I would say I was burned out, but I will certainly say that I was extremely compassion fatigued. That’s another interest of mine, this physician wellness, professional wellness in general. I see a lot of these symptoms in not just palliative care providers but a lot of other co-workers practicing in other fields these days. So I will say I was compassion fatigued and just kind of lost, because I’d been going straight through since, goodness, kindergarten. I never took a break.
We see that more commonly these days with medical students. They will take a year or two off between college and medical school, which I think is just beautiful. Back when I was in school, that was unheard of. So I had been going straight through, and I never really had that time to just pause and reflect on, you know, what is my purpose in life? What is the impact I’m trying to have on my patients and on the community around me? So I really took that time to just have those reflections without the busyness of emails and all those things. A week’s vacation was not going to lead me to those types of reflections. I really had to step away.
Kevin Pho: Now, I have a two-part question. First off, explain what compassion fatigue means to you. And second, what are you doing differently now that prevents you from undergoing compassion fatigue again?
Jaime Lewis: Compassion fatigue, for me, I like to describe more as a metaphor that I actually got from one of the attendings who trained me. You start your week or your day with this basket full of apples, and these are apples of compassion and empathy. As you go through each patient and family encounter, each encounter with another physician that maybe you’re helping in a family meeting, you’re passing out these apples. At the end of the day, or at the end of the week, you look at your basket, and your basket’s empty. So you’re essentially running on empty, trying to give compassion. You’re still able to do your job without making mistakes or harming patient care or anything like that. It’s just that you’re spent, you’re tired, and it’s that kind of tiredness that affects you physically, mentally, and emotionally.
As for what I’m doing now, I will say I do experience less of that now, and I attribute that to developing more of a niche in my own practice: being able, one, to focus on a patient population that I was being pulled toward, so seeing patients with cancer diagnoses. An opportunity came up in my medical center where I was able to step into that role. And then being able to incorporate, or begin to incorporate, yoga therapy and yoga practices by leading classes in the cancer center. We’re also trying to hopefully develop a yoga therapy program and really expand these other complementary services to patients in the cancer center.
Kevin Pho: So let’s transition now into the KevinMD article that you wrote. It’s titled “Recommending yoga to your patients? Consider this first.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?
Jaime Lewis: Yeah. So I am currently studying to become a yoga therapist. It’s a pretty intensive program; it’ll probably take me about two and a half years to finish, because it really is its own field. Being in that program, studying in this field, actually prompted me to write this article, because I get a lot of patients coming to me asking about these other types of ways, these non-medicine ways, we’ll say, to help with their pain, to help with their sleep, to help with their mood. Patients want to know information on these things. A lot of them will be motivated to actively participate in their own care and not just feel like they’re taking pills all day when they’re already on enough medications.
So it stemmed from patients asking me these questions. I usually would let them bring it up, like if they’re asking me, “Oh, do you know anything about yoga?” or “Do you know anything about acupuncture, tai chi, these kinds of things?” If they bring it up, I’ll say, “You know, yeah, I’m actually certified. What is it you would like to know? Is there anything I can recommend?” It would just come up informally, from them asking me these questions.
Then, once our classes started in the cancer center, I realized there was a lot of education that needed to be developed, not just for patients but also for health care staff, in understanding how to safely recommend these kinds of movement-based practices to patients. Not all of them are going to be the same; you go from one community class to another, and they’re all going to be different. We have to be a little bit more mindful, obviously, of how we guide our patients to some of these classes, so they don’t get hurt, so they don’t actually worsen their pain.
In this article, I describe the difference between therapeutic yoga and what we refer to as contemporary yoga. Contemporary yoga is the yoga you just go to in the community, or in a gym or fitness center, where the classes are geared more toward generally healthy people, and they’re a lot more focused on the physical postures themselves. Whereas in therapeutic yoga, there’s still an element of using the postures, but there’s also a focus on the meditation aspects, the breathing exercises, and the lifestyle changes, and I think that’s a huge part of it. In yoga therapy, we are trying to encourage and motivate our patients to take an active part in their own care. So the article describes the difference between those, and just how yoga therapy is really becoming integrated within comprehensive pain management these days.
Kevin Pho: Now, what are some common conditions that could be treated with therapeutic yoga?
Jaime Lewis: Yeah. So most of the referrals to yoga therapy are going to be for pain-based complaints, whether that’s chronic back pain or other chronic musculoskeletal conditions, and a lot of mood disorders, so that could be chronic depression or chronic anxiety. I would say a key part here is chronic illness. Yoga therapists really work with people who are going through that spectrum of illness, working through illnesses that may not necessarily have a cure, and working with them to be able to find wellness, whatever that looks like for them. It’s very individualized, but it’s helping them to move toward wellness in the midst of illness.
Kevin Pho: I’m an internal medicine primary care physician myself. If I see a patient who may be a candidate for yoga therapy, where would I find one for that particular patient?
Jaime Lewis: Yeah. So the International Association of Yoga Therapists is actually a great website to start with, because they will actually list, or have a database of, certified yoga therapists in your area, and then you’d be able to refer patients to them. Some major health care centers are starting to integrate yoga therapy within their outpatient-based practices, or even sometimes in the inpatient setting as well. But the IAYT.org website is a great place to start, because then you know that the practitioners are certified; they’ve gone through the appropriate accreditation.
Kevin Pho: Now, if I wanted to send a patient to yoga therapy for musculoskeletal pain, can you contrast the treatment course with something like physical therapy?
Jaime Lewis: Well, both, I would say, are fairly individualized. I think that with physical therapy, there are going to be more standard protocols, as opposed to yoga therapy, and, you know, there are pros and cons with that. I’ll say the problem with not necessarily having standardized protocols is that it’s hard to replicate potential benefits in research, which is why yoga therapy is honestly not fully covered by insurance companies, because we need that replication in the studies to show that, yes, this is consistently helping. So physical therapy is going to be a lot more standardized, whereas yoga therapy is really going to be more individualized. What is this person working with right now? What stage of their illness are they in? What are their goals of wellness? What is their current function like, and what are we trying to achieve? Everyone’s going to be very different, and so yoga therapists really work on individualized care plans.
What’s similar, though, between the two is that both therapists, physical and yoga therapists, are going to work with the health care teams. They’re not trying to do anything that would contradict what the medical providers are doing; they are collaborative. So I think that’s a good similarity as well.
The main difference is that it’s going to be very individualized. One person may only be working with one or two physical postures, and maybe they just need a lot more of that breathing exercise and meditative component. Whereas maybe another person really needs to just be working with the postures, because maybe they’re not quite yet ready for that meditative practice. With certain conditions, you have to work people to get there. We see that with our patients with PTSD or addiction as well: You have to gently lead these patients to be able to practice certain methods within yoga therapy. So everyone’s very different, and yoga therapists keep that in mind.
Kevin Pho: We’re talking to Jaime Lewis. She’s an internal medicine and palliative care physician, and she wrote the KevinMD article “Recommending yoga to your patients? Consider this first.” Jaime, are there any techniques from yoga that a primary care physician or a clinician listening to this podcast can incorporate into a typical office visit, something that’s quick and easy?
Jaime Lewis: So, one, if patients ask you about yoga, knowing the difference between contemporary yoga and therapeutic yoga is a great place to start. And if they’re like, “Hey, is there anything that maybe you would recommend?” just starting with a simple breathing practice could be great. With some of the physical postures, again, everyone’s going to be different; there are some that need to be adapted for patients to be able to do them, based on their physical function. But breathing practices are always a great place to start.
This is something we do in our clinic visits with patients. The social workers who partner with me in practice will teach some of these techniques to patients as well. Or I think a common place is when people are getting chemotherapy and they’re in infusion, and maybe they’re getting a little anxious from their infusion. We work with a breathing practice, and one could be a simple diaphragmatic, or belly, breathing practice. I think a lot of us doctors are probably familiar with that, and even familiar with the benefits of diaphragmatic breathing to help with anxiety. As anxiety calms, the body relaxes as well. So even just simply teaching diaphragmatic breathing, and getting people to learn how to breathe through their belly a little bit more to help calm anxiety and relax the body. So a breathing technique would be a great place to start.
Kevin Pho: And for patients who want to see whether yoga therapy is right for them, or for clinicians who may want to consider prescribing yoga therapy, what are some online resources that you could recommend? I think you had mentioned the website previously.
Jaime Lewis: Yes, I think the IAYT.org website is a great place to start as well. And even Mayo Clinic’s main website: They’ve already started incorporating yoga therapy into their health system, and they have good information there as well. I will say IAYT is a great place to start, because they have information for patients and health care providers.
Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?
Jaime Lewis: Similar to palliative care, I think therapeutic yoga has a wonderful approach to helping patients be able to focus on living well in the midst of illness. So just keep in mind, when you’re recommending certain movement-based practices to help with whatever chronic condition a person is experiencing, that therapeutic yoga may benefit our patients better than standard contemporary yoga in the community.
Kevin Pho: Jaime, thank you so much for sharing your time and insight, and thanks again for being on the show.
Jaime Lewis: Thank you so much, Kevin.
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