“What Matters to You?” The Profound Effect of Purpose with Benjamin Kligler, MD, MPH

[00:00:00] Dr. Ben Kligler: All these things like coaching, acupuncture, etc. are amazing tools.But in the end where we're going is really helping people reconnect with purpose in their life.

[00:00:09] Dr. Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being.. Let's take your health to the next level.

[00:00:36] Dr. Melinda Ring: Today's guest, my good friend and esteemed colleague, Dr.Ben Kligler, is on a mission to transform the healthcare conversation in our country. At the VA, he's shifting the focus from, what's the matter with you, to the more meaningful question, what matters to you? This approach is at the heart of the Whole Health Model, which was developed at the Veterans Health Administration more than a decade ago.I am so thrilled to have my friend Ben here on the show today to discuss the profound impact of this whole health model and explore ways we can all assess and improve our own health and well being. Welcome, Ben.

[00:01:15] Dr. Ben Kligler: Thank you. And thank you so much for having me. And before we start, I'll just say the official thing I'm supposed to say, which is I'm not here officially representing the Veterans Health Administration or the federal government, but I'm very excited to talk about it.

[00:01:29] Dr. Melinda Ring: Let's get to know you, Ben. So you're a board certified family physician and you've spent many years, you've been a clinician, an educator, a researcher, and really, one of the leaders in the field of complementary and integrative medicine. But you and I have never talked about what initially drew you to the field. So what was it that brought you to integrative medicine? 

[00:01:53] Dr. Ben Kligler: Well, I think it was, I mean, I know it was in college and you know, some of it is kind of in college, first time away from home exploring, you know, what do you really think about the world? And one of the things that happened to me in college is I stumbled into a course that was taught by an amazing guy named Richard Schultes, who was kind of the the founding father of ethnobotany. And so it was a really neat course about all the ways cultures around the world have used botanicals for a variety of things, not just medicines but, building and personal use and millions of different things. And it was just such a fascinating course and it happened in this really amazing kind of classroom up at the top of one of the buildings where Dr. Schultes had all his things that he'd collected in his travels through the Amazon. It was kind of a magical place. And as part of that course, I got excited about herbal medicine and particularly got interested in Chinese herbal medicine and ended up doing an independent study and then ended up kind of pursuing some more stuff along that route and getting into my own health things like meditation and How could it apply to me? And then since I was pretty much solidly on the path to becoming a physician, I had to figure out how to bring those two things together. And that was a little challenging, took a little thinking. And I did think about some other health professions, acupuncture, et cetera, along the way. But I decided the best way to pursue what I really wanted to was to be a physician, but to keep hold of that idea about how wide the range of approaches can be, and how big the toolbox is, and how exciting it can be to bring in things that haven't been part of conventional medicine before. So that was the beginning, and then it's been a long

[00:03:49] Dr. Melinda Ring: A long and circuitous journey since then. Yeah, I think when you and I both started out, you know, still a lot of people don't know about integrative medicine or what it is, but certainly, you know, a few decades ago when we were in training, I know when I was at medical school, It wasn't a thing. Like, I had to go find people in the community who were doing it. So, at least now we know it's in a lot of academic centers, so hopefully more future doctors are getting exposed to it. But I agree, like, back then you really had to seek it out.

[00:04:23] Dr. Ben Kligler: I think the other thing that's changed is that kids who are growing up now and going to medical school. They're growing up in a society where there's a lot more visibility for a lot of these things. I mean, yoga is everywhere, right? Meditation and mindfulness are everywhere. Nutritional supplements. And so, for example, my daughter just finished medical school. I mean, she grew up with me, so that's not a fair comparison. But a lot of her classmates, these things just seem, sure, that's normal stuff that people do for their health. And so I think the visibility of the whole area has really increased in our society over the years.

[00:04:57] Dr. Melinda Ring: So if you were to describe what was different when patients would come to see you for integrative family medicine versus maybe a more conventional biomedical family medicine, like, what did that look like? Were the plans different? Was your approach different? Like, what would it actually mean for your patients?

[00:05:17] Dr. Ben Kligler: Yeah, good question. I think what it meant first and foremost was that, and some patients weren't necessarily expecting this and had to grow into it, was that they were in charge, you know, whether in charge of their family as parents or in charge of their own health as adults. And kind of goes to, well, what is the heart of this whole concept of integrative health and whole health is that the doctor may have a lot of knowledge and expertise, but ultimately healing and change comes from inside of people. So it's not like I would have that conversation explicitly with everybody, but that was always in my mind when I was seeing an adult or family or kid or whatever. And I think that just changes the whole nature of your practice because it sets people up, ideally, to realize that they have an intrinsic capacity for healing, and their kids do too, and that's a really empowering kind of concept. And again I wouldn't say this out loud most of the time, because it wouldn't really make a lot of sense to people. But just people having choices about, for example, you know, not rigidly following a certain way of feeding their kids in a certain rhythm, or not necessarily quitting breastfeeding at X months, because that's what sort of mainstream pediatric recommendation might say, The good news is that I was always committed to making sure that people had access to anything conventional that was going to be helpful to them or that was a good fit, so I never really felt like I had to exclude the great things about conventional medicine. For the sake of making room for some of this more person centered approach. And that's why it was so great over the years, because I felt like I was really able to bring people kind of the main stuff that regular doctors could bring them to, but it had this kind of bigger container around it that enabled them to really grow. And I think, especially satisfying when I had a pair, I had so many families with little kids and, you know. When you first have kids, basically it's like nonstop panic for the first year because you just feel like, how did this happen? I don't know what I'm doing. I have this little vulnerable creature I have to take care of. And so a lot of my mission was just helping people grow into the understanding that they knew what to do, that there's a reason that everybody is biologically equipped to have kids, because if you stop and you're just thoughtful about it you do have good instincts. You are going to know what to do. And so a lot of times people would be asking me for an answer. To a behavioral problem, whatever. And I might make suggestions, but it was always in the context of, well, what's your gut feeling tell you? And that was just a really fun and kind of inspiring way to practice all those years.

[00:08:09] Dr. Melinda Ring: the definition of integrative medicine is like a paragraph long. And I always try to tell students and patients and others that yes, there is like this expanded toolbox of things like acupuncture and herbal medicine and, you know, body work and things like that. But really that the core of it is that philosophy of being a, you know. We're in a partnership to help you reach your health goals. I think people always view it as, Oh, which supplement should I be taking? What exact diet should I be doing? And things like that.

[00:08:46] Dr. Ben Kligler: Yeah. And I know you're having Andy Weil as one of your guests and I just want to say a book, his book, Spontaneous Healing, I think was if I had to point to one book that has had the influence on my thinking about my career and my own health, because one of the things he really builds out in that book is this notion of a healing system that you have this intrinsic capacity, whether it's wound healing or regenerating part of your liver that needs to be regenerated or healing from depression or from loss. And I just, that just rang so true for me. And it rings just as true today that, that's the thing that conventional medicine has a little bit forgotten or, you know, certainly doesn't emphasize enough in the way we think about patients that our job is to really mobilize this thing that's already inside of people, not necessarily just to do something from outside, to do something to them or fix something. It's really about How do we connect you with that intrinsic ability that everybody has? And that's just always super exciting because everybody has it. Everybody has it. The most sort of challenged and socially struggling and perhaps economically or otherwise, you know, constrained. Everybody still has that inside and sometimes it's difficult to help them figure out how to access it But it's just part of being human and I think that's what's so exciting about this whole field is that we have that amazing thing to work with and I think helping conventional medicine remember The potency of that is really a great part of our job

[00:10:30] Dr. Melinda Ring: Yeah, that's great. It's funny because in the TED Talk I did, I mentioned Andy Weil's book. He's had many, but as being like the aha moment for me also. Just to shift a little bi . Can you just talk a little bit about why you think it's important to do the research and publish and advance research in the field

[00:10:51] Dr. Ben Kligler: I didn't really come to research till kind of middle of the way in my career. And a lot of it was because at some point I was like, well, we're making good progress, but research is the language that sort of conventional healthcare and medicine speak. It's a kind of like the currency that you really need to trade in order to have those conversations with people. And so, I kind of got interested in thinking about, well, what kind of new information, new knowledge do we need to generate that's going to really further the conversation? And that was kind of what got me into it. And then from the beginning, I really was interested in understanding also what are the models or the ways that we can help people without a lot of resources or a lot of money to access some of these great healing approaches. So for example, you know, at the time I started to get into research in, I don't know, 2007, acupuncture had a lot of research behind it and a lot of evidence for effectiveness, but it really wasn't explored how do you deliver it to an underserved population. And so some of the first kind of stream of studies that I did or that I was part of was looking at delivering acupuncture in a group setting. And we specifically looked at community health centers in the Bronx and how did that work and was delivering it in a group setting as effective as delivering it as an individual setting? Were there going to be cultural barriers because the people who were getting their care in these centers weren't necessarily familiar with the whole idea of acupuncture or the concept of other kinds of healing. And so I was involved with several studies looking at the best ways to deliver acupuncture in that kind of setting. And we did it. In the primary care setting too, which was the other thing is that a lot of the research about various kinds of integrative health techniques had been done in these kind of more researchy settings where somebody went to a special place to get the treatment and they were just part of a, you know, kind of a very special setting and, orientation. And I thought it was really important to bring it into the place where people were actually getting their care. And so a lot of the research we did had to do with figuring out how to make that happen. Where's the space? Where are the chairs? Can you do it lying down? Do you have space? Can you do it in a group? How do people like it? And I think group acupuncture is not because of my studies, but I think group acupuncture has really become a pretty standard thing these days. My son who lives in Providence, Rhode Island, and, you know, He goes for acupuncture. It's always a group setting for him. It's because it's cheaper

[00:13:36] Dr. Melinda Ring: Yeah.

[00:13:36] Dr. Ben Kligler: You know, so I think that was a big stream was looking at how to bring these kind of approaches to More underserved populations one of the early findings we had when we first started implementing whole health on a big scale, which was in 2017 18 was that veterans who were on who had chronic pain, who were on a standing or an ongoing opioid prescription had Groups of veterans who participated in Whole Health and particularly veterans who chose to participate kind of more deeply where they had The number we used was eight or more visits They were able to lower their opioid dose much more rapidly and much more substantially Than veterans who were just going about the conventional approach now everybody in that study was able to drop their dose the average was, I think, 11 percent in the general population over the course of a year but the veterans who were really active in whole health were able to drop that more than three times that much. So that was very impactful. I do want to say about that study, because I think it's important to be sort of transparent about this, that it was an observational study and a lot of the work we've been doing in VA has been observational. It hasn't been. a randomized clinical trial where you do it just in a research setting. And so that's both great and it's a challenge. It's great because it allows you to look at how these things are happening actually in the real world and are they effective in the real world and not in kind of the rarefied or somewhat artificial, you know, bubble, right, of a clinical trial. But the downside is you have this thing called selection bias, which is where you basically have to ask, Are the people who are choosing to do whole health, people who are ready to decrease their opioids more rapidly? And, that same question has to come through in, because we've done a lot of observational research now, and some of it with amazing findings, but you always have to be honest about that. selection bias potential. And we do lots of sort of statistical techniques and there's this fancy thing called propensity score matching, where you do your best to balance out the characteristics of the group and to factor out the influence of the different characteristics, but it still ends up being not a perfect answer.So we're always really careful to say. Not that whole health causes more rapid opioid, decrease in dosing, but that it's associated with it, it correlates with it, it may be helpful to veterans in, in getting there.

[00:16:09] Dr. Melinda Ring: Yeah. Well, given the, you know.

[00:16:12] Dr. Ben Kligler: Honestly, so.

[00:16:13] Dr. Melinda Ring: Yeah, well, and give, you know, I mean, the nation, we know the opioid epidemic and like the disability cost that it, you know, the cost to people's quality of life. So, whatever it is that did it, a three, you know, that three times level of decrease of requirements is just amazing.

[00:16:35] Dr. Ben Kligler: Yeah, and it was a very important finding for us in advancing this further in VA and getting more support for implementation because, you know, obviously that's such a high priority. So many veterans with chronic pain and the opioid overuse was just, you know, it was a real problem for the whole health system, obviously, but VA was one of the places that really wrestled with that the most. And actually, VA has been out front, really, in, in dealing with that. They've had a really fantastic opioid mitigation problem and really high rates of people getting some of the other medications that are available for opioid dependence. So, yeah, it's great to be a little part of that.

[00:17:17] Dr. Melinda Ring: Some people have a perception that integrative, functional, holistic medicine is, like, for the wealthy, for people who can afford it. You know, out of pocket services and fancy tests and other kinds of things. But really, your work has been, from the beginning, really focused on traditionally under-resourced communities, the VA, and, like, some more of these vulnerable populations. So I think that's just a really important thing that it's integrative medicine. For us, you know for me, and I know for you, you're like, it's for everybody.  It's,I walk down the street. I'm like, you should be coming for Integrative Medicine. You should be coming, you know, now that being said, of course, we're still at a point where in conventional, you know, payer models, a lot of those services like acupuncture, massage may not be covered. And so, that is a barrier. I think the VA is more of a self enclosed model. So, you've been able to be really creative. We've talked about the VA model without, like, explicitly saying what it is. Can you maybe say what the, you

[00:18:31] Dr. Ben Kligler: Sure.

[00:18:32] Dr. Melinda Ring: what is the VA's whole health model

[00:18:34] Dr. Ben Kligler: I think the basic principle, the basic way it differs or, augments maybe is a better word from standard medical thinking is what you talked about at the beginning about really being about it. Focusing on what matters most to the person. So really making that front and center in the conversation that they're having with the health system, whether it's their primary care doc or their health coach or their acupuncturist, whoever. So making sure that we're always attentive to not just delivering a new therapy, like, Oh, I'm going to fix you with acupuncture, but that we're having that conversation about what's important to you in your life. What's stopping you from getting there? How are you going to, you know, change direction, or how can we support you in taking the steps to get where you want? So that's kind of the underlying premise, which is really why we have this saying that whole health is not something you do, it's a way that you are, right? And that's kind of a fundamental concept. In terms of how we set up the system to help people get there, it's called the whole health system. That's what we call it. It has three fundamental sort of pillars. First is this thing we call the pathway, and the pathway is not a clinical kind of experience or encounter. Veterans get to talk to a fellow veteran, either in a group or individually. Who's been trained as a kind of a conversation facilitator. And really they get to talk about this to you of what matters to you most, what's getting in your way. And we use this great tool called the personal health inventory, which is a very brief tool where they walk through all the different ways that we can take care of ourselves, whether it's food and drink, or whether it's, you know, are we connecting with people we love? Are we connecting with our spiritual selves and really work out identifying where they want to. Set goals and move forward. So that's the pathway. It's kind of an opportunity to really focus on the person and what matters to them. Then we have what's called the wellbeing programs, which is where people might go there for new knowledge about self management. They might be going to a healthy teaching kitchen, or they might be going for an exercise class, or they might be working with a health coach to help them set goals and meet those goals. They might be accessing one of the complementary integrative health approaches that VA now covers. So for about seven years now, we've covered eight evidence-based integrative health approaches, acupuncture, massage, meditation, yoga, biofeedback, clinical hypnosis, guided imagery, and I'm going to forget one, but I'll come back to it later.

[00:21:13] Dr. Melinda Ring: Hard to hypnosis, did you say hypnosis, chiropractic,

[00:21:18] Dr. Ben Kligler: Well, chiropractic has been covered by the VA for a long time. And interestingly, it's kind of an interesting story because VA does not consider chiropractic to be complimentary or integrative since 2005. VA has been integrating chiropractic into the whole rehabilitation medicine kind of infrastructure.  And I forgot tai chi. That's the one I left out. So anyway, that's the well being programs. And then the third leg of the stool is what we call whole health clinical care, which is basically where you're still getting the same kind of clinical care you were getting before. You're going for your primary care, you're getting referred for colonoscopy, you're going to your PT if you have a pain or mobility problem, you're going to mental health. But all of those practitioners have been taken a little bit of a turn in sort of how they orient the relationship and ideally, and obviously this is an ideal state. I wouldn't say we are there yet, but we're making amazing progress. So ideally then, that idea of what matters most to you becomes kind of front and center in that visit with whatever clinician you're talking to, whether it's your cardiologist or your psychologist or your primary care provider. And that, part of the, kind of the whole health system, obviously, was required a huge educational effort to really help providers. Clinicians think about what that means, and the saving grace with that is that it, we're really just kind of reconnecting a lot of people with why they went into medicine or healthcare to begin with, which is that they wanted to help people have a better life. They wanted to help them get more connected to what was important to them and what mattered. And then a lot of kind of our conventional training and the way the incentives are structured in conventional health care, it kind of beats it out of us. And it makes us more oriented towards, you know, how many visits did we have and how much did we prescribe and et cetera. So that's what we have going for us in doing all that education is that a lot of people are like, Oh, thank goodness. Somebody's finally bringing this back into our job description, you know? So those are the three parts of the kind of whole health system. I would say another part that's really emerged in the last few years is we've really, become more aware and more explicit about the connection between social drivers of health, things like racism, food insecurity, housing instability, you know, class inequality, and how they contribute to, obstacles or how they can facilitate people's ability to do what matters to them. And so we've really made sure, or we're working to make sure that when we're talking about what matters most to somebody, we're also checking in with them about How are they in relationship to those social drivers? Because one of the other great things about VA is that VA can tackle a lot of those areas. There's housing assistance. There's education assistance. There's vocational training. You know, VA is a real wraparound organization. And so we think that really making sure that conversation is part of the whole health discussion is really crucial too. And I think we're making good headway with that. So that's the whole program. Just very briefly, in last fiscal year, that's the last one I have really complete data for, we reached, I think it's 1. 8 million veterans, which is the active veteran population using the VA. There's 9 million people who are somehow connected, but the active population is 6 million. So that was about 28%. Veterans had some or another kind of encounter with Whole Health. Some of those people, it was a real, you know, just very brief and superficial. Maybe they went to one yoga class or they had one visit with a coach, but they didn't really pursue it. But then a good number of those people had really substantive and, you know, potentially transformational experiences. Experiences where they really engaged with whether it was one of the complementary therapies or health coaching or their work with their provider, whatever it might have been. So, we've really had a lot of success. Our current undersecretary, whose name is Dr.  Dr. Shereef Elnahal, has really recognized the potential of whole health. And he's really made it a front and center priority for the whole program. system, which is quite amazing in terms of really forward looking leadership. And he's been very, really supportive. And that's really helped us grow the program in the last couple of years.

[00:25:35] Dr. Melinda Ring: So Ben, do you have any stories you can share about vets who have actually benefited in maybe unexpected ways by going through the whole health program?

[00:25:44] Dr. Ben Kligler: Yes, absolutely. We have so many stories. One of them is a fellow I won't share his name, but he was an army vet who had come home with some chronic knee problems, foot problems, back problems. Mental health challenges kind of related to his time in the service and had kind of gotten into a setting where he was really smoking heavily. And this fellow was a pastor. He had trained as a pastor when he came out of the service, and he had been very active in his community, but he'd gotten himself into a situation where he was walking with a walker, he really couldn't get out much, he couldn't do what he wanted, and somebody, he lived in in Virginia, somebody on his team referred him to the whole health system. They started off by connecting him with acupuncture for his pain problem, because he was also on some pretty substantial heavy duty pain medication, which was adding to his trouble getting around. So the acupuncture helped him manage the pain that helped him drop some of the pain medication dosing, maybe not off it entirely, but just get to where it wasn't such a big, heavy weight he was carrying. And then he got connected with a whole health coach, which I think maybe was perhaps the most critical part of his experience. They talked about what did he want to do, what mattered to him in his life, and what mattered to him in his life was being able to get up and out and do things again in his community. And they figured out that a lot of what was getting in his way was the smoking, because it was really impairing his breathing and his ability to walk around and do what he wanted. And so the coach and he got him into a smoking cessation program, he quit successfully, really changed his respiratory status. The different approach to his pain treatment and being able to decrease his medications helped him, you know, it sounds corny, but put away his walker and be able to just get out and feel stable and safe and getting out and doing things. And now he's out there back again working in his community and doing counseling and spiritual counseling. And I think in particular working with groups of veterans in his community. So that's just one example. And then a person like that, because now they've gotten back to what it was that gives their life meaning and purpose. They used these tools that were available that might not have been available in a different setting or 10 years ago and it helped them reconnect with what their life was about and that just changes everything about that person's life and how they relate to their family and even about their long term sort of health and mortality, you know, there's this amazing data about it. When people at age 50 have a loss of purpose in life, they report a low sense of purpose. So that's kind of the, you know, all these things like coaching, acupuncture, etc. are amazing tools. But in the end where we're going is really helping people reconnect with purpose in their life. So that's just one story. There's like a million stories

[00:28:43] Dr. Melinda Ring: I'm sure. And I would imagine as a pastor, if he's still doing that work, that it's not just transformed his own life, but probably has impacted everybody that he interacts with in that role.

[00:28:55] Dr. Ben Kligler: Yeah. And I will say one other thing, which is on our website, which is va. gov slash whole health. There are all these videos including this particular veteran who actually gave us permission to put this video up describing his story, but there's lots of them sort of coming from all different angles. You know, what problem was I confronting and how did this approach enable me to kind of work my way through it? So if people are interested in that, there's a lot of amazing stories on the website there. 

[00:29:23] Dr. Melinda Ring: You mentioned before that you start with the whole health inventory, and I'll tell you that in the fellowship I teach to doctors and nurse practitioners about integrative medicine, one of the things I have them do is do the whole health inventory and, compare it to like a standard intake that you get when you go to your doctor's office and then just reflect on as a patient. The difference in how you feel doing it. Because the standard medical intake is, what diseases do you have? What medicines do you take? What surgeries? What problems? What hurts? What's wrong with your family? Like, what runs in your family? It's all about, again, what's wrong. And their experience of doing the whole health inventory was really one of more reflection and inspiration

[00:30:15] Dr. Ben Kligler: I think that what, it does when you approach it from the point of view of what matters most to you as a person, and then what can you do, you the patient, you the person do about it, as opposed to the position of, I need to know all your problems so I can try desperately to fix them, which is our conventional approach. It totally changes the experience as the clinician. Because it's suddenly I have a partner. I don't have someone or an object or that I'm trying to do something to. I have somebody who's in charge, who is helping me figure out where they want to go. And I think it just really helps with reducing the potential for burnout, because I think a lot of the problem with How we get trained as physicians is this idea that we have to fix everybody, and a lot of the things we have to fix don't have ready solutions. And so we're always up against this kind of, oh, my job is to fix these people, but I can't get them fixed. And I think that really contributes to burnout. So I think it really has a benefit, not only for the person or the patient, but a really big benefit for the clinician. And we do have some good evidence now that clinicians who are doing a whole health approach actually do report lower levels of burnout, which is pretty interesting. So, one of the great things that's on our website is we have this tool called the Circle of Health, which you can find sort of front and center on the website. It's got eight domains of self care around it. So, things like food and drink, friends and family, spirit and soul, moving the body. There's a feature on the website where as you hover over each of those, it'll take you to kind of an area that gives you ideas, suggestions, videos for, you know, what are ways that people have approached challenges in those areas, information, what are some of the challenges. And so there's a lot of things you can do there in terms of, you know, even just working on your own. And then there's another great resource that I would, I think it's really underutilized and I would really encourage people to use it. It's called hashtag live whole health. And this is something we started up during the pandemic because the VA leadership wanted to make sure we were helping veterans continue to have access to a lot of the complementary therapies, even though they couldn't come to the office. And obviously we couldn't do everything. It's hot. You can't do acupuncture over the internet. But so we started this program where we were getting VA staff all over the country to make brief videos of Maybe it's chair yoga, maybe it's a guided imagery, maybe it's an acupressure session. And all those videos, there's over 200 of them now, are uploaded to this site, hashtag the full health. And they are up there front and center for people to access and use and try out with your patients. They're anywhere from three minutes, some of them are longer, like 15, 20 minutes. But it's also a great tool if you think about the idea of underserved populations, because maybe you think An acupuncture visit would be good for your patient, but you can't access it because it's not covered by their insurance and there's no group acupuncture handy.Well, on that site, there's some really amazing acupressure training videos, either training on how to do it on yourself or how to do it for a family member. not quite all the way to getting acupuncture, but you can get some really great benefits. So it's a really, it's publicly available. It's for everybody. It's anybody can go there anytime. 

[00:33:39] Dr. Melinda Ring: So Ben I just wanted to close with, what piece of personal wisdom would you share with listeners to help them reach their own next level of health?

[00:33:49] Dr. Ben Kligler: Yeah, great question. I mean, I think the first thing I would say is that it's not a destination that you arrive at and you're done. It's a way of looking at your path and your journey. And so I say that for myself because I've got a million health goals. That I, whether it's lose some weight or exercise more, do more, you know, dedicated mindfulness practice. But I have periods where I'm really successful in pursuing that goal. And then I have periods where I'm totally failing. And I think it's really easy to be in one of those periods of where you're totally failing and just say, I'm never going to get there. I don't have it in me. I'm not the kind of person. And so whatever it is that I'm pursuing, that's most important to me. I'm just never going to get there. And I think the number one. The message I would send to myself as well as to everybody else is it's a journey. Like, yes, you're going to have moments when you feel you're succeeding in shifting into the Attitude you want to take towards your life and your health. And then you're going to have moments where you're not. And the, most, I think the most important quality really is being able to get back up and say, I knew where I was going, and I'm going to just take that first step again in the direction I was going, because I, it's not like something, you know, life is always going to bring us more challenges and difficult things to deal with. And certainly as we get older, it only gets more intense. And so I think that's probably the primary. The sort of message I would want to share is, it's not a destination. I know it sounds corny. It's not a destination. It's a journey. And so you really just have to keep your eye on where do you feel like you're going ultimately and, not feel like it's all about, I have to get there or I'm some kind of failure. It's really about what is the quality you bring to your day to day life as you're trying to travel there.

[00:35:43] Dr. Melinda Ring: Yeah And having, yeah, and

[00:35:47] Dr. Ben Kligler: tell myself every day.

[00:35:49] Dr. Melinda Ring: right, well, you know, and I think mixed in there is the idea of self compassion, like accepting we're all human there's no such thing as perfection, you know, progress over perfection and, yeah, and sometimes it can feel so overwhelming to think about like, well, I want to get. I'm here and I want to get there. And instead of saying, like, picturing all of that, just picturing the next moment, like the next minute of what I can do and taking that little first step. Because once you do that, the first step is the hardest one. And like, you know, getting on the bike, once you're on it, it's easier to keep going. It's the first thing that's always the hardest. Well, thank you so much for being my friend, for being a leader in the field, for the work that you're doing and continue to do.You're an inspiration and you know, it's just, you know, been fun to have a chance to learn more about you and, share the great work you're doing.

[00:36:52] Dr. Ben Kligler: Well, thank you so much, Melinda, and thanks for having me. I really appreciate it.

[00:35:58] Dr. Melinda Ring:  Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers. Be sure to follow Next Level Health with me, Dr. Melinda Ring, as we continue exploring the path to healthier, happier lives, together.