Editor’s note: This commentary is by Joanne Belviso Puckett, of Hanover, New Hampshire, who recently retired from the federal government as director of Quality and Risk Management for both Department of Veterans Affairs and US Air Force health care organizations. She considers interviewing veterans for the WRJ VA Medical Center’s My Life, My Story program, as her post-retirement dream job.
She was only 11 years old, and her favorite song had the words “faraway places with strange sounding names.” She eventually became a nurse, joined the Air Force, and lived those lyrics to Vietnam and beyond.
He was in the Army Signal Corps and is now an 80-year-old marathoner. He watches his diet carefully every day and has been taking a juice supplement since 1993. His goal is to make it to 100 years old.
She joined the Army National Guard after the 9/11 attacks, at the age of 36. When depression and life stressors became overwhelming, she created a written suicide plan which was discovered by her son. He took away her gun until, after extensive counseling, her doctor approved its return. Just to be sure, her son kept the gun a few more months.
He was an Air Force missile systems programmer and launcher and served in Vietnam and Okinawa. He was attacked and beaten by five U.S. Marines. His body healed but the traumatic memories remain to this day. He thanks God for his regular appointments at the White River Junction VA.
These are excerpts from veterans’ life stories shared through White River Junction VA Medical Center’s “My Life, My Story” program. The benefits of learning about veteran life experiences for providers and health care teams have been explored over the years since the Madison, Wisconsin, VA Medical Center started this program in 2013. The goal is to help build stronger relationships between patients and their providers. The program further humanizes patients so that providers can deliver more individualized care, going beyond the sum of their diagnoses or problem list.
The “My Life, My Story” program has gained national attention. NPR, Press Ganey, and the Washington Post have all featured articles about the virtues of this program. Although currently optional, the program has gained recommendation from the Veterans Experience Office in Washington, D.C., for nationwide implementation. The program has since been expanded to over two dozen additional VA facilities across the country and several recent publications have supported the value that a more robust, broad understanding of patients’ life experiences can help individualize and improve care.
An article in Bostonia, references the book, “Well: What We Need to Talk about When We Talk about Health” by Sandro Galea, Boston University’s dean of the School of Public Health. Galea speaks to how we often define health by doctors’ visits, medications, and how many steps per day. He recommends we reframe this discussion and define health more broadly in terms of family, friends, neighborhoods, and the choices we make. The “My Life, My Story” program invites veterans to share these topics with the interviewer.
The Valley News (Sept. 16, 2019), reported on “a different kind of treatment” described in a new book, “The Rabbit Effect: Live Longer, Happier, and Healthier with the Groundbreaking Science of Kindness,” by Kelli Harding, clinical professor of psychiatry at Columbia University Irving Medical Center. Key concepts include the impacts of kindness on our state of health; and how factors such as love, dignity, friends, family, neighborhoods, and workplaces may play a more important role than previously believed, in what truly makes us healthy. Sound familiar?
A recently published article, “Health Care Not Screening for Social Needs” (Valley New, September 24, 2019) was based on a new study led by researchers at the Dartmouth Institute for Health Policy and Clinical Practice. The study uncovered that just 24% of hospitals were screening for the five key social factors outside medical care that could impact health outcomes. These five issues include housing instability, food insecurity, utility needs, transportation needs, or interpersonal violence. These very topics are often shared by veterans during the “My Life, My Story” interview.
It appears that we are starting to recognize that optimal health care consists of more than just diagnosis management. Still, changing the context of health care delivery and improving the patient experience by integrating programs such as “My Life, My Story” remains a challenge. The scope, technology and complexity of the health care environment today all contribute to making this difficult to accomplish.
Perhaps the greatest victory in all this has been simply providing the veteran/ patient with an opportunity to tell their personal life stories to someone with no agenda other than to listen. The “My Life, My Story” program offers outpatient veterans dedicated time to tell their story, discussing anything particularly memorable or significant throughout their lives. This strongly supports the concepts of dignity and giving a full voice to the veteran as a partner in care. Volunteers first get a written consent, then actively listen to the stories, take notes, and type up a full draft of about two pages in the veterans’ own words. They give the draft to the veteran for review, and then upload the final story into a centralized location in the electronic medical record. Finally, the volunteer gives the veteran a copy of the story on “My Life, My Story” letterhead for them to use however they wish. It is their story.
As a volunteer over the past four months, I have met with many veterans who were surprisingly eager to share their stories. All worked with me in scheduling the time and gave significant thought to what they wanted to talk about. Several were ready to offer their stories on the spot. I have spent time with veterans at the White River Junction VA Medical Center but also the community based outpatient clinics. One veteran at the VA Burlington Lakeside Clinic came prepared with 22 pages of handwritten notes to share the times most memorable for him.
My experience has been that many veterans were thrilled that someone was interested in all the parts of their life, outside of their medical issues about which they felt confident their health care providers already understood. Most of these wonderful people required little prodding and openly shared. One veteran told me to “bring tissues” and I was happy to have them handy because I needed them. The veterans were most excited about getting their own final copy of the story. They called it their legacy. One veteran said she always wanted to write a book about her Air Force career, but it was too late now, and this story would be a perfect mini-version for her family.
As a writer/editor, whenever I see veterans around the hospital that I have interviewed, we greet each other as old friends. We already share a bond and it is a wonderful feeling to have honored them in this way.
White River Junction VA is fortunate to have resident physicians adapting the program to an area of great clinical need. As part of the ambulatory rotation, in partnership with Dartmouth Hitchcock, each resident participates in the “Healing Through History” program, which is focused on high-frequency, high-cost, and socially and/or medically complex veterans. Interviews are conducted by the resident physicians and reviewed with dedicated VA faculty. After review, they are posted, pending the veteran’s approval, in a centralized location in the patient’s electronic medical record. As part of the veteran’s story, the care team can see a detailed social and behavioral health interview as well as a summary and list of recommendations for care. Integrating this into residents’ training helps ensure future sustainability for this important program while encouraging innovative uses for medical education and patient care.
White River Junction VA Medical Center is looking forward to further developing the “My Life, My Story” program. Any veteran who receives care through White River Junction VA Medical Center or any of its community based outpatient clinics is invited to participate. We also welcome new volunteers to participate in this program, either as interviewers/writers, or as veterans who would like to share their story.
If you are a veteran, or you know a veteran who wants to tell their story, I would love to hear from you.
Contact information:
Joanne B. Puckett, Ed.M., R.N.
Writer/Editor, My Life, My Story
Joanne.Puckett@va.gov
(802) 295-9363 Ext. 5390
Scheduled Office Hours: Tuesday and Thursday, 1100 – 1600
