Flourishing in Medicine

The concept of flourishing has the potential to transform clinical care.

Posted Jul 29, 2019

Adobe Spark
The concept of flourishing has the potential to transform clinical care.
Source: Adobe Spark

One of the central goals of the Human Flourishing Program at Harvard is to study and promote flourishing in human life. We aim to do this in life in general and also through the investigation of flourishing in specific contexts, including the workplace, families, schools, and within medicine.

In May, we published a Viewpoint piece in the Journal of the American Medical Association on how the concept and measurement of flourishing are relevant for medical practice.

Flourishing could be a transformative concept for clinicians and for medicine. Too often in medicine, and in public health, we focus on disease and its predisposing risk factors. This work is important, but its narrow focus often ignores the bigger picture of what leads to a truly whole and flourishing life.

People certainly care a great deal about health, but they care about other things as well—about being happy, and having a sense of purpose, and trying to be a good person, and having good relationships.

Our own conception of flourishing is a state in which all aspects of a person’s life are good. We have argued elsewhere that flourishing involves numerous domains of life, including happiness and life satisfaction, physical and mental health, meaning and purpose, character and virtue, and close social relationships.

This, of course, is a very broad conception, and a conception so broad is not always going to be relevant in every clinical encounter. However, when it comes to major treatment decisions that could have side effects that alter one’s capacity for work or affect aspects of one’s relationships, efforts to maximize physical health (or years of disease-free survival) may sometimes come into conflict with the goals of having a sense of purpose (e.g., through one’s work) or with satisfying relationships.

In these cases, we believe that looking at clinical decisions through a lens of flourishing can be helpful. Examples we’ve given in our papers or presentations have included:

1. A man wrestling with treatment decisions over relatively advanced stage bladder cancer, thinking that a cystectomy will maximize life expectancy, but may severely hamper the quality of life and happiness

2. A young woman tests positive for a genetic variant that greatly increases the risk for breast and ovarian cancers; removal of ovaries would substantially protect her against these cancers but would also make her infertile, thereby potentially compromising her sense of social well-being, purpose, and happiness

3. A chef faces surgery options for his tongue cancer that might maximize his chances of survival, but would impede speech and effectively end his career.

Many of these decisions relate not just to questions of quality of life, but specifically to questions of relationships and of meaning and purpose. Thinking about how various decisions affect different aspects of flourishing may help clinicians provide better care for patients and provide care that is more holistic.

It may also be helpful in clarifying the right decision for each individual. It is easy to presume that physical health and longevity are the highest values in life. The concept of flourishing may challenge that presumption, or at least bring into consideration life’s other important aspects and enable more patient-centered care.

A focus on flourishing might also be helpful in addressing issues of physician burnout. Physician burnout has been documented as an increasing problem over the past years, and one that threatens the practice of medicine. But research suggests that a focus on improving a sense of meaning, of control, and of optimism might help protect against such burnout.

Our flourishing measure can be useful in assessing flourishing for both patients and clinicians alike. It can be useful for research purposes, or for a simple check-in with regard to how various aspects of life are going.

It can be useful outside the clinical context for purposes of life reflection. But it can likewise be helpful in reflecting on the implications of important clinical decisions and how treatment success or side effects might alter these various aspects of flourishing.

We’ve included the 12 questions from our flourishing index in the image below, and you are of course welcome to use it for your own reflection for these purposes, or in research.

Tyler VanderWeele
Flourishing Questions from: VanderWeele, T.J. (2017). On the promotion of human flourishing. PNAS 31:8148-8156.
Source: Tyler VanderWeele

We have already started to partner with medical faculty at Johns Hopkins School of Medicine, the Medical College of Georgia, and Stony Brook University Medical School to collect data and carry out flourishing assessments on both patients and clinicians, and we have been in discussion with numerous other medical schools and centers as well.

In some cases, this has been for research purposes; in some cases, for a student, trainee, or clinician assessment; and in some cases, to further promote patient care.

Recently, to explore the concept of flourishing further for a non-academic audience, the School of Public Health at Harvard worked with us to produce a podcast examining how the study of flourishing is relevant within public health and medicine.

We believe a greater emphasis on flourishing would promote the well-being of patients, of society generally, and would also enhance the practice of medicine.

References

VanderWeele, T.J., McNeely, E., and Koh, H.K. (2019). Reimagining health: flourishing. Journal of the American Medical Association, May 7; Volume 321(17):1667-1668.

You can sign up here for a monthly research e-mail from the Human Flourishing Program, or click here to follow us on Twitter. The Human Flourishing Program at Harvard University aims to contribute to, bring together, and disseminate knowledge from various academic fields on topics fundamental to human flourishing.