Rahul works as an integrative medical physician, professional coach, mindfulness instructor, and advocate for physician wellness. He is a Certified MBSR Teacher through the Center for Mindfulness to facilitate Mindfulness-Based Stress Reduction Programs and offers this service to both physicians and patients. He also is a professional coach accredited by the International Coaching Federation and supports physicians as a consultant for the Physician Health Program of BC. He lives and works in Gibsons, BC and travels throughout the province to speak on the topics of patient self-management and physician self-care.
What got you into mindfulness and coaching?
I got into health coaching in 2000 and it started from my experience being in Family Practice. I was surprised by the number of people coming into the office that had psychological problems ranging from acute to more chronic. The challenge I had was I did not feel that I had the skills to support their well-being. It felt to me at the time the only choices I had were to give patients prescriptions or refer them to counsellors and they often did not have the money. It bothered me that I did not have other answers and so I undergone intensive training to become a coach. I took those tools back in the office and was surprised to see coaching did not just impact patients who had anxiety and depression, changes in patient behavior emerged and could be seen from those who would not quit smoking before went on to quit smoking. Also, people that I thought who would never start to address their health around weight or had alcohol addictions were starting to take care of themselves.
Over time I adjusted coaching training to fit the medical model. I began creating workshops for physicians believing that others might benefit in the same way. I started designing workshops for both the UBC medical school and Family Medical program once a year as well. It has now grown to running three day workshops upon request from medical communities so they can take a deeper dive at learning some of these tools too to coach their own patients. Another thing I am involved in is working as a GP consultant seeing patients that are going through different conditions whether it’s physical pain, disabilities, or psychological challenges (e.g., anxiety, depression), and trauma such as PTSD. Essentially, I am involved in supporting patients and their family physicians in a non-pharmacological way to help them move forward and empower them to access resources within themselves.
In my involvement with health coaching in the past nine years, I also work one-on-one with physicians across the province through the Physician Health Program, supporting them through times of transition, trauma, and growth. The program structure is between 3-8 sessions through video/tele-conference. At UBC CPD, I host a workshop on optimizing communication in health care and it supports physicians, other allied health professions, and administrators to cultivate communication skills to improve inter-professional collaborations. This is in recognition that most breakdowns and litigations are due to communication breakdowns and not because of technical competency issues. The College of Physicians and Surgeons jointly with UBC CPD wanted to design a workshop to address this issue. My involvement was on the Steering Committee and I am now a facilitator for the workshop.
My path to mindfulness is a bit different and started in 2004. I heard about meditation and was so intrigued by it I decided to dive in and attend a ten day intensive retreat. It was brutal at first, but it was also transformative and I came out of it with so many insights and shifts within myself. For the first 7 years or so, it was more of a personal journey I did every year for myself in attending these 10-day annual retreats. I would also meditate for myself on my own time. In 2011, my wife suggested I explore getting a certification as a trainer in mindfulness because I was immersed in this practice. That was when I went through the Centre for Mindfulness in the Massachusetts Medical School where Jon Kabat-Zinn had started training for providers. The process of certification took about two to three years before I could run their 8-week mindfulness program. Incorporating this style of mindfulness into my practice was a great complement to what I had already learned myself, allowing for an integration of self-awareness, self-compassion, and interpersonal resonance. Once I got certified I started running workshops for two different groups. One of the groups were physicians who were going through personal transitions, burn out, professional challenges, or had medical problems themselves.
2) Along with my colleague who is similarly trained in mindfulness, we run a series of group medical visits where we do it through the MSP model and on a referral basis on the Sunshine Coast for family physicians who have patients that have chronic pain, mood disorders, PTSD, and are looking for ways to access resources within themselves. Physicians can refer their patients to this 9 week program. These workshops involve going to different communities such as the Kootenays, Prince George, St. Paul’s Hospital, VGH, and RCH. This program has received a lot of positive feedback and has been personally rewarding for me as I work to support other physicians.
That is how I got into both health coaching and mindfulness, and they have proven great complements to each other in the service of cultivating wellness. Health coaching works to help people gain a sense of autonomy in their life which is really optimized in a one-to-one environment. Mindfulness programs are typically group-oriented and essentially support people to build awareness and compassion (towards self and others), along with learning how to relate with the unknown, unwanted, and unpredictable aspects of being human. Participants find a way towards more inner peace and navigating life in a clearheaded way. People can either come to one of the sessions in isolation or may attend both for different reasons.
Being part of the Clinician Scholars Program where you did research incorporating mindfulness and health coaching in building capacity in health, would you be able to share with us some insights that emerged from the findings of your research?
I just finished the two-year Clinician Scholars Program and decided to get into it because I felt what we were doing with our patients was unique with having the mindfulness group, health coaching, and GP consultations. I thought it would be useful to research these modalities, but I had no research skills so I decided to apply to the Clinician Scholars Program and was grateful to have been accepted. It has been a wonderful journey in the last two years. What I decided to do with my project was conduct a qualitative stakeholder engagement study where we would invite patients that had attended one or both of the programs. We also included participant’s referral physicians and regional health care managers to attend this one-day event to see if we could understand how and why these physician-led programs were working to build capacity when they are integrated into the medical system. We wanted to know what features would be important for other communities to consider if they wanted to upscale these programs into their own communities. Wendy Norman gave me the idea of involving a graphic facilitator to attend the one-day workshop so we could have focus groups and then capture what was being shared to all participants in an iterative graphic format. As a group, we could verify together peoples experiences and perspectives. In the study, six themes emerged ranging from personal to systemic factors that were enlightening to us as a research team. Some themes corroborated what I already knew and others have brought new ideas for consideration. This research can be a starting point for more robust forms of evaluation (outcome evaluation) or evaluating economic impact.
What do you find an important element to consider when conducting research?
I still feel like a complete novice in research, so it seems strange to provide counsel! But if I were to share a few points that I find important a few things come to mind:
- If you are new to research, get involved in a program that has some structure to allow you the space to explore and learn. Without dedicated time and support, research would feel overwhelming.
Taking the Clinician Scholars Program was a wonderful way to learn about research because we would always meet every week online. There was always this platform where we could ask questions, share ideas, learn from each other, and access resources.
- Seek out places for support
This includes getting mentorship whether that be for getting advice throughout the research process or establishing connections. One advantage in taking the program was I felt clearer about what organizations were out there to help support research. It enabled me to build connections and friends over time. Another factor to seek out is grants to help various aspects of your research project such as knowledge translation. I was very fortunate that early on in the two year program I applied for a Michael Smith Foundation grant called the Convening and Collaborating Grant. That gave us some funding to initiate our research. I got another grant from the RCCbc to take steps on initiating the process of knowledge translation within the project. Without funding, it is challenging to move forward in your research project.
- Focus your research scope – start small
Most of us when we come into the program, we often have big ideas and want big change. It is important to start small and focus on a research question that is answerable. There will be multiple iterations that you will undergo to find “the one” through feedback with others and to have the time to reflect.
- Work life balance
During the program I heard one of our mentors say that is a process of “grant then study, grant then study etc”. After having gone through both myself, I suggested that research should better be thought of as “grant, recover, study, recover etc”. Trying to conduct research while also performing clinical or teaching duties can be challenging, so learning how to pace oneself is key!
What are some obstacles you faced when conducting the research and how did you go about overcoming them?
What I alluded to earlier was the process in distilling a question that is answerable and workable. This process takes time and informs how you will ultimately conduct your project. Another thing I had to improve on was making myself vulnerable with the Director and my colleagues. It took a lot of courage to face moments of adversity and convert them into growth opportunities. Another obstacle was work-life balance where I tried to integrate doing research at the same time when I had other responsibilities. There were intense periods where I was facing deadlines such as applying for grants and applying for ethics. It sometimes can take over my life for a few weeks or even a couple of months. Overcoming that involved planning in advance (i.e., knowing the deadlines for relevant grants) and trying to structure my life such that I had the time and energy to address those research needs. It felt overwhelming at times when project tasks were seemingly endless, so I had to find ways to appreciate the process and really enjoy the quieter times!
What inspired your interest in rural health?
To be honest, I have not thought about research specifically in rural areas. I just so happen to live in a rural area. My supervisor (and mentor) Bob Woollard that conducting research in rural areas has a distinctive advantage. We are operating at a smaller scale. The possibility for experimenting ideas or novel ways of doing things is much more possible in rural settings because of this smaller scale. It would be incredibly valuable for society to support communities in doing rural health research because there are possibilities for doing very unique things that can then be translated into urban areas.
If there is anything you would like to share? Research tips or fun facts about yourself?
As far as any fun fact about myself, I do love racket sports! But because of my wrist injury, I am trying to be ambidextrous with table tennis (the only racquet sport I currently can handle). In our living room, my wife and I agreed a few years ago that instead of having living room furniture we would have a ping pong table instead! The table gets a fair amount of use and any arguments we might have disappear once the rally starts. I am an advocate!