It’s more like that movie Everything Everywhere All At Once.

When I review biometric and lab results with patients at the end of a Day of Care (our practice’s name for the full day executive physical), results often correlate with what people tell me about their habits and circumstances in the past year, or even the past several days. Sometimes, though, one or more results do not align, and we have to stop and consider why. Occasionally this leads to additional testing and we actually find something that needs to be treated. But most of the time it’s not clinically significant and it’s okay to monitor for relevant signs and symptoms and repeat the test annually as per routine. It’s life.

But we humans fixate. Whether it’s weight, glucose, cholesterol, or some metric on a wearable device, it’s easy to get caught up in ‘the data’ and seek the one central variable (or latest technological solution) that we can address solely and thus yield the result we want. Expert scientists devise studies that control for all variables but one, intervene, collect the data, and make correlations into conclusions. There is definitive value in these experiments, and we should absolutely continue rigorous, evidence-based study and practice of medicine and public health.

And, we healthcare professionals must also step back often and look at whole systems–individual humans (body, mind, and spirit), humans in family and community, and local and global economies–not just snapshot data in vacuums. Weight, glucose, cholesterol, body fat, and cognitive function, among other things, often move in tandem. The good news is that the lifestyle advice we give to optimize all of these is all the same. The general principles are definitely not rocket science, and I think we can safely stop spending time, energy, and precious resources proving ad infinitum that good sleep, physical activity, whole foods, and healthy mindset and relationships are good for us.

That said, if it’s that simple, why are we not all already doing it? Because simple in theory too often becomes complex in practice, and we tolerate complexity less and less in our modern, instant gratification-seeking world. I borrowed a sign from a colleague early in my career: “Move more. Eat less.” Simple–deceptively and delusionally so. Now I see these words and want to reply with a scoff and an expletive–as if it’s just that easy. And yet we get so many messages that everything should be easy; that if it’s not easy then we’re doing it wrong. This supplement, that diet, this other meditation app, and any number of new cutting edge products–online, shipped to your door tomorrow!

If our goal is to elevate health and wellness and prevent disease, it’s not only our individual actions that matter. How do our behaviors intersect with, and how are they driven by, in entropic and synergistic combination with our environment and things we cannot control? In integrative medicine when inflammation is assessed to be high, a trial of elimination is often recommended. My colleagues point first to caffeine, alcohol, added sugar, dairy, and gluten: Eliminate them all for a month or so, and see how you feel. Many people report feeling significantly more energy, relief from digestive symptoms, clearer cognition, and myriad other benefits. One might interpret this as the result of removing ‘toxic’ substances from the body, which may be at least partially true. But I posit that it’s likely also due to elevated attention, intention, and mindfulness around eating, which likely cascades to subtle alterations in other health domains such as sleep and exercise. Nothing in a system happens in a vacuum–everything affects everything, directly or indirectly.

Look no further than COVID lockdown in 2020. The vast majority of corporate executive patients in my practice experienced marked improvements in almost all health metrics by the end of that year. They had eliminated work travel, business dinners, long commutes, and at least some office politics. Earnings projections and all manner of professional expectations were scaled back and down. For this privileged population, life acquired a drastically new balance of better sleep, more consistent movement, more quality time with loved ones, and net fewer calories consumed per week. After an elimination diet, patients are instructed to reintroduce foods one at a time in small quantities, to determine reactions and and thresholds. This makes sense, and can also be misleading because whatever makes us feel badly is often not just one thing. Corporations have varied in their reintroduction of prepandemic practices essentially reverting to prepandemic state. Many of my patients’ 2020 health gains have regressed commensurately.

So in practice, what can any given individual tweak in their daily routine or immediate environment to make healthier behaviors easier and more consistent? How can we change the default systems settings so we don’t have to exert such heroic intentional energy fighting our status quo habitat to be well? I still think we need to take a harder and more honest look at our global institutions, traditons, and default practices, especially those driving corporate culture. This is exceedingly difficult and complex, ‘way beyond the scope of an internal medicine doc’s weekly blog.

But I have a plan starting this week: Look for the bright spots. This idea comes from Chip and Dan Heath’s 2010 book Switch: How to Change Things When Change Is Hard. In this post-COVID era of deep psychological and social ambivalence, who’s doing well? Which organizations or teams have figured out an apparently optimal dynamic balance of in person and remote work, productivity and accountability metrics, morale, cost management, and overall integrated systems coordination? Who’s doing allostasis–maintaining stability through change–well? It’s almost never just one thing–it’s everything everywhere all at once but likely in small, cumulative, integrated ways, sometimes at the periphery and sometimes central.

Looking at whole systems can feel so daunting, especially when we get really humble and honest and see just how intricately webbed everything is–how even a small change in one domain can domino and propagate across a whole network. It can freeze us in incertainty and fear. Or it can free us to experiment–in an ‘uncontrolled’ rather than ‘controlled’ way–because too often we have no control and must act anyway. We can experiment mindfully, transparently, humbly, accountably, and flexibly. Small tweaks can establish new standards, which lead organically to subsequent adjustments downstream. A realiable cycle of assessment, action, learning, and application can help prevent getting stuck in rigidity and attachment to status quo well beyond its functional efficacy.

Life is change, an uncontrolled trial of human nature in variable and dynamic context. Everything Everywhere All at Once, all the time. We can breathe through the overwhelm, and look from both ground level and ten thousand feet. Any one thing matters both a lot and not very much in any system of systems–one of my favorite paradoxes!

So let’s get out there and BE and DO what we can! Take responsibility and own our attitudes and actions, respect others, and live in alignment with our values and integrity. What else can we ask of ourselves than that?