Frederick O. Foote, MD, CAPT, MC, USN (Ret.)

headshot of fred foote

Home Institution: The Uniformed Services University of the Health Sciences (Health Services Administration), Bethesda, MD

Field: Neurology

Current Positions:

My Driving Question

How do we spread the model of holistic care established at Walter Reed National Military Medical Center to other health care facilities, both civilian and military?

Scholar Project

The Epidaurus Project: Writing Its History for the Future

Since 2001, Dr. Foote has played a leading role in an initiative to introduce an unprecedented level of holistic care and assessment in the Military Health System. This effort, known as the Epidaurus Project, aims to enhance the health of service members and veterans through:
  • Family-centered approaches
  • Multi-disciplinary care integration
  • Tools and practices that support wellness, including nutrition, exercise, mind-body medicine, complementary/alternative medicine, healing arts, and spirituality
  • Evidence-based design of healing environments
The Epidaurus Project—named for a celebrated sanctuary of healing in ancient Greece—scored a major victory with the creation of the new Walter Reed National Military Medical Center (WRNMMC) in Bethesda, MD, and its regional integrated delivery system of hospitals and clinics. All incorporate the key elements of holistic care. Dr. Foote’s work as an Institute Scholar is to produce a series of publications documenting and analyzing this historic development at one of the world’s most prestigious and influential healthcare institutions. In journal articles, Dr. Foote is detailing strengths, weaknesses, and opportunities for improvement, and discussing issues that are central to the further evolution of holistic care. Dr. Foote’s ultimate goal is to publish a book that will, in his words, “serve both as a manual for medical students constructing their general concepts of medicine and as a resource for residents in complementary and integrative medicine.”

Biography 

Frederick O. Foote, MD, a retired U.S. Navy physician, leads the Epidaurus Project, which aims to integrate whole-person care in hospitals and clinics throughout the U.S. Military Health System.

A practicing neurologist for 20 years, Dr. Foote served at the National Naval Medical Center (NNMC) in Bethesda, MD, in numerous positions, including chairman of the NNMC Ethics Committee and team leader of the Neurosciences Service Line. As head of special projects for the Neuro-musculskeletal Service Line, he was responsible for the inception, funding acquisition, and development of clinical programs, including the Vietnam Head Injury Study, Conemaugh/Jackson Neurosciences Research Program, NNMC Multidisciplinary Sleep Center, NNMC Spine Center, NNMC Centers of Excellence for Cranial-Spinal Surgery and Total Joint Replacement, and the NIH/NNMC Center for Musculoskeletal Research.

Dr. Foote served in Operation Iraqi Freedom as a staff neurologist and assistant medical department head on the USNS COMFORT, a seagoing medical treatment facility. He was then deployed to West Africa, where he developed programs for improving health care at sea, including the IMPACT at Sea Program for medical quality management; the IWO Successful Sailors Program; and initiatives in space redesign, infection control, and mass casualty care.

In 2006, he was appointed project officer of the Epidaurus Project. In that role, he serves as a subject matter expert in advanced health facilities design, holistic medicine, use of the arts in health care, and patient/family centered care. He was assigned as an advisor to design teams for Walter Reed National Military Medical Center (WRNMMC), Fort Belvoir Community Hospital, The National Intrepid Center of Excellence for Psychological Health and Traumatic Brain Injury (NICoE), and the Medical Home and Patient/Family Centered Care initiatives at NNMC.

Dr. Foote has been honored by the Navy with two Meritorious Service Medals, four Commendation Medals, a Meritorious Unit Commendation, a Good Conduct Medal, a Humanitarian Service Medal, and a National Defense Medal.

His 2014 book of war poetry, Medic Against Bomb, inspired by his experiences in Afghanistan treating the wounded of the Iraq/Afghanistan Wars, received the Grayson Poetry Prize among other honors.

Education and Training
  • Residency, neurology, Yale University School of Medicine
  • Internship, University of Tennessee Hospital
  • MD, Georgetown University School of Medicine
  • MS, pharmacology, Georgetown University School of Medicine
  • BA, general studies in the humanities, University of Chicago
Selected Honors
  • Two Navy Meritorious Service Medals
  • Four Navy Commendation Medals
  • Navy Meritorious Unit Commendation
  • Navy Good Conduct Medal
  • Navy Humanitarian Service Medal
  • National Defense Medal
  • Sandoz Award for Pharmacology Research
Selected Publications

Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) “When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.

Suffering

Suffering is the ongoing pain from wounding. There is debate about whether or not one actually needs to experience suffering on the path to healing.

Wounding

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. “The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”