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Mark Hyman, MD

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Should You Fire Your Specialist?

Posted: 04/ 7/2012 10:04 am

The way most doctors practice medicine right now isn't working. Medical students are trained to see the body as a collection of isolated parts instead of one whole system. The ensuing move toward medical specialization -- organizing medicine by organs and diseases, by location and symptoms -- is flawed and, as a result, modern medicine is at a breaking point. Not only does this hyper-focused approach to medicine dehumanize patients, it also ratchets up health care costs. We know, for instance, that medical specialists hospitalize more patients, write more prescriptions, and order more tests than primary care physicians. However, more spending rarely equates to better patient outcomes. I know because that was how I was trained.

In medical school, my classmates and I learned how to diagnose diseases and assign standardized treatments no matter who was suffering. I was taught to see the body as a set of symptoms, not one large system. Part of my training was learning how to refer patients to cardiologists for heart problems, gastroenterologists for stomach issues, and rheumatologists for joint pain. Given that most physicians were trained this way, it's no wonder that the average Medicare patient has six doctors and is on five different medications.

What I now know is that the key to good medicine is seeing the whole patient instead of just a collection of broken parts. My approach is called functional medicine. Functional medicine is not a new modality, specialty or technique. Practicing functional medicine means thinking about how the body's systems are interconnected. Functional medicine is about moving beyond a superficial diagnosis and discovering the root cause of illness. In functional medicine, we want to answer the question "Why?" not just "What is the right drug for this disease?"

This is what I did with Evelyn. Evelyn came to see me after suffering a decade of health problems. In 10 years, she'd seen 12 doctors and been diagnosed with 29 different diseases. Her list of ills included pre-diabetes, high blood pressure, food addiction, migraines, depression, PMS, infertility, irritable bowel, reflux, asthma, allergies and even psoriasis. By the time she saw me, Evelyn had a different specialist for every inch of her body. With that many doctors at her disposal, she should have been the healthiest person on the planet, but instead she was overweight, overwhelmed, and overmedicated.

My approach was different. As a functional medical practitioner, I look at the whole person, not the disease. I've spent the greater part of my career studying the root causes of chronic illness. There are more than 12,000 diseases known to medicine, but there is only one Evelyn. Instead of thinking about her as a hodgepodge of 29 different diagnoses, I shifted the paradigm. I looked at what might be throwing her body out of balance.

The body maintains balance in only a handful of ways. At the end of the day, disease occurs when these basic systems are out of whack. The human body is very resilient, yet its systems are derailed by VERY few things, namely TOO MUCH of things that detract from health -- bad food, bad bugs, toxins, allergens and stress -- and TOO FEW of those things that promote good health -- whole foods, water, air, light, rest, movement, sleep, rhythm, connection, love, meaning and purpose. (For more information on the seven fundamental systems in your body that can get out of balance, see The Blood Sugar Solution.)

If I could figure out how to help Evelyn get her body back in balance, her diseases would largely take care of themselves. The tests revealed three major systemic challenges. First, Evelyn was allergic to wheat, which was creating low-grade inflammation in her body as well as damaging her thyroid. Secondly, she had an unhealthy level of bad bacteria in her gut that were contributing to her fatigue and weight gain. Finally, she lived in Minnesota, and the lack of sunshine, especially in the winter months, led to a severe vitamin D deficiency. Between her gut, her hormones, and her immune system, Evelyn had roughly three basic systems we needed to address. In short order, I got her off wheat, treated her thyroid, and gave her high doses of vitamin D. Six weeks later Evelyn was symptom-free and had lost a whopping 21 pounds. The key was getting her body's basic systems back in working order.

A similar paradigm shift -- away from seeing patients as a collection of various diseases and toward recognizing the foundational systems that organize a person's health and well-being -- is what's needed to pull the health care system back from the brink. Placing too much emphasis on a yes/no diagnosis, meaning you either have a disease or you don't, can lead even the most well-meaning physicians to miss underlying causes and early warning signs of illness. And that's where the real skill lies -- in identifying red flags before they lead to disease. With this approach, you may never need to see a specialist again! We need doctors who can connect the dots and treat your whole system, not just the symptoms.

To learn more please see The Blood Sugar Solution. Get one book or get two and give one to someone you love -- you might be saving their life. When you purchase the book from this link you will automatically receive access to the following special bonuses:

  • Special Report -- Diabetes and Alzheimer's: The Truth About "Type 3 Diabetes" and How You Can Avoid It.
  • More Delicious Recipes: 15 Additional Ways to Make The Blood Sugar Solution as Tasty as It's Healthy!
  • Dr. Hyman's UltraWellness Nutrition Coaching -- FREE for 30 days!
  • Hour 1 of The Blood Sugar Solution Workshop DVD

Now I'd like to hear from you...

Does your doctor just treat your symptoms?

Are you seeing more than one physician for different ailments?

Do you see yourself as one interconnected system?

Please leave your thoughts by adding a comment below.

To your good health,

Mark Hyman, MD

Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.

For more by Mark Hyman, M.D., click here.

For more on personal health, click here.

 
 
 

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The way most doctors practice medicine right now isn't working. Medical students are trained to see the body as a collection of isolated parts instead of one whole system. The ensuing move toward medi...
The way most doctors practice medicine right now isn't working. Medical students are trained to see the body as a collection of isolated parts instead of one whole system. The ensuing move toward medi...
 
 
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09:49 AM on 04/24/2012
Dr. Hyman - I completely agree with you and am currently reading your book The UltraMind Solution because my mother has Alzheimer's disease and I want to do everything to prevent getting it. A woman asked (in a different article you wrote) in the comments section if you could comment on perimenopausal and menopausal women and reactive hypoglycemia. I would love to hear about this because I think it is related to AD. Too much insulin causes too much cortisol which damages the brain and depletes magnesium which is essential to brain function. I also think glucocorticoids (asthma medicines) do this in spades and are part of the AD problem. What are your thoughts on this? Is reactive hypoglycemia brought on by low progesterone levels at menopause (starting the whole cascade)? I wish there were more doctors like you....We need to change the whole mindset of the medical community.
12:27 PM on 04/13/2012
Great article, Dr. Hyman. As a practitioner of Chinese medicine, I'm surprised that you didn't mention that our system of medicine is the oldest documented methodology of functional medicine. We've been treating the root cause of illness along with the symptoms for over 2,000 years. It is wonderful to meet M.D.'s who practice their own variety of functional medicine. We all do our part in healing patients that other doctors do not have the education to serve.
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Pavarti Ben
08:37 PM on 04/10/2012
Thank you Dr. Hyman for such a great article! I come from a family of health practitioners, myself included, and have always questioned and/or doubted some of the protocols, diseases, and diagnosis that are thrown out there. Our society likes quick solutions; something hurts, take a pill. I have had patients complain of the many medications they are taking and when I suggest to change their eating habits and to actually work towards their health, something that doesn't work as quickly as swallowing a pill, i get frowned upon.

People/patients often ask me why at 46 y/o I look much younger, do not suffer any disease, and never get sick. My answer: I watch what I eat, I exercise, and I sleep eight hours a day; then the eyes roll.
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dancerctry
I love Gardening and Decorating
10:33 AM on 04/09/2012
There are three main doctors I see and a nutritionist. My Gynocologist, my Psychologist, and my regular doctor. Mt regular doctor wants me to continue to see the nutritionist because I have a history of an eating disorder and even though he has determined I'm a healthy weight I still say I'm fat. The nutritionist is mostly moral support. When I broke my foot last May for the 5th time I saw a specialist and keep his number handy. My regular doctor though, generally tries to treat things himself first. When I was concerned about a thyroid issue holding my weight loss back, he did the bloodwork. He wasn't against sending me to an Endocrinologist if it appeared I was having weight issues and the tyroid was normal but didn't when it was obvious I'm healthy. He did send me to my gyno out of concern for a pain in my pelvic area and a change in my periods. My husband has a shunt and he sent my husband to the emergancy room since that was the best place for the necessary testing. Luckily, we rarely need a doctor. There is just something about this time of year though.
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stape45
No brag, just fact.
12:00 AM on 04/09/2012
My specialist is the only reason that I'm alive today. (Guess that answers that.)
09:34 PM on 04/08/2012
As a result of the way medicines practiceed people like me that have serious disease go u diagnosed for years and are dismiised by doctors as faking our symptoms. I have friends dying because of this approach and sheer laziness and lack of common sense. Otnshould be patient centered care and acute and chronic conditions separated.
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Capricious Capricorn
Don't wait for a storm to pass. Dance in the rain!
04:18 PM on 04/08/2012
I haven't visited our GP for nearly four years. I'm fit, exercise watch what I eat and at 5'3" tall 110 lbs. I'm not overweight. I was having some gastrointestional problems which prompted my last visit and I told him about having pain every day, to which he replied he woke up with a headache every day and dismissed me. On my own I made some dietary changes and in time my condition has improved. I have little faith in doctors since several years ago I had abdominal surgery and the surgeon nicked my bowel and I ended up with a terrible e-coli infection. He wanted to open me up in his office to drain the infection rather than put me in the hospital but I refused and he had to re-admit me, placing me (a very young woman) in the geriatric ward.
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Sharon Hanson
Skeptical of the *pseudo-skeptics*
08:35 PM on 04/08/2012
I had a similar experience but a lot worse. I was terrified of cancer and I have the BRCA mutation. It was recommended to get annual MRIs with gadolinium based contrasting agents (GBCAs) and I did, 12 of them. Now I'm totally disabled. Gadolinium is a toxic metal and causes a new man-made disease called nephrogenic systemic fibrosis. We are only seeing the tip of the iceberg regarding these scans that have been administered over 300M times with GBCAs. See this scribd account and read some of the horror stories in the court filings on this case. People are dying waiting for GE to settle.
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Capricious Capricorn
Don't wait for a storm to pass. Dance in the rain!
03:42 PM on 04/09/2012
I am sincerely sorry for what has happened to you. Isn't it tragic that we have the most expensive healthcare in the world and it is ranking behind other countries overall. It's disgraceful.

According to the International Fund, despite having the most expensive health care system, the United States ranks last overall compared to six other industrialized countries—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—on measures of health system performance in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives, according to a new Commonwealth Fund report. While there is room for improvement in every country, the U.S. stands out for not getting good value for its health care dollars, ranking last.
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Sharon Hanson
Skeptical of the *pseudo-skeptics*
04:06 PM on 04/09/2012
Here's the scribd account. This poison is going to cost our country trillions in additional healthcare costs. http://www.scribd.com/gasfgd
RSGmusic
Instrumental music is great
12:30 PM on 04/08/2012
I was at 320 lbs and 5 10 in height at age 53, taking about 15 bills a day. Went to the hosptital and they found a blood sugar of over 1000. spent 5 days in intensive care. Insulin was pescribe and a better diet was outlined. I also drank large amounts of water.Two weeks later, after changing my diet to healthy foods.
I lost 60 lbs and started using less insulin. after another three weeks,kept the same diet and lost another 10 pound and stopped insulin altogether. My energy was way up. The lack of excersize was another problem. so i gained back about 15 pounds. Started taken many small works and taking medium amounts of B and C vitamines. after about two weeks of this I am losing about 3 lbs ever 2 weeks and my blood sugar is about 92 and blood pressure is about 135/88. currently i have 3 Pre meds and the 2 vits.

Today I am still fight excersise, but when i do exersise more I am maintaining my 250 lbs and take feeling well. I am revisiting my diet and taking out tuna and will try and keep excersing well. Lets see what happens. hopefully I will gradually lose Lbs and get to 200 lbs and will be fine.

RSGmusic ( can practice playing music for 3 hours at a time now. )
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alw2080
a loved Dem.
03:58 PM on 04/08/2012
RSGmusic
I love it when something good happens for some one .We are happy for you.
I know how hard it is to drop 5lbs. so I know it took some will power to do it.
May God bless you and keep the wind at your back good for you. Hope that this helps others too . GOOD JOB!!!!
RSGmusic
Instrumental music is great
07:59 PM on 04/08/2012
alws2080, Thank You Very much!

I still have a big hill to climb and it is great to have encouragment!

Many small walks and some larger ones will get me there in perhaps a year.
A daily exercise routine I plan to add will help more.

Again Thanks

Peace to all

CONGRADULATIONS B Watson and his Family and may He will Many More.
His Father is Very Pround of THis Day, on Easter what a gift for ALL.
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optimage
09:00 PM on 04/11/2012
Don't stop at 200 lbs.
Go further. Go the distance. Run PAST the finish line.
Then pause to ee if you like it. If you don't, you can always gain it back!
(Add Vitamin D - 4000 units/day while you're at it)
RSGmusic
Instrumental music is great
11:47 PM on 04/13/2012
Thanks optimage, I ulitmate weight will be about 175 lbs.

I plan to keep the weight off, will see!

Thanks Again and Prosper
12:09 PM on 04/08/2012
I found this article thought provoking, and it has obviously inspired some good dialogue between patients and doctors here in the comments. Maybe that was the intent all along. However, I can't help but wish that Evelyn had written this article. Her perspective is one that really matters here.
12:03 PM on 04/08/2012
I'm a GP and I also refer to specialists. I'm not against any specialty since specialists give what is the best evidence-based medical care according to their practice. But there have been instances in my practice when patients came back to me complaining about how specialists handle their management. "It's too costly," or "I have no more money to shell out." My patients always say that the management is great but it's not for them. Specialists tend to give out their best opinion about any case but often, they forget to tailor the management to the patient's capability.

I got the author's point in this post and I don't really think it's an attack to specialists. It's just a wake up call. As for the author's self promotion, he wouldn't be a best selling author if he didn't.
noahmarder
Exposing the regressive lies, one by one
05:31 AM on 04/08/2012
Over the last 20-30 years, there has been a huge explosion in the amount and availability of medical information. A general practitioner, or even a first level specialist, can't possibly keep up with all of the new developments while delivering effective care to patients. GPs and first level referrals are fine for routine cases of common ailments, but for difficult, unusual cases, sub-specialists are necessary, and patients should be glad they exist.

The trouble starts when those sub-specialists don't communicate effectively with other doctors involved a patient's care. This leads to the fragmented, and inefficient care that the author is complaining about. In many cases though, the patient NEEDS a specialist, and he shouldn't fire one unless he already has found a better replacement, or is confident that he can do so quickly. Of course, a patient should probably fire any doctor whom he believes is not acting in his best interests.

This entire article really stinks of self-interest and greed, and I believe Huffpost made the wrong decision in posting it. I would imagine that doctors would be especially annoyed by it, as Dr. Hyman is taking an incredibly divisive and destructive stance to promote himself.
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Sharon Hanson
Skeptical of the *pseudo-skeptics*
08:45 PM on 04/08/2012
Bull. The worst thing a PCP can do is refer to a specialist. Most are greedy and only want to do treatments on the patients to make money. Patient safety has suffered terribly and I will never go to another mainstream doctor again. You know they are going to become extinct. Why because most Americans are impoverished and can't afford them. And you know this is going to be a very good thing for patient care.
noahmarder
Exposing the regressive lies, one by one
12:11 AM on 04/09/2012
I'm not happy with the current state of the medical profession either. Doctors have all sorts of perverse incentives to act contrary to patients' best interests, and a majority of doctors succumb to those conflicts of interest.

That being said, the medical field is just too vast for a PCP to be expected to handle difficult and unusual cases alone. This problem is compounded by the limited amount of time doctors can spend with each patient (due to low insurance payments for office visits). If a PCP doesn't think he has the ability to handle a case, he absolutely SHOULD refer to a specialist. Of course, if the patient has PPO insurance, or can afford to pay out of pocket, he can pick his own specialist.

I understand your resentment of the medical profession, and frankly, I agree with a lot of it, but getting rid of specialists won't fix anything. I'm sure you'd want one if you needed complex surgery or had a rare cancer.
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BPorter51
10:16 PM on 04/08/2012
I agree completely with your second paragraph and here's why: I had a simple laproscopic gall bladder surgery, and immediately developed disabling nausea. Went back to the surgeon, no help, not his field. Went back to the gastroenterologist who followed me in the hospital; he said it was all in my head. Went back to my PCP. She explained to me, after attempts to treat were unsuccessful, that she would prefer I see a gastro specialist again. No way was I going back to the hack that just wanted to schedule a colonoscopy. Who did she recommend? She arranged for me to see a great specialist, who was able, after special testing, to diagnose and treat my condition. He communicated with my PCP and shared my records. The communication was great, the med management was great, and my recovery was great.

I'm fortunate to have an Internal Medicine specialist as my PCP. She can handle most of my problems.

One other point. As patients, we need to accept a certain amount of responsibility for the quality of the care we get. I won't settle for a PCP who doesn't have time for my probing questions. I make sure any specialist I see gets a copy of my medical history and a release to speak to my PCP. I talk to my pharmacist. I read and research meds and conditions, so I know what I need to ask.
noahmarder
Exposing the regressive lies, one by one
12:32 AM on 04/09/2012
I totally agree with you about patient education and responsibility. With all of the conflicts of interest facing doctors, a patient's only defenses are education and assertiveness.

I have had multiple experiences where a doctor misdiagnosed me, and I ended up correctly diagnosing myself via the internet. Doctors are expert consultants whom the patient employs in the hope of improving or maintaining health. Patients should remember that, in most cases, they are the boss, and that there are other options if a relationship with a particular doctor isn't going well.
12:26 AM on 04/08/2012
As a fellow physician it disturbs me to read articles like this. It doesn't do the patients any good telling them to fire their specialist in favor of purchasing the author's own books. Beware of someone trying to sell you cure all type books and supplements. This is a huge conflict of interest and smells of quackery. Finally in an era of declining reimbursements, I'm afraid we will begin to see more Dr. Hymans in the future trying to turn a profit selling his products while criticizing members of his own profession. Leave the real doctoring to professionals and save the nonsense for the used car lot.
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NoraHuffposter
Liberal socialist
03:24 PM on 04/08/2012
Do you have any comments on the essence of Hyman's article or is this just your shot in the turf war?
07:18 PM on 04/08/2012
I thought I pretty much covered the 'essence' of the article. No one in my estimation is disputing the benefits of healthy diet, exercise, proper rest, no smoking etc. Common sense type stuff. Moreover, a good primary doctor is worth his weight in gold. However, when the author attaches his suggestions to peddling his own books, in my opinion, that is a clear conflict of interest and seems unethical. I also don't think it benefits patients to recommend firing their specialist without knowing the details of a patient's medical history. In fact, that is bad advice as most patient's actually don't like such sweeping generalizations and prefer to have a more personalized approach to their health care. Let's also remember that the plural of anecdote is not data, and the standard of care is to practice evidence-based medicine. Finally Nora, "turf war"? I assure you that I am not fighting for turf with internists and primary care docs, but you should know that insurance companies and third-party payers love when doctors quibble with each other as it allows them to continue to cut reimbursements.
professor
Correkt the Spelling and Pick on the Moniker
12:19 AM on 04/08/2012
Every doctor I ever met
A. Condescends to me as if I can't look things up on the computer too.
B. Acts like he doesn't know how to socialize with people properly, like they have asbergers or something.
C. Far from giving different diagnoses, they all give the same one, the wrong one, and without anything more than a cursory once over.

Why do they tell lawyer jokes? Lawyers are smart. Doctor jokes are needed.

Why did they send junior to medical school? So he wouldn't flunk any more easy tests.
11:57 PM on 04/07/2012
Yeah lets play dump the patient on the specialist when the disease process is so far along that only urgent and expensive interventions are warranted. If anything see a specialist early