At times I feel like I'm practicing medicine in a tunnel, one where the only way out is to prescribe pharmaceuticals that have gone through double-blind, placebo-controlled trials. Modern medicine has brought us many wonderful advances -- and, believe me, I understand that controlled trials are important -- but what about the art of medicine?
Have we forgotten about the many modes of healing at our fingertips? And what about the individuality of each patient? The reality is that what happens in a laboratory or in a clinical trial is not always what we see in practice every day. Besides, the data we read in scientific journals may not even be reported accurately. I recently read Sherri Tenpenny, M.D.'s blog on fraudulent medical research, where she discusses researchers making up results and publishing them in prestigious medical journals. Yet we base so much medical advice on what this research reports.
I'm charging all of us to demand more from our health care providers. And for those of us working in the health care industry, step back for a moment and take an inventory of all that you know, inside and outside medical research. What have your patients taught you? What have you learned in your life? What studies have you read and put into practice that have made a difference? There is wisdom here that we've overlooked, and I think it's about time we come back to our black bags, our medicine chests and apothecaries, and take an inventory of all the tools we've been collecting.
A Patient-Centered Focus
In the world of Functional Medicine, we approach each new case with a patient-centered focus, rather than a disease-centered focus. In a recent article by Andrew Weil and others on medical decision-making in integrative medicine, the authors ask: "Is a treatment valuable if it cures the illness at hand but damages the health of a patient in some other manner?" I think the answer to that question depends on the patient's needs. There is a give and take with every new patient I see, which is what makes the practice of medicine an art.
In functional and integrative medicine, we look at diet, nutrition, exercise, adult and childhood trauma, the environment in which the patient lives, digestion, and the relationships they have all as factors that influence their wellness.[3] This is called the Functional Medicine Matrix.
This approach is certainly more complicated and almost always takes more time to carry out than spending five minutes with a patient and prescribing a drug, but the results are amazing. It takes the patients' belief systems and desires into account. And offers choices about what might be most practical for their unique situation.
For example, some of my patients have some very real emotional concerns connected to their physical issues. When we discuss emotional work that needs to be done to feel better, these patients often agree, but the reality of their lives (paying bills, taking care of kids and working full time) forces them to chose a more direct path to feeling better, such as day-to-day stress relief or even an antidepressant, rather than intense emotional counseling. Others who might benefit from a more nutritious diet, may chose to simply add a multivitamin rather than change everything they eat.
What I'm saying is that our bodies and lives are complicated, and offering choices is what I think will ultimately lead to better patient outcomes. Using a "Matrix approach" offers so many more ways for the patient to feel empowered and to change his or her life to feel better. If it's a pharmaceutical drug they choose, that's fine. If it's acupuncture, herbs, or massage, that's fine, too. The bottom line is that when patients make choices about what treatments are best for them, those treatments will most likely work better.
Our Bag of Tricks is Vast and Wide
I know most healthcare practitioners don't generally carry around little black bags anymore, but let's use the bag as a metaphor. In today's society, not only are our patients interested in non-conventional options, but there are more and more ways to incorporate them. Medical literature certainly fits into our bag, as do pharmaceutical drugs and surgical procedures, but there is also clinical experience, gut instinct and trial and error. There's nutritional intervention, lifestyle changes like better sleep, less stress and enjoyable exercise. There are emotional components to tackle, like negative relationships with jobs or people. We have centuries of wisdom on the healing capabilities of herbs, acupuncture, massage, Ayurvedic medicine and more.
In other words, we have so much to chose from and to explore as practitioners that our black bags should be bursting with options, options that match our patient's unique needs and our capabilities as healers. It's a shame that we haven't drawn on our vast knowledge about healing to better serve our patients. To me, it feel similar to having a Eurail pass good for travel to any country in Europe, but visiting only one place. Yes, the data counts, but so does connecting with your patient.
Oh, the Places We'd Go!
The other day, I was talking to a friend who finished her nursing degree last year and has been working in a hospital here in Maine. She told me she is leaving the job. In her opinion, her mission in nursing was at odds with the medical model we currently have in place in our hospitals. This woman is a certified yoga instructor, well versed in herbs, nutrition and other alternative therapies, not to mention the fact that she now has a sound traditional science background with her nursing degree. Yet she hasn't been able to find satisfying ways to incorporate her knowledge in her daily practice as a nurse. If you ask me, the hospital that employs her is missing the boat!
There is a way to draw on all of our knowledge about healing, including the science of today and the natural wisdom of the past, to treat the whole patient in a way that works for that patient's life. We can take medicine to amazing new places with the collective knowledge we have about the human body, but we need to step out of the tunnel and stop focusing solely on the data published in medical journals. Listen to your gut, your mind, and your spirit -- then consult the numbers. As patients and healthcare providers, we are all responsible for changing the system. And I truly believe we can.
Follow Marcelle Pick, OB-GYN N.P. on Twitter: www.twitter.com/marcellepick
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The U.S. Federal government should build a Health Academy, similar to the Military Academy or the Naval Academy. The government should pay for 100% tuition. It should be a 6 year undergraduate and graduate academy. Upon graduation, they would be a fully credentialed Doctor of Health, licensed to practice anywhere in the U.S.
They would then be hired to serve the American people in U.S. government hospitals, on ground owned by the federal government, staffed completely by U.S. Federal employees. Everyone on the health campus is paid on a schedule, with yearly raises, and unionized.
There will be no "logos" allowed on the campus of any kind. No corporations allowed in any form. Pure government. Just like what I enjoyed when i was in a socialist wonderland in Santa Ana, Ca. Marine Corps Air Station El Toro.
If i needed rest, i got rest. My employer did not threaten to fire me because my doc thought i needed 27 days to recover from the Chicken Pox, and i got paid.
Sick leave should be 100% paid for, by some combination of employer & gov't.
No doctor should be employed by a businessman,http://articles.latimes.com/2009/jun/17/business/fi-rescind17 who will always be looking to minimize costs even at the expense of the lives of people.
We ARE all individuals and Naturopaths spend great a amount of time analyzing how one patient is different from the other and which treatment modality will likely work best... that's the "art".
The gross misrepresenting of drug-testing in scientific journals has been known for some time.
www.workengagement.com/crew
Evidence based medicine is not the problem and neither are protocols. Many stroke patients used to leave the hospital without cholesterol or anti-clotting therapy? Protocols make sure the MRI gets done so TPA can be within the three hour window. Lives are saved with routine.
Evidence –based medicine tells us lots of drugs don’t work—or if they do work poorly. Read the Cochrane Review. Most of the reviews say that more study is needed; the endpoints measured in the trial were of no value, or not the same measures, not enough time or patients studied. But your doc says—you have to take the drug for life—even if there is only a 30% chance it works. Oh, and by the way, the patent keeps getting extended, so no generic and the price goes up 10-15% a year.
And then there is the little problem of self-referral. The complete embracing of exams to bring in the cash. 35 years ago, we used to say medicine was an art and a science. The art is gone, and the science is often times just well-funded PR.
My father's Cardiologist no longer sees patients in-house. Too busy doing cardiolite stress test at the office. My own Neuro expects me to have a MRI at his facility. One doc has a one-year fellowship in faux Radiology—the rest have no fellowships—just the MD. That’s who they expect me to have interpret my exams!. My Neuro can look at it after the trained professional does. Four eyes are better than two—but if I only get two they had better be some who has years of training and thousands of exams under his/her belt.
This is becoming more and more prevalent and needs to stop. Recent studies have shown no better care and only an increase in cost—not to mention radiation.
So, you are correct, if you don’t own the equipment and refer to a Radiologist—you get nothing in cash—but at least you get a pro. And in my mind, a physician who refers patients’ to these one-stop shops is doing patients a disservice. Can you be sure the patient needs the exam or the repeat exam—or if the bill from GE came in.
I find these baby steps a nice first try but absolutely ridiculous. Quite frankly, we docs gave up our youths and subsequent good night sleep because we LOVE being doctors. We just want to talk to our patients, KNOW them, treat them in the best way we know how, send our kids to college, and NOT spend half our day fighting with insurance companies. Single payer is the only way this will happen....when so many docs are begging for government involvement in their medical decisions, people really must know that things are REALLY REALLY bad for our patients and ourselves.
What I can say is that the situation will get worse as the government gets more and more involved in the process. Eventually, they will have SET rules about EXACTLY what to prescribe in any given situation. Most alternative medicine will be prohibited if they haven't stood up to intense scrutiny. Of course, nobody will be willing to fund the studies on some of these substances and procedures.
The other problem is the severe restraints on time. As the government tries to squeeze more and more out of reimbursements; the less and less time is available to dedicate to a patient. There is absolutely no way around this and many patients MUST be seen in less than 10 minutes in order for an establishment to remain profitable. If circumstances dictate that 16 minutes must be used to treat one patient than some other patient will need to be rushed out of there in 5 minutes sometime during that day! The future is bleak with the government in the driver's seat!
It is to the point I don't want to go, all they do is give me whatever drug is popular at the time and tell me to come back in 6 months, even when sent to a specialist they do the same thing
A listening problem: During an ER visit after an accident, I complained of shoulder pain, extreme numbness & difficulties with motion. The emergency room doctor told me I didn't need an X-ray & it was just a bruise. The nurse who cleaned my wounds wouldn't stop twisting the shoulder during the cleaning even when I asked her to stop because of the pain. I had to visit 2 other doctors before someone finally gave me an X-ray & said "Your shoulder is fractured. You need to a sling to heal properly."
Dangerous oversights: My sister, a nurse, said that during her studies a patient was given the wrong amount of medicine. I'm not sure what kind it was. It sent the otherwise sane patient into a sort of psychosis. The nurse's fault was never mentioned & the patient was placed in the mental ward on anti-psychotics. His family doesn't know what happened. When she finished the program, the patient was still in the mental ward. I asked her why she didn't say anything. She said others knew & the mistake was documented, but if she said anything she'd never be able to get a job. I don't know how I feel about that decision. If this is true, it makes me