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.