Updating the Physician’s Bag: Providers Grapple with Old Tools, New Needs
Jan 06, 2017 07:19PM
● By Yufang Lin
Is health care about the care of health or the treatment of disease? If we take the words literally, health care should be about the care of one’s health to maintain health and wellness. However, in today’s medical system, health care is dominated by treatment of chronic diseases with ever-increasing costs to the people involved. The United States spends the most in medical costs at $9,990 per person in 2015, or 17.7 cents per dollar spent; yet our country ranked 37th in health in a World Health Organization survey. Compared to 10 other developed countries, the U. S. came in last as reported in 2014 by the Commonwealth Fund.
The primary reason for this disconnect is that the majority of chronic medical problems in our society stem from lifestyle issues, including nutrition, exercise, stress management, and habits such as smoking and drinking alcohol. However, these issues are rarely discussed in depth in a medical office encounter. Allopathic medical schools focus on anatomy, physiology, diseases and pharmaceuticals, but spend very little time, if any, on nutrition and stress management. While protein, carbohydrates and fats may be discussed, the quality of nutrients is not discussed in depth. While they learn that stress kills, medical students are not also taught tools to help themselves or patients. This trend can continue into residencies, where doctors learn how to prescribe parental nutrition—nutrition through intravenous lines—but still have to refer patients to a nutritionist for nutritional advice about common ailments such as diabetes, high cholesterol and high blood pressure. Despite realizing the importance of lifestyle management, most physicians become increasingly adept at diagnosing diseases and prescribing drugs while still having little knowledge about how to prevent or alleviate illness via lifestyle management.
For healthcare providers, this can be frustrating. Physicians care about patients and want to help them heal, but are not given enough tools in their medical “toolkit” when they emerge from medical school. In addition, the healthcare system has changed in ways that further reduce the time doctors spend with patients, along with ever-increasing restrictions from non-medical entities such as insurance companies and corporate overseers. But there are a growing number of doctors who agree that our medical system needs a drastic overhaul. In the 1980s, Dr. Jeffrey Bland and Dr. Andrew Weil independently started movements to look at health in a more holistic, integrative and functional manner. The basic premise of their approaches is that, in order to heal a person, we have to look at individuals as a whole, not just a sum of their diseases. We need to find the root cause of illness and address each imbalance with personalized plans.
The “whole person” evaluation starts with a full health history—prenatally to the present—genetic disposition, environmental exposure, and diet and exercise patterns. Since the practitioner also understands that emotion plays a huge role in our health, they look at critical life events, have they been joyful or traumatic. In addition, the physician examines how we cope with stress. Do we tend to sweat it out with exercise; talk it over with friends; or bury it with food, cigarettes and/or alcohol?
Consider a hypothetical example.
Let’s say “Joe” has high blood pressure and he smokes. He knows he should quit smoking. He may even have had transient success, but something always seems to triggers him to smoke again. If smoking is his way of coping with stress—and he hasn’t found another way to cope—a stressful event will most likely push him to fall back to what worked in the past. He may replace it with another habit, such as food or alcohol. In this scenario, the root problem (stress) of his disease (hypertension) has not been addressed, and the symptom was only controlled by the medicine. The likely consequence is that the hypertension will continue or progress, requiring more and more medication with time; Joe may continue to smoke off and on—and/or put on weight because he ate instead—and whatever pushes his button and creates his stress will continue to do so.
How would a “wholistic” healthcare provider look at this example differently? We may start with Joe’s diet. How much salt is in his diet? Does he have enough potassium and magnesium? How much plant-based nutrition does he get daily? We may examine Joe’s sleep patterns as sleep deprivation increases blood pressure, blood sugar and stress hormone levels. What healthy stress management skills does he have now? The healthcare provider might then work on broadening that skillset. What kind of genetic predisposition exists for this condition? We may consider supplements and herbs to support him in this process.
At the end of the day, Joe may still need some medication to help control his blood pressure, but it may be less in number and in dosage. The added benefit may be that he learns to deal with stress better, and may have been able to finally stop smoking altogether.
This type of healthcare approach is not a passive process, but rather a team approach. A doctor acts as teacher and coach to guide us in this healing journey, but only if an individual can make the necessary changes. This may not be as easy as “a pill for every ill”, but every positive step gets us closer to an authentic health and wellness that we deserve.
Connect with Yufang Lin, MD, at WCMG IntegrativeMedicine.Org or 203-920-1603. See Community Resource Guide listing, page XX.
RESOURCES: FIND THE DOCTOR FOR YOU
When we are ready to reach out, there are resources to find doctors who can help us as whole beings. Start with the ads, articles and Community Resource Guide listings in Natural Awakenings. Widen your search beyond your local area. Look online at the following organizations that either train or certify integrative, functional medicine physicians, including Institute of Functional Medicine (Functionalmedicine.org), American Board of Integrative and Holistic Medicine (ABIHM.org/Search-Doctors) and University of Arizona Center of Integrative Medicine (IntegrativeMedicine.Arizona.edu/Alumni.html).