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It's Complicated

It’s Complicated

An established patient revealed she had visited a naturopathic physician as she explained the changes in her supplements and prescription medicines on her treatment record. She was surprised that I did not dismiss the ideas and constructs that her naturopath promoted. She believed the changes were necessary since her worldview of health held a special place for natural healing. In her mind, any natural medicine is better than anything synthetic. The patient’s daughter is a nurse practitioner and midwife. Her daughter is the voice of reason in her life as my patient tries to navigate the propaganda of both traditional occidental orthodox allopathic medicine and naturopathy.

It took me by surprise when she remarked, “You are a functional doctor. Right? You practice functional medicine. That’s what I tell people.” I sat for a minute, thought about the functional label, and then spoke. “No. I don’t consider myself a functional medicine physician. I consider myself a general physician. One who tries to treat the all of you.”

She smiled, and replied, “Generalist seems so simple, you are complicated in a good way.” I laughed aloud. I replied, “I try to find as much basic science information to support my approach to medical treatment. I am not a big fan of clinical research. It is biased. Many times, clinical studies take on a flavor of misstating the facts to promote a medication or procedure. But all healthcare marketing overstates the value of a supplement, medications, or procedures. It’s New York City marketing.”

She asked, “What do you think about naturopathy?” I thought for a moment, “It depends. If a naturopath promotes mustard plaster and elderberry tonic for pneumonia, I would doubt their truthfulness. Mustard plaster and elderberry doesn’t cure pneumonia. People die from pneumonia. Antibiotics are miracle drugs. So, it depends. If a naturopath uses an assortment of pseudoscientific practices labeled as natural or non-invasive, I wonder about their integrity. I am also skeptical of those who promote self-healing. Old school naturopathy is based on vitalism and folk medicine. Many newer practitioners believe in more rigorous science. So, it depends.”

The patient looked at me, smiled and responded, “How do I assess them? What do I use as my barometer?” I looked down for a moment, then at her, and I replied, “Only the mongoose can smell the breath of the snake.” I smiled. She smiled. And our conversation moved on.

Humans have a strong desire to belong to something that identifies who they are and what they do. But a stronger, more vital desire is the need to be right, regardless of the circumstance. Currently, the term alternative medicine is being used to house a group of healthcare practitioners who employ an array of healing constructs that deviate from traditional medical practice. Functional medicine, integrative medicine, Chinese medicine, homeopathy, naturopathy, chiropractic medicine, orthomolecular medicine, medical intuitive, clinical nutritionist, and anthroposophical medicine are several groups that have emerged over the past twenty years. Pharmacists are beginning to promote themselves as diagnosticians, some of them desire prescriptive rights to treat people who show up at their pharmacy windows asking for advice. I am sure I left out several other groups. There are too many to count.

Practitioners who label themselves as belonging to one or more of the above groups participate in standard practice protocols designed by founders and teachers of their brand of medical practice. The same holds true for traditional allopathic physicians. There is no room for physicians to diagnose and treat each patient individually in the modern world. However, that is what I desire: to evaluate and treat patients separately since no one else is genetically or environmentally just like them. This desire assaults the lynchpin of modern medicine: medical epidemiology. Epidemiologists are the scientists that study populations of illness and assign causation. Even though statistical correlation does not allow for conclusions about the cause, epidemiologists are notorious for making bold statements concerning the origins of disease. How many times have they been wrong? Too many to count. Why do they continue to espouse theories about the source of illness? They feel empowered to do so.

The bottom line in all of this is that we as individuals want to be listened to and evaluated on a case by case basis. By taking a detailed account of each patient’s medical biography, a practitioner can uncover the common and uncommon aspects of their illnesses. Eighty-five percent of patients reveal their diagnoses through their history. A careful review of the same patient’s clinical laboratory and imaging data tends to reveal several intersecting illnesses that are manifest as one wholly ill person. No one disease accounts for every symptom in a patient’s medical history, although traditional allopathic physicians assign every symptom to an umbrella illness out of sheer convenience to the doctor. Convenience is the driving factor in one-stop shopping, fast food, and gas stations. It should not be the primary factor in diagnosing an illness. Mayo Clinic has every specialist under one roof, and they are no better at diagnosing disease than a well-educated traditional physician in a medically sophisticated healthcare system. Ignorance knows no walls.

How do I characterize my approach to medicine? I would label myself a Holonologist. A holon is something that is simultaneously a whole and a part of a greater whole. Arthur Koestler coined the word in his 1967 book entitled The Ghost in the Machine.

It sounds simple enough, but don’t be fooled; it’s complicated.

Doc

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