I’m a holistic doctor

Ok, I know I’ve been digging up old posts lately, but it’s because I love them so darn much. Thanks for your indulgence. –PalMD

That’s apparently all it takes to be a “Holistic” practitioner. I’ve been searching online for their medical board, or for any consistent definition of “holistic medicine”. What’s involved? Where do I get my training? Is training standardized, and based on good standards of evidence?

According to the American Holistic Medical Association:

Holistic Medicine is the art and science of healing that addresses care of the whole person – body, mind, and spirit. The practice of holistic medicine integrates conventional and complementary therapies to promote optimal health and to prevent and treat disease by addressing contributing factors.

Sounds good; art and science of caring for the whole person…sound a lot like, well, non-“holistic” medicine. As to integrating “conventional and complementary therapies”, I’m not sure what that means (but I hope they will tell me). As I’ve written earlier\, there is that which works, and that which does not.

In practice this means that every person is seen as a unique individual, rather than an example of a particular disease.

Every person who comes to see me is, by definition, a person and a patient, but not simply one or the other. They are also both a “unique individual” and “an example of a particular disease”. To ignore the disease part leaves the “medicine” out of “holistic medicine”.

Disease is understood to be the result of physical, emotional, spiritual, social and environmental imbalance. Healing therefore takes place naturally when these aspects of life are brought into proper balance. The role of the practitioner is as guide, mentor and role model, the patient must do the work – changing lifestyel, beliefs and old habits in order to facilitate healing. All appropriate methods may be used from medication to meditation.

“Disease is understood to the be the result of…imbalance.” That’s nice. Warm. Pretty. And wrong. Disease is not understood that way, nor should it be. We know the pathophysiology of most disease, and “imbalance” isn’t part of it. Let’s take heart attacks. They arise out of complex set of factors: genetics, blood pressure, smoking, diabetes, stress, inflammation, cholesterol. We even know how to interrupt the march toward a first or repeated heart attack. To top it off, modern medicine knows how to effectively treat a heart attack.

To treat the the patient “holistically”, I must convince the patient that I understand these factors, and that they must work with me to change them—quitting smoking, changing diet, exercise, medications—all these things require the patient to trust in me and my judgement. Some of these modalities are more effective than others. Quitting smoking is more important that meditation (unless meditation helps you quit smoking). In a large percentage of people, diet and exercise cannot achieve the proven goals for blood pressure, cholesterol, and diabetic control. These folks need medicines. It’s not a failure, it’s science.

The whole thing is quite vague. All good doctors take into account “physical, emotional, spiritual, social, and environmental” factors affecting their patients. We already have a label for that—it’s “physician”.

If holistic medicine is to differentiate itself from “mainstream” medicine in a positive way, it will need to define itself very carefully. What are the goals? How do we measure achievement of these goals? Are we fumbling around in the dark trying to “achieve balance” or actually going about treating patients in a compassionate, evidence-based way?

Holistic medicine exists as a concept, perhaps, for two reasons. First, doctors are seen as lacking compassion for the whole person (actually a fallacy–most people like their doctors, but never mind that). Second, many doctors and patients wish to express this compassion through routes that are not proven, but seem nice, like “alternative therapies”.

We need to continue to train our doctors, especially our primary care physicians, to use knowledge wisely, and to exercise compassion.

That’s why I’m hanging out my shingle. I am a holistic doctor.