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 holistic medicine.
In a way, I agree with the imbalance thing. Why does a man have a heart attack? Well, it’s not just from finding out his teenage daughter is pregnant, though it could have been the last straw. We’ll say genetics is another… usually by itself, it doesn’t cause MI’s. This guy smokes. Why does he smoke? Did he start because it was cool? Did he continue and increase it to two packs a day because it’s still cool or because nicotine calms him down?
Why does he need to calm down? Well, he’s stressed out. Why is he stressed out? It’s not like you can tell someone to decrease their stress and not expect a raised eyebrow. What is making him so stressed? Maybe it’s money. Maybe he just needs someone to help him make a budget or learn how to manage it better.
Did stress make him start over-eating and watch TV all afternoon? It is plausible. It’s an escape from the real world and McDonald’s fries are so much better when you’re watching Cops.
Do you see what I mean? That’s what holistic is. It’s not some fancy definition with meaningless words. Heart attacks aren’t caused by physical problems only. There’s other stuff going on. Telling a patient to start exercising, quit smoking, and lower their stress is not going to stop them from having another heart attack. We also can’t do a detailed history of their entire life and figure out that one little thing that set the snowball in motion, either. It’s not that we’re not willing. We just don’t have the time.
They have to do that themselves and with some help from their families or a counselor at least. But they have to figure out that something is wrong… and sometimes, a heart attack is not enough to make them realize it.
I think consumers of health care are drawn to the “holistic” because it implies that the practitioner will pay attention to their whole self. Having worked in managed care settings that pressure docs to see patients for an average of 7 minutes, I can definitely say that there is not enough time in modern managed care to do much caring for the “whole self.” “Holistic Medicine” is a predictable reaction that uses the touchy feely woo to differentiate from the meat grinder mechanistics of managed care. (Yes I am bitter about the state of modern medicine…) If medicine was more about health than about stretching managed care or insurance dollars, there would be no need for a “holistic” alternative.
Real holistic doctors do ask questions about lifestyle, diet, relationships, the works. It’s better than asking what symptoms I have: fatigue, fever, diarrhea…all three are symptoms of over some 2000 different ailments, right?
Great post. The biggest problem with all the “holistic” jabberish is that people doens’t have enough information about how science works. If there’s not a base about the foundation of science, is gonna be difficult to discriminate about what knowledge has a real background or is just a big amount of crap.
Sorry, never answered Charz’s post above, and I should.
I don’t know what “real” holistic doctors do, since there is no standard.
As a real doctor myself, I need to know your symptoms…yes,they can mean lots of different problems, and yes, they are only part of the picture.
That’s why I went to medical school, residency, and continue to learn from journals, my colleagues and my patients.
That’s the point. Read Jerome Groopman’s book “How Doctors Think”. He has a chapter on your point—how the primary care doctor deals with the fact that many symptoms are common and meaningless when taken alone.