A recent article in The New England Journal of Medicine talked about the patient as a "great case" but not as a person. What a sad state of affairs when the thrill of a doctor's workday is to have something exciting to talk about in the form of a unique or interesting case rather than the satisfaction of helping people be happier and healthier. This got me thinking about the limited choices I have as a patient in attempting to maximize my own health. If I am not feeling well, I can call my general practitioner, who is part of a 15-doctor "factory"... wait an hour after the scheduled time of the appointment... see the doctor for 10 minutes... and then be handed the "drug du jour" that will ease my symptoms in the hopes that symptom abatement will substitute for illness diagnosis. For this, I cough up my $15 co-payment. Or, I can call my naturopathic physician (ND), who will charge me retail (insurance may not cover naturopathic care) to give me his more natural solution to my problem. Now here's the really hard part: If I mention one doctor to the other and suggest that they work together as a team, I receive big sighs about the problems with "the other guy." Would a schoolteacher and a tutor give me a hard time about working together? How about an architect and a builder? Yet, trying to get my two terrific health-care providers to work as a team leaves me with worse gastritis than when I started.
BRIDGING CONVENTIONAL AND NATUROPATHIC PERSPECTIVES
Fortunately, the times are changing -- albeit slowly. In recent years, more and more Americans have started incorporating traditional (a.k.a. naturopathic and alternative) approaches into their regular medical care, and there is an increasing amount of scientific research being done on such traditional remedies and supplements. Additionally, a new class of medical practices has been opened by some mainstream doctors who declare themselves "integrated practitioners." This is good news indeed. There's just one problem. The integrated practitioners have not necessarily received the appropriate education in certain of the traditional or naturopathic disciplines. Do I really want to receive nutritional supplements or acupuncture from a medical doctor (MD) who has attended only a weekend seminar or boned up on natural therapies via the Internet? Or would I rather receive such treatments from a licensed ND or acupuncturist who has devoted years to the study and practice of the discipline? Integrated medicine can be a great thing, capturing the best of both worlds. However, the key to success is that each practitioner does what he/she does best.
THE CRISIS IN CONVENTIONAL MEDICINE
How have we allowed ourselves to come to this place in medicine today? Among other things, the system of checks and balances seems to have broken down. Drug companies seduce MDs with lavish perks and a bounty of free samples. In return, even though they might not be the most effective or economical choices, physicians prescribe these patented drugs to patients. As government grants dwindle, cash-starved academic institutions increasingly turn to pharmaceutical giants for the bulk of their research funding, replacing the objectivity of old with new pressure on scientists to produce study results favorable to a company's products. Such all-too-cozy relationships have been allowed -- even encouraged -- to flourish among MDs, research institutions, drug companies and the FDA. Last year began with an FDA scientist presenting information to Congress about the cover-up of research linking antidepressants with increased suicidal thoughts in teens. It ended with the withdrawal of one of the most popular drugs in history, the arthritis pain pill Vioxx, and another FDA scientist warning that the agency was incapable of protecting us from further drug disasters. On the flip side, traditional medicines don't generally have large controlled studies supporting their use -- they have long-term results. Yet today's patients have been conditioned to believe that scientific evidence is good and that our doctor's are all-knowing. What then does it do to our sense of security when medical scandals occur? What are health-care consumers to do?
THE WAY OUT
As usual, Americans want to have it both ways. We want what we see as the security of conventional medicine with its official American Medical Association stamp of approval and immediate gratification remedies, along with the holistic and preventive naturopathic approach. We must, however, realize that getting what we want may require a whole new perspective on the roles of medical practitioners.
THE FUTURE OF INTEGRATED MEDICINE: A TEAM APPROACH
If integrated medicine is to work, we need to have a more coordinated system in which it can operate. The insurance industry has been very effective at training the public to use different doctors for different needs -- there's the "gatekeeper" primary care physician (a.k.a. generalist)... and then there is an array of specialists for every area of your body. It would be a natural extension for the circle of specialists to be broadened to include traditional practitioners. One of the keys, however is that training and experience in all parties is paramount, and standards in both conventional and naturopathic medicine must be equally rigorous with all physicians being licensed. Let each health-care provider do what he or she does best, and it will create the best possible outcome for the patient. Conventional medical doctors can practice conventional medicine, because that is what they are best at. In turn, when it comes to natural medicine and pharmacy, leave that to the NDs, and only they will prescribe herbal therapies and medicinal doses of dietary supplements. One day, perhaps people can use NDs as their primary care physicians and receive specialty referrals to MDs for treatment of specific illnesses and conditions, since that best leverages the MDs' disease-driven training. For me, I will be happy when all of my doctors are pleased to consult with each other, appreciating the values that different philosophies and training can bring to the treatment protocol. Then, even though insurance may require a gatekeeper, the doctors will all be working in the same garden.