It’s been two and a half months since the publication of my book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, and I’m exhilarated and exhausted. Since January, I have been traveling around the country to talk about why it’s so important for doctors to listen and how patient empowerment can transform medical care. The reception to these messages has been excellent, and I’m very grateful to my colleagues around the country for inviting me to speak.
Having given dozens of talks on When Doctors Don’t Listen,
I can predict most audience questions. Invariably, someone will ask about
medical malpractice: aren’t doctors just protecting themselves by ordering more
tests? (My response: the primary cause of malpractice is lack of communication,
and tests don’t replace communication.) There will be another question about
how the medical profession has reacted to the book. (My response: quite
well—who wants to admit that they’re the doctor who doesn’t listen?)
There is one more question
that is consistently raised, from Boston to Los Angeles to St. Louis to
Cincinnati, one that I wouldn’t have predicted. What do you think about
integrative medicine, someone will ask. Why don’t doctors advise patients on
other options beyond pills and CT scans? What about treating the whole person,
and preventing disease from occurring in the first place?
This question surprised
me, as did my lack of knowledge of how little I actually knew about integrative
medicine. Even though I was born in China, a country steeped in combining Western practice
with Eastern philosophies, my medical training has been exclusively from
conventional Western institutions. I cannot recall one course during medical
school or residency that focused on complementary medicine or holistic care, or
anything other than the disease-oriented model of Western medical care.
In fact, it wasn’t until
I was asked this question during my book tour that I began looking into the
concept of integrative medicine. I learned that integrative medicine is not
synonymous with complementary and alternative medicine, but rather is
“healing-oriented
medicine that takes account of the whole person (body, mind, and spirit),
including all aspects of lifestyle. It emphasizes the therapeutic relationship
and makes use of all appropriate therapies, both conventional and alternative.”
This sounds like the
type of medicine that all doctors should all strive to practice, and all
patients strive to receive! In the words of physician and noted humanist Dr. Abraham Verghese, integrative medicine isn’t “wedded
to a particular dogma, Western or Eastern, only to the get-the-patient-better
philosophy.” Indeed, millions of patients in the U.S. and around the world embrace
this holistic medical practice, and the pioneers of integrative medicine, such
as Drs. Andrew Weil, Bernie Siegel, Deepak Chopra, and Dean Ornish, are widely
revered.
Yet, from my own experience, I know that integrative
medicine is not something we are teaching future doctors. I can also see that, based
the persistence of this one question asked around the country, patients are
hungry for knowledge on what they can do that goes beyond our Western concepts
of disease. Instead of prescribing a pill for blood pressure and cholesterol,
what is an exercise regimen that I can try first? Is there an alternative to
surgery for my back pain, including yoga and massage? How can doctors coordinate
my care with more “traditional” healthcare providers like nutritionists and
physical therapists, as well as more “alternative” providers such as
acupuncturists and naturopaths? Health is not just about illness, but about
prevention and maintaining wellness—how can patients partner in all aspects of
their health?
I am in the midst of writing a
series on medical errors that occur in the hospitals. We
know that conventional Western medicine can save lives, but we also know that
medical error happens
far too frequently. We also know that 30% of
all tests and treatments are unnecessary. Patients are seeking an alternative
approach to health. They want information about prevention and natural
approaches to health. They want to talk to their doctors about it, but are finding
that their doctors—like me—know precious little about integrative care.
During my research
in China last summer, I spent some time observing the practitioners
of Traditional Chinese Medicine, who were adept at integrative medicine.
Unfortunately, this, and my brief but educational visit to Emperor’s
College, an oriental medical school in California, is the extent of
my interaction and knowledge of integrative medicine.
Now that the book tour is coming to a close, I am looking to
learn more about the surprising topic that has emerged and to think more about
how to educate conventionally trained doctors like myself to practice a
holistic approach to patient care. Please reply with your suggestions for
resources. Include links. Recommend books. Suggest places for me to visit, virtually and in person. Contribute your experiences. I’ll
post more from my journey in this blog.
10 comments:
Although I wasn't able to see you at Emperors this month (I was downstairs supervising in the clinic) I know the students really appreciated your talk. I would say 30% of what we see in the clinic are patients dealing with the side effects of their Western meds. As one example, an otherwise 70 year old woman with high blood pressure is on 4 medications that have left her a virtual zombie where she can't drive nor even think coherently. As "alternative" practitioners we try to help but often their MD appointment is a month away or longer and meanwhile the patient suffers.
http://www.cewm.med.ucla.edu/
The fellowship curriculum includes the following key components:
Extensive clinical training in the CEWM referral/continuity clinic
Participation in teaching of trainees rotating through CEWM
Regular academic conferences on a broad range of relevant topics as well as interesting and challenging case discussions
Involvement in research, education and publishing projects in collaboration with faculty and peers at CEWM and the UCLA Division of General Internal Medicine
Participation in lectures, academic conferences, and hands-on workshops conducted by experts found locally, nationally and internationally
The UCLA Center for East-West Medicine (CEWM) is offering a new fellowship in East-West Primary Care. The fellowship is designed for physicians who have completed an ACGME-accredited residency program in internal medicine. This two-year program will help meet the demand for high-level generalists that practice integrative medicine. The integrative East-West medicine model as practiced at the CEWM is a person-centered approach operating within the biopsychosocial framework with a strong emphasis on self-care to help solve clinical problems while incorporating many diagnostic approaches and therapeutic modalities originating from traditional Chinese medicine.
East-West intergrative dentistry said... March 29, 2013 at 1:19 PM
The Ucla East-west medical center has trainning for MDs, residents, med-students and dentists on integrative medicine, with the whole person approach.
MED 180: Integrative East-West Medicine for Health and Wellness
This course is designed to provide an overarching introduction to integrative healthcare, particularly the therapeutic approaches originated from traditional Chinese medicine (TCM). Students will learn (1) the theoretical underpinnings of integrative medicine and TCM, (2) the management of personal well-being through experiential learning of various therapeutic modalities, and (3) current clinical applications of integrative medicine from practitioners and patients. Topics include: integrative East-West Medicine and its role in prevention and health cultivation; herbs and nutritional supplements; pain management using acupuncture, acupressure, massage and other self-help techniques; as well as maintaining a healthy immune system and reducing inflammation and stress. Hands-on practice and clinical site visits will be incorporated.
Leana,I met you in French class in St. Louis several years ago and am impressed by your medical career, writing, etc. You are wanting to learn more about integrative medicine; my suggestion is that you contact a St. Louis doctor, Dr. Varsh Rathod, when you come into St. Louis. She did her residency at Washington University but has since gone more into holistic medicine. She is extremely intelligent and helpful, and she listens very well. She prefers now to recommend supplements and other therapies rather than traditional medications.
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