Reflections on two years of practicing integrative medicine
After two years of seeing patients with Dignity Integrative, I have been thinking a lot about how practicing integrative medicine is different than my previous practice of 25 years in emergency medicine.
Without a doubt, the biggest difference is time. Not only time with the patient but time to think about what is going on and the best initial approach to help an individual achieve the goals they are seeking.
I love the practice of medicine and thought I helped a lot of people take one step forward when I would treat them in the emergency department. In many ways, it was a numbers game. I knew there would be a line of patients waiting to be seen and it was my job as the ER doc to help lead my team to take care of as many patients as quickly and effectively as possible. It was a never-ending job of sorting the very sick and injured from the not so sick and injured.
It was gratifying to be able to ease pain and suffering using the vast array of drugs and technology at our disposal to make people better. Sometimes that meant delivering a few simple words of reassurance that it was not a serious condition and then follow up with your doctor for further evaluation.
Principles in integrative medicine
In my current practice, it is all about pulling together a person’s life history and coming up with a plan that will help them achieve their goals and minimize their long-term risk factors. What I have also found is that integrative medicine is about helping patients to understand what truly does drive their long-term health—from the food you eat, to how you move, to getting enough rest for your mind and body.
There is a great quote by Harrington Emerson:
As to methods, there may be a million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have trouble.
While each one of my patients has unique challenges, the principles to apply to bring that person to optimal health are few. They have been known since the time of Hippocrates over 25 centuries ago.
The principles start with eating a whole food, mostly plant-based diet, and minimizing ultra-processed foods. Another guiding principle is to move daily. For some this is walking and body weight exercises, for others weight training and biking or swimming. Getting enough restorative sleep for the body and mind, another principle, is another common cause of concern for many patients.
The one thing that keeps recurring in my practice is the connection between the mind and physical ailments. The impact that physical conditions have on mental health and the reverse are a consistent theme for all of us. The concept of mental resiliency and how that impacts our daily life is understood today more than ever. I see it in my patients' concerns of anxiety, stress, difficulty sleeping and outright depression.
The structure of a holistic program to address these issues follows a straightforward process. First, identify any micronutrient issues to ensure optimal brain metabolism and functioning. Second, make sure you are consuming a variety of healthy foods in addition to supplementation to address any gaps. Next identify a mindfulness activity that can be used to balance the sympathetic (fight or flight) and parasympathetic (rest and digest) systems. Next, ask yourself: how is my tribe? That group of people with whom you travel through life is critical to longevity and optimal healthspan. As needed, support through referrals to counseling and mental health specialists is another component. Finally, how do you reflect on meaning and purpose? Some do it through prayer and others through reflections in nature, or contemplating the most important things in our life.
From 20 minutes to 3 hours
When I was in the ER, I spent an average of 20 minutes with a patient who might be there for three hours getting labs, imaging and treatments rendered.
Currently, I spend at least three hours of in-person time with a patient diving deep into their personal history and genetics as well as discussing lab results. The personalized plan itself takes another 2-3 hours to pull together and research to ensure it is the most up to date based on latest research. Part of the work is to balancing the patient’s desired outcome with minimizing long term risk factors such as cardiovascular disease, cancer, and dementia.
Personally, that is the biggest adjustment I have had to make as a doctor: the ability to step back and think more deeply about the best methods to use to help a particular individual achieve their goals is refreshing after 25 years of picking up a chart and rushing into the next room. It also carries, in many ways, a higher obligation to get it right for that particular patient.
I’ve been privileged to be a physician for over 30 years and care for tens of thousands of patients. I am also human and realize constant learning is a critical component of any profession. There is always more to learn and more tools to explore to help my patients move towards optimal health.
I am humbled by those patients that have taken the journey with me and will in the future. My commitment for the future is to continue to learn and teach the principles that will result in optimal longevity and healthspan.