The Shift: from ER Doc to Integrative Health Physician

Over the last six months, I’ve had the opportunity to reflect quite a bit on our medical system and how we care for patients. I’ve gone from 10-minute average times with patients to two-hour initial evaluations. The overwhelming sense I’ve taken away from this shift is the reality that we have become a health care system that is based on treating disease instead of keeping people healthy and living their best life.


Our modern western medical system tends to reduce disease to a body area. It is referred to as the reductionist approach to healthcare. If you have heart disease you see a cardiologist. If you have severe anxiety, you see a psychiatrist. If you have chronic abdominal pain, you see a gastroenterologist. Most primary care physicians will refer you to the appropriate specialist to deal with whatever body system seems to be the source of the particular malfunction.


Unfortunately, western medicine has taken this to the extreme. Many times, when I worked on call in the ER, I remember calling a specialist for a patient and finding out they didn’t take care of that specific condition in their own specialty. The most amusing (and horrifying) one to me was calling an ophthalmologist for a patient with a serious eye issue only to be told, “I only deal with retinal issues—not the front of the eye.”


A typical situation for the reductionist approach is a patient with a malfunctioning gut due to a food allergy, a disrupted microbiome, gluten sensitivity, or celiac disease triggering symptoms like cramping, anxiety, difficulty concentrating, or memory issues. That one patient will likely get three different referrals—gastroenterology, neurology, and psychiatry—when the real cause is fixing the gut imbalance.


One of the many things which attracted me to learn more about integrative medicine was the concept of addressing issues across different body systems. In my short time practicing integrative medicine, I’ve been privileged to take care of many patients, from 13 to 66 years old, with varied complaints. The two common themes are gut issues and sleep disturbances resulting in different and varied symptoms.


In functional and integrative medicine we describe the process as getting to the root cause of disease. I know many of my MD colleagues will be rolling their eyes when they read this. Not long ago I was one of those eye-rolling doctors when I heard words like gut-brain connection, microbiome, and the root cause of disease. It wasn’t until I started practicing integrative medicine that I witnessed for myself these principles in action as a new way of caring for patients.


Unfortunately, this way of keeping patients healthy has been replaced by treating conditions (that are 80% completely preventable) with high-priced pharmaceuticals and procedures, including the greatest threats to our health and longevity like cardiovascular disease, cancer and dementia.


To start, we know that doing these five things will allow you to have better health and longevity:

  • Eat a plant heavy diet with low sugar and minimally processed foods

  • Move a minimum of 30 minutes every day

  • Do not smoke

  • Get eight hours of sleep

  • Limit alcohol to 1 to 2 drinks per day

As I tell my patients, these are simple things—but they are not easy. We are bombarded by ads on TV about the latest medication to cure arthritis, cardiovascular disease, or diabetes. I was astounded when, for the first time in years, I actually watched an evening news program and saw 50% of the ads were for pharmaceutical agents including one that promised to treat serious eczema in children. When did it become OK to target children via direct-to-consumer advertising? A true sign of our times.


Each individual patient carries with them their history. And not just their medical history. The more important parts of anyone’s life are what I call pivot points that alter the course of their health and well-being. For some this maybe a physical trauma like a serious accident. It can also be an issue from childhood that becomes embedded in our biology like mental or physical abuse. It can be a serious infection that alters our microbiome and leads to chronic gut issues or food sensitivities. It may be something as simple as taking multiple courses of antibiotics which similarly changes your internal gut ecology and causes chronic problems. Or, it may be exposure to environmental toxins like heavy metals or to certain endocrine-disrupting compounds commonly found in our homes or places of business.


In many ways, an integrative physician is a medical detective. We approach patients holistically to take a 360° view of their life to tease out what is causing their myriad symptoms. The attraction for me is familiar to what drew me to initially train in emergency medicine. Seeing every patient who walks through the door, from newborns to the elderly, regardless of who they are or where they where they were born. Emergency medicine requires making quick decisions with limited information. The luxury I have now is taking hours to address a person’s history and the ability to research and come up with the best plan to achieve optimal health.


Most importantly, as clinicians our greatest teachers are our patients. Continuing to honor that principle, by starting with the dignity of each individual, is one of the reasons I chose to call my practice Dignity Integrative Health and Wellness.


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