As medical practitioners, we are trained to fight disease, becoming familiar with all the metaphors of war, victory, failure, and the Cartesian views of deductive reasoning and mind being separate from body. Through said reasoning, we come to believe in a passive view of health; that health is an absence of something, in this case dis-ease. From that vantage point, it is no wonder medical practitioners have such high rates of burnout, fighting a never-ending uphill battle against bacteria, microbes, viruses and the like in order to help our patients reach a nebulous state of grace in body and mind.
Our changing medical terrain is showing us that it is time we redefined the word “health.”
Modern medicine excels at treating acute conditions, but the most frequently treated health issues are not acute in nature. A review compiled by an electronic health records software company of over 7 million primary care providers in early 2011 showed that almost all of the top 25 reasons why people were seeking medical care were for symptoms related to chronic conditions. The most common conditions were hypertension, hyperlipidemia, and diabetes, with back pain, anxiety, and obesity following closely behind (so to speak). These patients form the financial backbone of most primary care providers’ practices, and they are not happy with the way they’re being treated. I echo their dissatisfaction with modern medicine from my anecdotal observation as an “alternative” practitioner, and the research backs this up.
New studies by Survey Sampling International and The Research Intelligence Group show that two-thirds of patients around the world feel disrespected by their physicians. Unclear communication is a prime reason for patients’ dissatisfaction. About a quarter of patients globally complain that physicians don’t answer questions, don’t involve them in treatment decisions and use medical terms with no explanation. This appears to be a direct outcome of doctors not spending enough time with patients (44%).
These facts alone may account for patients seeking out practitioners of various complementary and alternative medical modalities (CAM). A study in the Journal of the American Medical Association found that the majority of alternative medicine users appear to be doing so largely because “they find these healthcare alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.” In particular, subjects reported a holistic orientation to health, a transformational experience that changed their worldview.
Whether or not you “believe” in acupuncture, chiropractic, naturopathy, homeopathy, or any of the myriad alternative medical options people are may turn to, is immaterial. The fact is that patients are increasingly taking matters into their own hands and seeking out alternative solutions. The most recent study of CAM usage I could find was in the New England Journal of Medicine (NEJM) from 1997. It showed that the number of Americans using an alternative therapy rose from 33% in 1990 to 42% in 1997, and some research estimates that the number may be as high as 70% today. The NEJM study also found that, in 1997, Americans spent more than $27 billion on these therapies, exceeding out-of-pocket spending for all U.S. hospitalizations, and that the number of patient visits to CAM providers exceeded those to primary care physicians.
The bottom line is that people would have no reason to seek out alternative medical options if modern medicine was solving for their issues, or if patients felt their treatment was congruent with their beliefs and expectations. The reason I’m in business is not only because modern medicine is largely ineffective for a large number of patients with chronic medical conditions; it is because they are not getting the attention they feel they deserve from their primary care providers. They don’t feel they are being “heard” by their doctors.
I often agree that alternative medicine may not work any better than modern western medicine for many of the chronic conditions that we attempt to treat. So what can we do for the massive number of patients who come to us seeking relief from chronic, unresolved issues that may have no effective treatment?
We must treat what we are able, and at the same time reorient our patients, reframe their issues such that a potential life living with their condition is not so much a dark place to end up as an enlightening new opportunity. I say this not to be condescending, not to “give up” on medicine as such, but because it is the right thing to do as a health care professional and it may actually be more in line with our patients’ expectations. And what is the alternative, really? To send them back out the door, heavier in spirit, lighter in wallet, and alone in their condition?
Our current view of health as the absence of disease is not sustainable, and the fact that so many people are seeking alternative views and taking matters into their own hands is only further evidence that our fundamental understanding of what health is needs to change. In order to be effective, in medicine or anything else, our goals need to be framed in a way where we move toward an outcome rather than away from one. Toward an understanding of health rather than away from disease. In that spirit, we may choose to define health as a dynamic state where flexibility is the cornerstone. Health may simply be the flexibility to adapt to circumstances and to continue to have an acceptable quality of life. Such a definition changes where we as healthcare practitioners fit into the lives of our patients. We become much more the arbiters of helpful information in our patients’ journey toward a continued quality of life than the center of their hope that they can get rid of something.
Jason Luban is a licensed acupuncturist and teaches continuing education courses on non-verbal medical communication at Practice Rapport.
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