I bill myself as a “holistically minded” doctor. What I mean by this is not that I have any formal training in “holistic” care – I haven’t, for example, done a course in functional medicine, or in acupuncture. Rather, I have always had the bias that the human body is a wondrous and complex machine about which even we 21st century doctors know very little, and that many health problems can be either averted or healed if the body is simply given the optimal environment and left to do its own thing.
When I use the term “holistic”, what I really mean is the broadest and most comprehensive approach to healthcare that can be scientifically justified with the knowledge available to me as a physician at this moment in history. So that does absolutely include “traditional” medical treatments such as medications and procedures when they are appropriate. But it first emphasizes the stuff that EVERYONE KNOWS works to promote optimal health: Good nutrition. Good sleep. Exercise. Stress management.
And it also includes things that are less well known but that are increasingly supported by scientific research, such as optimizing circadian rhythms within the body, using red light therapy (aka photobiomodulation), the calculated use of temperature treatments (both cold exposure and sauna therapy have a growing body of evidence for positive health effects), certain supplements, and so on.
It might seem obvious why many patients would be interested in an approach like this – in which medication is used as sparingly as possible and the focus is more about optimizing your health – but I think it’s worthwhile to highlight just a few points:
A holistic approach gives me a fuller set of tools to help patients prevent or treat chronic disease
Imagine for a moment that you were the President of the United States just one day after our entry into the second world war. Now imagine that your advisers came to you and told you the following: “Mr. President, we are now at war with both Japan and Germany. Our advice is that America should build up a great army, and while we’re at it, let’s expand our navy a bit. We don’t recommend that we grow the Marines corps, develop our air power, build up our network of spies, work on strengthening our relationships with our allies, increase our factory production at home, or focus on developing newer and better weapons. How does that strike you for a plan?”
This above advice is obviously absurd. Winning a world war required us to do all of the above things, and more besides. And yet, this is a good metaphor for how so much chronic disease is treated in this country. “Mr. Smith, you’ve been diagnosed with type 2 diabetes. I’d like to give you some pills for this, and while you’re at it, it would be great if you could try to lose a few pounds. We’re not going to really discuss HOW to lose those few pounds. Nor how research has shown that the timing of your meals throughout the day can help lower your blood sugar. Nor some clinically proven supplements. Nor work on your sleep, even though it’s a well established and significant factor in blood sugar control. Nor discuss how stress reduction techniques like breathwork and meditation can also be very helpful in controlling your blood sugar”
As your doctor, I want to have the fullest set of tools available to me to help you out. Why limit ourselves to prescriptions at the pharmacy, when these are just one useful tool among many?
A holistic approach gives me at least a chance to help those who are otherwise written off by the system
According to some studies, more than 50% of the problems brought to medical attention are never solved. Oftentimes this is no big deal – a patient might come for some fatigue of a few weeks duration for example, get a workup that is normal, and then the symptoms go away as mysteriously as they appeared. In such cases, no major harm has been done to the patient, and in fact a bit of reassurance and “tincture of time” was indeed probably the best treatment option. But unfortunately, a large body of patients out there have chronic, persistent, complaints that nobody can figure out.
There’s an endless list of chronic diagnoses for which conventional medicine really has little specific treatment to offer. Chronic Fatigue syndrome. Chronic/post-Lyme disease syndrome. Irritable bowel syndrome. Fibromyalgia. Interstitial cystitis. And the list goes on.
Then there are the patients whose symptoms don’t even fit a known diagnosis, such as the person with persistent “brain fog,” or the person who can’t lose weight even though they seem to be doing everything right.
The typical medical approach to such patients is to do a workup to rule out anything sinister, reassure the patient that they have no serious or life-threatening disease, and then to more or less throw up our hands and surrender. Sometimes this is done kindly (“I’m sorry I don’t have a better answer for you,”) and sometimes less so (“perhaps you should see a psychiatrist…”)
I’m not a magician, and I certainly am not able to solve every problem that comes to me either. But I have found over the years that many problems that lack a clear medical diagnosis do get better – at least somewhat – once a patient starts fixing underlying lifestyle issues such as their sleep, their circadian rhythm, their diet, etc. Taking a holistic approach offers me at least a chance to better help such patients. And even when a problem can’t ultimately be solved, I think most patients feel better knowing that at least somebody took their concerns seriously and took more than just a superficial shot at trying to help them.
A holistic approach helps to restore trust to the doctor-patient relationship
The COVID pandemic changed society in so many ways. One way that I feel is underappreciated is how much it eroded trust in the medical profession. Whether politically on the left, right, or in between, many people came to feel that a lot of policy decisions and medical advice might be driven by political narratives and business interests, rather than objective science. Whereas most people used to assume that if a doctor recommended a particular treatment to them it was because the doctor felt that treatment to be in their best interest, increasingly people have become skeptical of medical advice. They wonder if their doctor’s decisions might be driven by the mandates of the insurers, the pharmaceutical companies, or the government, or if perhaps the doctor themself has been kept in the dark about certain important issues by these greater powers.
I personally believe that much of that skepticism is well justified. But it’s also a problem, because trust is at the core of a good doctor-patient relationship, and sometimes a medical test, procedure, or medication really is what’s best for a patient.
By emphasizing a more natural and holistic approach to care, I believe that I can better earn my patient’s trust, so that in those circumstances where I truly believe a “conventional” medical treatment will benefit them, they can rest assured that that belief is coming from an objective place of sincerity, independent from any outside influence.
After all, as a direct primary care doctor, I work directly for my patients and am not beholden to any particular mandates from the insurers or regulators. And as a holistically minded MD, my patients can be confident that if I know of a good way to treat their problems without a medical intervention, I will offer it to them.
