During my third year of medical school, my attending admitted an elderly Korean patient with a diagnosis of pneumonia and fever. Her recovery was a slow process until I, with approval from my attending, allowed her family to bring Korean food into the hospital. Her condition improved dramatically within 24 hours and she was discharged the next day. In this case, the patient was unable to tolerate hospital foods for several days to nourish her body, which was essential to the recovery of her illness. Recognizing cultural differences was a key to successfully treating this patient.
I recently saw a 46-year-old female complaining of daily nausea and vomiting for the last three years. She was seen by two different gastroenterologists who treated her with proton pump inhibitors and H2 blockers. An EGD and colonoscopy revealed mild antral gastritis and two small hyperplastic polyps. She also had irritable bowel symptoms for the past 10 years. Her other medical diagnoses include fibromyalgia with chronic widespread pain, depression, insomnia, chronic fatigue, and intermittent migraines. The patient also recently had a DEXA scan which revealed borderline osteoporosis. Subsequently, Fosamax was prescribed. She was also taking Duloxetine (Cymbalta), Pantoprazole (Protonix), Zolpidem (Ambien), Cyclobenzaprine (Flexeril), and Amitriptyline (Elavil), as well as Eletriptan (Relpax) and Vicodin as needed. At the time of her presentation to my clinic, she was seeing eight different healthcare providers who were trying to manage her multiple symptoms.
Unfortunately, this is not a unique case in the primary care setting. In fact, this case epitomizes the modern chronic diseases we face today, which have multifactorial etiologies including unhealthy lifestyle and behaviors, toxic chemical exposure, poor postures, relationship problems, polypharmacy, daily stress, and toxic emotions. Treatment of this type of complex patient requires a comprehensive holistic approach utilizing different modalities to create optimal healing.
After establishing a good rapport with this patient, I reduced the dosages of her amitriptyline, cyclobenzaprine, duloxetine, and zolpidem and discontinued Fosamax. I then recommended an anti-inflammatory diet, with increased consumption of whole plant-based foods and avoidance of processed foods. After obtaining neurotransmitter levels and nutritional analysis, I was able to address her biochemical, hormonal, and metabolic imbalances with supplements. Her chief complaints of nausea and vomiting were treated with acupuncture and meridian wet cupping directly over conception vessels 12, 14, and 17 to redirect her Stomach Qi downward. From a traditional Chinese medicine perspective, the direct cause of vomiting was the loss of gastric homeostasis and the ascending Stomach Qi flow. Her chronic widespread pain responded well with a combination of osteopathic manipulation, wet and dry cupping, and yoga. I now see her occasionally for maintenance treatment and reemphasize the importance of stress management including acceptance of reality, positive attitude, focus on simplicity, gratefulness, love, and kindness, and living in the present.
As much as most physicians want to both treat and heal, to care for the whole person, to be patient advocates, to apply the best science, and to serve the suffering, we often find in medical school, residency training, and our practice that the skills needed to be healers and the environment needed
to execute those skills are not adequately taught, available, or funded. I consider myself fortunate to have grown up in an environment and family background which allowed me to observe holistic medicine and to experience dual cultures with an open mind.
I was exposed to traditional Chinese medicine while helping my father at his clinic during my high school years. His medical skills and passion toward healing patients inspired me to become a doctor as a young college student. During this time, I also realized that health is not merely the absence of disease; rather, it is the active pursuit of wellbeing through a combination of a balanced diet, proper exercise, adequate rest, and wise stress management. I also discovered my passion for preventive medicine, which focuses on protecting, promoting, and maintaining health and wellbeing.
During my time in medical school, I learned not only osteopathic manipulation skills but also was trained to first consider the person within the patient. I have practiced throughout my medical career with these doctrines in mind. Currently, at my Integrative Oncology clinic in Indianapolis, I see many diverse and challenging cases including cancer, auto immune diseases, mental disorders, complicated musculoskeletal disorders, and chronic degenerative conditions. With every patient I see, complicated or not, I try to apply the same basic principles of good medicine—optimizing the patient’s natural innate healing power, primum non nocere, treating the whole person, individualizing treatment, and focusing on education and prevention whenever possible.
Natural Innate Defense
The human body is equipped to effectively fight against infection, repair damaged tissue or organs, slow progression of disease process, eliminate toxins and cancer cells, and deal with external environmental influences through a number of defensive mechanisms including natural barriers, angiogenesis, stem cell regeneration, microbiome, gene modification, and immune system. Recently, we have experienced one of the worst pandemics in a century with severe acute respiratory syndrome coronavirus 2 (COVID 19), which infected millions of people and ended tens of thousands of precious lives worldwide. The majority of people who succumbed to this virus had at least one chronic condition which compromised their immune system. One of the most important roles as a physician is to recognize our body’s natural defense mechanisms and create an optimal environment in which the social, psychological, physical, spiritual, and behavioral components of healthcare can support and stimulate our innate healing capacities.
Primum Non Nocere (first, do no harm)
A widely cited 2016 Johns Hopkins study calculated that more than 250,000 U.S. deaths annually are due to medical errors. More than 1 in 10 patients are harmed in the course of their medical care and half of those injuries are preventable. All of us have made medical decisions that may have harmed our patients at some point of our medical career. The phrase, “Primum non nocere,” is one of the principle precepts of bioethics that all medical students are taught and is a fundamental principle
throughout the world. I personally believe this creed does not say doctors must never provide a clinical intervention that may benefit a patient without also triggering some degree of harm. If physicians had to live with such a code of ethics, they would be unable to provide any treatments offered in medicine. Nonetheless, “Primum non nocere” is a potent reminder that every medical, surgical, pharmacological, alternative treatment, or diagnostic decision carries the potential for harm. Patients making informed decisions about treatment options should receive balanced presentations about both the benefits and risks of treatments.
Treating the Whole Person
There are so many elements that make up who we are as people, including our biology and genetics, our behavioral and personality traits, the environment in which we live, our diets, and educational background. These characteristics have a considerable impact on our physical and emotional wellbeing, yet have been historically absent from the conversation about healthcare until recently. During the last few decades, the public has started to realize the limitations of Western medicine and want more attention paid to health and healing of the whole person. Integrative medicine, which focuses on caring for the whole human being including body, mind, spirit, and community, is steadily becoming a desirable and logical option for many people.
Integrative medicine integrates successes from both conventional and alternative medicine and is tailored to the patient’s needs using the safest, least invasive, most cost-effective approach while incorporating a holistic understanding of the individual.
Integrative medicine sets to offer:
- A gamut of traditional, complementary and alternative approaches for well-informed patients to choose from
- An approach to the whole person, including the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health
- Respect for the patient’s right to choose, while still demanding that patients live responsibly
- Assessment of the workings of multiple physiological sub-systems concurrently rather than reliance on any single markers as evidence of good health
- Genuine and intrinsic emphasis on prevention and quality of life by employing collaborative, patient-centered approach
- Relief to conventional medicine by cutting costs and sharing the burden of responsibility to keep people well
- A range of choices suited to a multi-cultural system
- Respect for illness and death as meaningful. Other defining principles of integrative medicine are that the patient and practitioner are partners in the healing process and practitioners of integrative medicine exemplify its principles and commit themselves to self-exploration and self-development.
Individualizing Treatment
Today in medicine, it is common that physicians often use a trial and error strategy until we find the treatment therapy that is most effective for our patients. With personalized medicine, these treatments can be more specifically tailored to individuals and give insight into how their body will respond to the drug and if that drug will work based on their genome. Although genomic testing is still a relatively new development, this field is rapidly growing. There have been recent scientific breakthroughs in our understanding of how a person’s unique molecular and genetic profile makes them susceptible to certain diseases. This same research is increasing our ability to predict which medical treatments will be safe and effective for each patient. Individualizing treatment is not a new concept, especially within Traditional Chinese Medicine. In TCM, patients with the same disease get different herbs and different acupuncture treatments based on their constitutions, symptoms, pulse diagnosis, socioeconomic status, and preferences. Personalized medicine will eventually reduce healthcare costs, reduce the probability of negative side effects, increase the ability to make more informed medical decisions, allow earlier prevention and intervention of disease, and result in better outcomes.
Preventive Medicine
In The Yellow Emperor’s Inner Classic, an ancient Chinese medical text, a legendary minister states, “Maintaining order rather than correcting disorder is the ultimate principle of wisdom. To cure disease after it has appeared is like digging a well when one already feels thirsty or forging weapons after the war has already begun.”
Most will agree that prevention in medicine is better than cure. Preventive medicine includes all measures which limit the progression of disease at any stage of its course. A distinction is usually made between primary prevention, in which measures are applied to prevent the occurrence of a disease, and secondary prevention, where a disease or its complications are halted or averted at any point after the onset of disease. Preventive measures include patient education, lifestyle modification, practicing good personal hygiene, keeping up with immunizations, and recommending appropriate health screening tests. As medical students and residents end their monthly rotations with me, I always remind them that an ordinary doctor treats illnesses, a superior doctor prevents disease, and an extraordinary doctor treats with compassion.
Optimal health is the primary goal of any medical practice. It is the conscious pursuit of the highest qualities of the physical, environmental, emotional, social, and spiritual aspects of the human experience, resulting in a dynamic state of being fully alive.