My focus on medicine is towards prevention and getting to the root cause. I always ask “why is this happening?” My ultimate goal is to treat that deeper cause instead of focusing on the symptoms.
After residency I was feeling the effects of exhaustion. I don’t know if I’d call it burnout, just exhaustion. I worked 80 hours a week for 5 years straight between the end of medical school and residency. I had 3 kids during that time as well. While I knew my passion was to focus on the root cause, I was way too tired to fight that battle in traditional medicine. Instead, I thought I’d find happiness with the intellectual stimulation and flexibility of hospital medicine.
Fast-forward a year, a lot of introspection and some more rest.
I was becoming jaded, irritable, and hopeless with medicine. I was beginning to experience burnout after just 1 year of hospital medicine. I knew it had to change. I dug down deep to remind myself why I went into medicine in the first place. To get to the root cause. And in the process realized THAT is why I went into medicine – to get help people get to the root cause of their medical ailments and treat the underlying problem. While band-aids can be cute, I’m not a fan. I’d rather get in there with the sutures and fix the big gaping whole in front of me.
This led me to explore how I could apply my interests in medicine. I wondered if there was a specialty I should focus on or more training I should obtain. It turns out there are many people just like me – frustrated with conventional medicine’s band-aid approach, trying to find a way to bridge all areas of health. Today’s blog post is all about these different specialties and what they can (and cannot) do for you.
Of all the areas I am going to talk about today, this is most in alignment with the way I view medicine and what we need to do as a country to reverse the chronic disease epidemic. This approach uses diet and lifestyle to prevent, treat and potentially reverse chronic disease. It is evidence-based and is board certified through the American Board of Lifestyle Medicine. It has a strong evidence base but requires buy-in from patients. It focuses on a predominantly plant-based diet. Many who practice are vegan but others (like myself) still eat meat, dairy and eggs in moderation. Over 80% of chronic disease and cancer are attributed to lifestyle choices. The downfall of this speciality is reimbursement from insurers and the need for buy-in for patients. Most clinicians are not trained in the level of motivational interviewing and behavior coaching needed for patients to be successful. A program needs many specialities (counselors, dietitians, exercise physiologists, pharmacists, etc…) and this can be tough to convince a health care system to adopt up-front.
This is a new specialty and it is a nice blend of evidence-based medicine and preventive medicine while still acknowledging the validity of conventional medicine. The only counter argument I have heard thus far is that they are advocates of a whole foods, plant based diet (WHPB – aka vegan). When you read their materials, they do not say you must be vegan, but that you should try to increase WFPB diet foods. I am not vegan and still consume these foods. The focus is on whole foods (i.e. fruits, vegetables, legumes, beans, nuts and minimally processed foods). I agree that less meat and dairy would benefit us all but do not feel it is realistic to mandate all people should be vegan or even vegetarian.
Exciting news – I am planning to sit for my Lifestyle Medicine board certification in June 2020! Shhh….. I’m secretly hoping to one day hold a leadership position within their organization!
Learn more here: https://lifestylemedicine.org/What-is-Lifestyle-Medicine
Integrative medicine is a specialty that focuses on a partnership between the physician and patient to address all areas of health and wellness. It integrates mind Body medicine, herbal medicine, lifestyle medicine, Eastern medicine/traditional medicine and conventional medicine. The aim is to treat and prevent disease with the least invasive approach possible. It emphasizes health promotion and disease prevention and emphasizes a strong evidence-based approach to care.
There are many physicians who feel integrative medicine is “woo-woo” medicine. The same providers will complain for days about their patients who are noncompliant, anxious, a little crazy and lack will-power. These same patients present with physiologic symptoms that the provider cannot fix. Instead of addressing the potential non-medical causes through other low-risk means they say there is nothing wrong with them. They balk at the idea of using an evidence-based, low-risk intervention because they think the evidence is flawed.
While there are some integrative providers who are against the use of conventional medicine, most integrate the two fields together to appropriately treat the patient without withholding necessary care. The treatments for integrative medicine are often low-cost and some are covered by insurance. The fact of the matter is that the mind is extremely powerful and can often influence disease. Not acknowledging this in conventional medicine is a huge disservice to our patients.
Learn more here: https://integrativemedicine.arizona.edu/about/definition.html
More exciting news! I am enrolled to start the Andrew Weil Integrative Medicine Fellowship in August 2020. I am beyond excited to begin to dive into the research around integrative medicine and various disease states. This is very much in alignment with my view of holistic health and disease prevention/health promotion.
Functional Medicine is focused more on the biochemical workings of the body. It looks at the body as a system and focuses on addressing the root cause of disease. If we don’t address the root cause we will never fix the problem (can I get an amen?!). Functional medicine takes genes, environment and lifestyle into account. Functional medicine providers tend to order a number of biomarker tests that have limited use in conventional medicine. Depending on the results, supplements and dietary changes are often recommended. In theory, this approach is very low risk and patients who participate in the services are often quite satisfied with the care they have received.
Some physicians are skeptical of the use of the specific biochemical tests used given their high cost and limited data. Functional medicine physicians will counter stating their data is quite robust and that many tests are affordable. I believe there is likely a middle ground here. As with Integrative Medicine, the majority of the profession practices evidence-based medicine with high integrity. Unfortunately, there are a few providers who have a conflict of interest with their tests and supplements they prescribe.
I believe the field of functional medicine is much needed and many patients are very satisfied with their care. Patients should always pause before handing over large amounts of money for supplements and testing and first ask “where’s the data?” If they feel confident in the provider and the data, they should proceed. If not, they should not feel bad about asking for an alternative approach.
Learn more here: https://www.ifm.org/functional-medicine/what-is-functional-medicine/
Mind Body medicine is focused on the integration of the mind and the body in the manifestation of disease. This field is integrated into integrative medicine as mentioned above. The focus is on the power of the mind and using techniques like meditation and mindfulness to harness the mind for our benefit. The field of mind-body medicine can span all areas of one’s life.
Mind-body medicine has traditionally been thought about as an approach for stress management, for which it is quite effective. But this field is applicable to all people, even those who don’t feel stressed. Many studies have shown the benefits of a positive attitude and gratitude practice for extending the quality and quantity of life. People with more positive outlooks on the world and gratitude tend to do better than those who are pessimistic and bitter. BONUS – this approach does not include ingesting anything, is free to practice, can be done anywhere by anyone and has no known harms.
Learn more here: https://cmbm.org/trainings/mind-body-medicine/
This is a HUGE field that spans from immunizations, to injury prevention to chronic disease prevention. It takes a global approach at a population level and tends to focus on system level changes to tackle these big issues. This is a rigorously researched field that uses epidemiology, biostatistics and systems engineering to modify behaviors and ultimately prevent disease. It has three sub-fields which include public health and general preventive medicine, occupational medicine and aerospace medicine.
My jam is in the public health and general preventive medicine. The environments in which we live dictate the decisions we make every.single.day. Think about it – if the stairs are bright and located in the center of a building you are more apt to take them. If they are in a dark corner with a closed door you either won’t even notice them, think they are just for employees or wonder if you’ll get jumped if you go up them alone. These individuals take a big-scale approach and have to deal with A LOT of politics when deciding which issues to tackle. Public health has HUGE opportunities to change the trajectory of our country’s health.
Remember, we can use this approach in our own little microenvironments too. No need to wait for someone else to do it for us. When we craft our environment (which I’ve posted about before here) we can set our lives up so the positive, desired choice is the easy choice.
Learn more here: https://www.acpm.org/about-acpm/what-is-preventive-medicine/
Complementary and Alternative Medicine
This field is extremely broad and touches on 2 general fields – complementary medicine and alternative medicine. I don’t think these two should share a field.
Complementary medicine is just how it sounds. It complements conventional medicine. It can include any of the fields in this post. I won’t beat a dead horse on this one.
Alternative medicine is just how it sounds as well. It focuses only on alternatives to conventional medicine. This field gets very questionable very quickly. This is the world of naturopathic and anti-vax and is not rooted in evidence. It is a world where anyone can be a provider and the years of rigorous study and training that physicians partake in are discredited. This field has grown in popularity over the years and takes an extreme approach against conventional medicine. You can think of alternative and conventional medicine as two divided parties, much like our political system. The two sides feel very strongly about their beliefs and values and feel the other is the ultimate threat. The truth of the matter is that most Americans want a middle ground. Something that is evidence based and also acknowledges that we are more than just a bunch of cells functioning as a machine.
CAM is a huge field that encompasses everything in this post and more. Over 83 million adults (⅓ of the population!) spent a total of $33.9 billion dollars on CAM in 2007 (the most recent data release by NIH that you can read here). You can read more about a wide range of organizations that fall under CAM here: https://www.amsa.org/advocacy/action-committees/twp/im-resource/
Since it’s huge, I can’t just send you to one main organization to learn more. Here are a few reputable sites to check out: http://guides.dml.georgetown.edu/cam/websites
There are many safe and effective forms of CAM but the adoption of it in conventional medicine has been jaded by a few bad apples (similar to what I mentioned above in the functional medicine part).
Do you use any of these complementary and alternative medicine modalities? Tell us about your experience!