If you have a chronic health condition—such as diabetes, allergies, asthma, depression, obesity, or chronic pain syndrome—chances are you agree with some of the statements above, and feel frustrated by the lack of help you're getting from your primary care physician. You're probably disappointed with your progress and not hopeful about your future health prospects.
Here's something that might surprise you: We doctors also feel dissatisfied with the care our patients receive, and we're equally disappointed with the slow pace of our patients' improvement and the quality of our doctor-patient relationships.
Each year in the United States, $1.7 trillion is spent on health care, yet America's healthcare system ranks 37th in the world. A 2002 Newsweek article reported that Americans make more visits to non-conventional healers (some 600 million a year) than to MDs, and spend more money out-of-pocket to do so—about $30 billion a year by recent estimates. Yet statistics show that, even with all this spending and so many treatment choices, as a nation we aren't getting any healthier. Is there a better way to achieve wellness?
The way our system works, patients use illness as a "ticket" to see their doctor, and doctors often see the illness rather than the patient. This is known as the problem-oriented approach. At your appointment, your doctor asks what the problem is, you discuss the history of the medical problem, and then the doctor addresses the problem by recommending blood tests, prescribing medications, or referring you to a specialist, who will ask you the same set of questions.
Kingston chiropractor Anthony Blisko, DC, agrees that the current medical paradigm is based on an old "needs perception" that people have had for thousands of years, "that something from the outside—a pill, potion, or lotion—would cure their ills. And everything is based on symptoms and symptom relief. The problem with that is that we've lost sight of the cause/effect relationship to wellness, and the fact that wellness is an internally derived process, not external." According to Dr. Blisko, medical doctors and the whole pharmaceutical industry are part of a culture of symptom care.
Amy Novatt, MD, who practices gynecology in Rhinebeck and Kingston, says doctors often see the mind and body as two separate components of the human experience. "To interview patients and only discuss their medical history in terms of the 'problem' doesn't make sense to me. So often what is going on in the somatic, or body, arena is a reflection of what's going on in the emotional arena. So by asking questions such as how things are in the family, how they enjoy their work, what's their level of stress, are they sleeping at night—it's my attempt to go under the surface of where they are emotionally."
As healthcare practitioners, we agree that what we need is a better, more positive approach to wellness, a solution-based model that fundamentally shifts the focus from illness, disease, and problems to wellness, hope, and healing.
Imagine a scenario in which your primary-care physician asks you what good health means to you, what your long-term health goals are, and how your emotional state, nutrition, and habits might be playing a role in how you're feeling. Imagine a physician who asks you what kinds of complementary treatments you'd like to try, in addition to the conventional medical ones recommended. Just imagine a doctor who consults with, say, your acupuncturist and your yoga instructor on a regular basis to assess how well you are achieving your health goals. Finally, imagine a network of multidisciplinary healthcare workers and healers working in concert to support your wellness objectives.
The scenario of medical doctors embracing alternative medicine and collaborating with alternative practitioners is not fiction or wishful thinking. It happens every day in Dr. Novatt's practice, for example. "I have a cohort of people who do homeopathy and acupuncture and massage therapy and uterine massage, et cetera," she explains. "These are people I really know and trust and have worked with. And I'm always grateful, because allopathic medicine has real dead ends. To say 'I can't help you and nobody else can' is an arrogance I've never assumed as an MD, because there are people I've seen healed these other ways, and I'm so grateful and glad for them."
Dr. Blisko would welcome more proactive involvement from MDs in referring patients to complementary healthcare practitioners than he presently sees. "The way MDs handle chiropractic now is that they wait for their patients to discover chiropractic on their own, and the patient comes in and reports that they either are going and getting benefit, or that they'd like to go because they hear that they can." This is instead of the doctor having directed the process. Moreover, there's little communication between MDs and chiropractors who are treating the same patient. "I'd love nothing more than to get together with all of the doctors in the community, individually and together, and talk to them about how we can all work to make this happen for our patients."
Five years ago in California, a group of physicians of which I am a part started a solution-based healthcare movement called Appreciative Medicine, which is redefining the patient-doctor dynamic and replacing the problem-oriented approach to patient health. Using the Appreciative Medicine model, patients—particularly those with chronic health conditions—are now actually meeting and exceeding their health expectations for the first time in their lives. And physicians are recapturing the enthusiasm we once had for the healing arts back in medical school.
The Appreciative Medicine model helps bridge the gap between patient and doctor, and between every other type of health practitioner, conventional or alternative. With this approach, the patient designs an individualized optimal health plan, with her primary care physician taking the role of resource person, guide, and partner, who coordinates treatments from various healthcare disciplines that work synergistically to help the patient meet her health goals.
Take, for example, a patient of mine named Genevieve. She was a 44-year-old, five-foot woman whose weight had ballooned to 211 pounds. By the time she came to see me, she had tried everything to regain control of her weight and was suffering from serious obesity-related health problems, severe depression, and extreme social isolation. Together, we focused on solutions, options, and possibilities rather than on her problems. Genevieve took responsibility for her health for the first time by designing, with my guidance, an individualized health care plan that would address many facets of her health issues. Under my medical supervision, she used yoga, herbs, chiropractic, a women's support group, and exercise, and gradually weaned herself off antidepressants. Genevieve lost weight and regained excellent health and a new attitude toward life. She got back in touch with her spiritual roots, has become an avid skier, and is filled with optimism and hope.
Patients like Genevieve are finding a new way to navigate the daunting maze of medical options, with the aid of physicians who are willing to be open-minded about the many complementary treatments out there that work synergistically with conventional medicine.
Julie Evans, a massage therapist based in Zena, calls this doctor-patient role shift "mentoring," as opposed to "doctoring." She explains: "Instead of the doctor as the expert, the doctor as the mentor is the collaborator. It's all about collaboration." Perceiving a need in the healthcare system, Evans created a role for herself that serves to further bridge the doctor-patient gap, as well as the chasm between conventional and alternative medicine. Calling herself a "health and wellness consultant," Evans advocates for people who need an ally when seeing medical doctors who may be averse to or ignorant of complementary medical options. "I work with a gentleman who has MS [multiple sclerosis]. His doctor is willing to allow me to slide into their relationship as an advocate for my friend because he doesn't know what questions to ask and what alternatives are available."
Because Appreciative Medicine involves a number of practitioners and asks the patient to take more responsibility than he or she would in the traditional medical model, structured journaling is, in my view, a central element of the Appreciative Medicine model. It keeps both patient and primary physician in touch with the emotional components of the patient's healing journey, and serves as a comprehensive medical record in the patient's possession, complete with test results, medical history, and progress reports. My patients complete a basic workbook to help them identify goals, evaluate different treatment modalities, and journal about aspects of their lives and day-to-day circumstances that impact their healing journey. This gives the physician insight into the patient. The therapeutic journal is also instrumental in changing our focus so we dwell on healing strategies.
A beautiful example is my patient Joseph, who came under my care after he was diagnosed with an aortic aneurysm in the emergency room, and required immediate surgery. Shortly after rehabilitation, Joseph came to see me and confessed that he had almost always suppressed his emotions, especially when feeling sad and depressed. Under my guidance, Joseph became profoundly involved in his healing journey through a structured journaling process that helped me monitor his emotional state, advise him on his long-term health goals, and keep up with how he viewed his progress. I recommended a nutritionist, who helped him lose almost 100 pounds and decrease his cholesterol ratios by greater than 250 percent. He became a vegan, took up meditating, and has made spending time with his grandchildren his main priority. Through a combination of Western medicine and complementary modalities, Joseph is a changed man.
A remarkable thing happens when patients and doctors form a true partnership: Patients start to heal. Appreciative Medicine asks patients to take responsibility for their own health and wellness, instead of passively handing over problems to doctors. With this approach, the focus shifts from patients depending on doctors, to doctors supporting patients. Numerous studies have shown that patients who are proactively involved with their healing process get better more quickly than passive patients. Appreciative Medicine also saves money, as patients need fewer medications, tests become focused, and treatments are not redundant and are less invasive.
There are other benefits of Appreciative Medicine's solution-based approach to wellness. It gets doctors and patients alike to focus on prevention and lifestyle. The National Institutes of Health report that nearly half of all deaths are associated with lifestyle and behavior choices, yet this nation spends less than five percent of its total healthcare dollar on health promotion. In addition, Appreciative Medicine addresses multiple aspects of a health condition at once. Scientific studies agree that patients enjoy significantly better rates of healing when emotional and spiritual components of health are integrated into treatment plans.
Modern medicine has made amazing strides when it comes to sophisticated diagnostic tests, procedures, and pharmaceuticals that can stabilize and save lives. But for chronic health conditions, neither conventional medicine nor alternative medicine alone gets a passing grade. What's missing are four fundamental changes that still need to be made in the wider healthcare community: (1) Patients and their doctors need to build trust through creative dialogue; (2) Physicians and complementary health practitioners must start cooperating; (3) Patients need to take responsibility for their health; and (4) Patients and physicians need to change their focus from a problem-oriented approach to creative, individualized solutions that maximize our own innate healing systems. As more doctors and patients learn about and shift to solution-based, patient-centered approaches like the Appreciative Medicine model, the prospects for positive change in our healthcare culture look promising.