Is treating the disease the same as treating the patient?
Healthcare of the body, mind and spirit has several components. Each component is driven by the primal purpose of the science and art of medicine defined by what Hippocrates said over 2,000 years ago.
A popular model of doctor-patient relationship is one where the patient comes to see a doctor because of an acute or chronic problem. When the patient presents herself to the doctor, the doctor is trained to focus on the chief complaint and work up the patient from that point on. Although a typical patient history includes all aspects of the patient’s past and present ailments, in fact the doctor-patient encounter is seldom complete when the chief complaint is adequately addressed. One has to look into possible underlying causes for the chief complaint, have a reasonable follow up for the underlying causes if any, and take measures to prevent recurrence and reduce risk factors.
A disease often affects several people associated with a patient. The impact of the disease on these others who either care for or are associated with the patient can, in turn, have a deleterious effect on the patient thereby exacerbating or increasing the burden of the disease to all concerned. Consider for example, a patient who presents with an acute upper respiratory tract bacterial infection. The doctor treats the acute illness with appropriate medications and the patient’s illness gets better in a few days. However, the underlying cause of the illness may be the stressful and infection prone working environment for the patient who works in a day-care centre. If no one addresses this issue, the stress continues. In addition during the illness phase, it may be that the patient is unable to function at home and her family may not be giving her adequate support. The patient may also be clinically depressed as a result of this. Thus the disease returns and the patient returns to the doctor who may once again treat the acute illness.
This type of encounter is all too common in the medical field. Surgeons perform surgeries and believe that their job is done. The truth is the doctors job is not done that easily. The doctor has to be involved with the patient’s past, present and future. The patient has to have closure of the past, present and future to get well. This mind-body connection is understood by primary care doctors who are trained to look for factors affecting the state of illness. Principles of management include treatment of the acute illness, management of factors affecting the state of ill health and recovery of the patient and finally providing the patient with an understanding of the state of illness and coping with circumstances that may affect the course of the illness.
It is more important to know what sort of person has a disease
than to know what sort of disease a person has.
- Hippocrates (remark made somewhere between 460-357 BC)
When physician education and training is geared towards treatment of the acute illness rather than the state of illness of the patient, it becomes difficult for the patient to have balance and coping strategies for the body-mind-spirit connection which is undoubtedly affected by the illness. Integrative health management leads to a healthier patient and, in some instances, can even affect gene expression of some diseases (Proceedings of the National Academy of Sciences, 105(24), June 2008).
David Freudberg wrote an excellent piece on this approach of integrative medicine for the Humankind Public Radio, published by Human Media in 2013 and distributed by NPR. He distinguishes between traditional medical practice and integrative medicine. He says that integrative medicine optimizes the health of the whole patient by treating the acute phase of the illness, but then also identifies and reduces the risk factors, anticipates possible future health issues and institutes prevention strategies, plans across the life span of the patient and supports the patient to achieve health goals to lead a healthy life for body, mind and spirit.
In addition to its impact on individual patients, integrative medicine will have a considerable impact on national healthcare budgets. A 2010 Bravewell Collaborative Report reviews the medical and corporate literature on the efficacy and economic efficiency of integrative medicine. They conclude that integrative medicine has an enormous impact on healthcare costs. For example in a case-control study published in The Lancet (The Lancet, 364 (2004), pp. 937–952), modifiable risk factors including simple lifestyle changes identified and supported by physicians with adequate follow up, can reduce the attributable risk of heart disease by about 90%. In the U.S.A., that alone is estimated to be a cost saving of about U.S. $ 10 Billion.
There is increasing awareness of the importance of integrative medicine in healthcare. Many educational institutions such as Ivy League schools in the U.S. and medical schools in other countries have woven integrative medicine into their curriculum so that the new crop of healthcare professionals are trained to look beyond the disease to see the patient.
In our analysis, this variable can be measured by estimating the number of institutions currently practicing integrative medicine in their patient care. A survey of the members of the specialties and primary care associations can yield this estimate.