Doctor Jonas is an important figure head of US ‘Integrative Medicine’. As we discussed in a recent post, he pointed out that many US hospital doctors fail to answer the following questions relating to their chronically ill patients:
- “What matters most for this patient?
- What is the person’s lifestyle like – their nutrition, movement and sleep?
- How does that patient manage their stress?
- Does that patient have a good support system at home?
- What supplements does that patient take? Has your patient seen any CAM practitioners to cope with their condition?
- Why do they want to get well?”
In my previous post, I tried to explain that this is embarrassing – embarrassing for doctor Jonas, I meant.
But Jonas also claims that most US hospital doctors he addressed during his lecture tour, were unable to answer these questions. And that might be embarrassing not for Jonas, but for those physicians. Let’s consider this possibility for a moment.
The way I see it, the doctors in question might not have answered to Jonas for the following reasons:
- They felt that the questions were simply too daft to bother.
- They were too polite to tell Jonas what they think of him.
- They were truly unable to answer the questions.
Here I want to briefly deal with the last category.
I do not doubt for a minute that this category of physician exists. They have little interest in what matters to their patients, don’t ask the right questions, have no time and even less empathy and compassion. Yet nobody can deny that medical school teaches all of these qualities, skills and attitudes. And there is no doubt that good doctors practice them; it is not a choice but an ethical and moral imperative.
So, what went wrong with these doctors?
Probably lots, and I cannot begin to tell you what exactly. However, I can easily tell you that those doctors are not practicing good medicine. Similarly, I can tell you what these doctors ought to do: re-train and be reminded of what medical school has once taught them.
And what about those physicians who advocate ‘integrated medicine’ reminding everyone of the core values of healthcare?
Aren’t they fabulous?
No, they aren’t!
Why?
Because they too have evidently forgotten what they should have learnt at medical school. If not, they would not be able to pretend that ‘integrative medicine’ has a monopoly on core values of all healthcare. Their messages are akin to a new ‘school’ of ship-building insisting that it is beneficial to build ships that do not leak.
What I am trying to say in my clumsy way is this:
DOCTORS WHO PRACTICE BAD MEDICINE SHOULD RE-TRAIN – TOGETHER WITH THOSE PHYSICIANS WHO ADVOCATE ‘INTEGRATIVE MEDICINE‘, BECAUSE THEY BOTH HAVE FORGOTTEN WHAT THEY LEARNT AT MEDICAL SCHOOL.
7 Responses to More uncomfortable thoughts on ‘integrative medicine’
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… and even after doing the preliminary exam again and again the problem will persist that the preliminary education and exam in medicine will not stop hundred of thousands of hysicians to practice quackery. …
So what has to change really ??
The practice of medicine by those doctors who fail to address the items in 1-6 above should only be described as ‘bad’ if the attending doctor was invited to accept professional responsibility for them in the first place. Not all doctors are responsible for ‘lifestyle’ issues (though all will have been taught their relevance in general).
General practitioners (family doctors) might be charged with those responsibilities, but specialists, well, specialise.
Says so on the tin.
Failing to address 1-6 and concentrating on the most important issues for which the doctor was consulted might be very good medicine indeed. Nothing has ‘gone wrong’.
Horses for courses.
‘Integrative Medicine’ is marketed as ‘combining the best of modern medicine with … (fill in the dots, which vary according to who is doing the marketing of the pillules, pricking, pummeling, potions, preternatural powers etc.).’
But we know such an approach is harmful to medical progress and ultimately, to medical care, and only serves to advance the cause of those who ignore EBM and promote quackery.
Do you have statistics about how many of the family doctors in a single European country or in Australia Canada or the US offer integrative/complementary/alternative methods ?
Is there any study about any effect at all of the preliminary subjects and exam onto such doctors/physicians practising alternative/complementary/integrative medicine ???
If there is no effect in statistics by the preliminary studies for a better and natural sciences oriented medical practice why should they repeat than any of such studies in order to practise evidence based medicine in the future??
Do you have statistics about how many of the family doctors in a single European country or in Australia Canada or the US offer integrative/complementary/alternative methods ?
THERE ARE PLENTY OF SURVEYS, IF YOU GO ON MEDLINE
Is there any study about any effect at all of the preliminary subjects and exam onto such doctors/physicians practising alternative/complementary/integrative medicine ???
THIS WOULD NEED A RIGOROUS RCT; AND I DON’T KNOW OF SUCH A STUDY.
To design such a RCT might be really difficult but having a result might change a lot and touch the roots of the problem leading to a change in the design of the medical education.
If there is no longer a profssional physician being interested in practising such quack because he/she has profound knowledge and whilst studying medicine sciences might cover all the questions being asked who else should sell quack?
The market will go underground and it is easy to prohibit and bann it by law.
Item 5 is absurd. Evidence from studies in recent years indicates that most supplements do more harm than good. The question is relevant only to learn whether vitamin or mineral toxicity may be occurring. Or toxicity from herbal drugs, since herbal drugs have been fraudulently labeled supplements by the DSHE Act and by herbal drug peddlers. And why should a CAM practitioner be consulted for this item? They inevitably advise people to poison themselves with vitamins, minerals and herbal drugs. Item 4 is problematic. If the answer is no, will the patient be advised to get married or adopt a child? This could result in huge problems. People often have good reasons for living alone. Support systems don’t have to be at ones home.
“The question is relevant only to learn whether vitamin or mineral toxicity may be occurring. Or toxicity from herbal drugs”
That is exactly why it is essential to ask these questions when taking a proper medical history. It also gives some idea of the patient’s understanding of their disease and how compliant they may be with treatment.
As an example from anecdote, when I was a medical student there was an in-patient whose blood pressure was responding poorly to treatment. However, somebody noticed that she had a particular fondness for eating liquorice, which contains carbenoxalone which has mineralocorticoid activity leading to sodium retention, explaining the poor response.
” Item 4 is problematic. If the answer is no, will the patient be advised to get married or adopt a child?”
Don’t be daft! If the answer is no then other support systems such as social services, hospital transport, patient support groups, charities etc. need to be involved.