“The desire to take medicine is, perhaps, the greatest feature which distinguishes man from animals.” I sat in a lecture on the topic of insomnia this past weekend that began with this quote by William Osler, the man who is often referred to as the “father of modern medicine.” At first I laughed, thinking, what about my opposable thumbs? Then I thought some more about our society, my family, my friends, myself, and, certainly, my patients. Even the people who resist taking prescription medications still, frequently, take vitamins or supplements to fill a void or bring about health, wellness, and happiness.
The point the lecturer, Oleg Kouskov, MD, was trying to make, and which has stuck with me, is that the cure for insomnia is not always a sedative hypnotic medication. Sometimes it is a lengthy discussion and subsequent lifestyle change related to sleep hygiene, screen time, diet, exercise, and stress, combined with medical treatment for other comorbidities that actually cures insomnia. Dr. Kouskov maintains that we should schedule a 40-minute office visit to address this complaint; and if we don't have that kind of time, we should refer the patient to someone who does. In the insomnia case studies, patients left the office with medicines, but not the ones they came in requesting. They were told to stop drinking alcohol, turn off the latest Internet gaming experience, lay off the energy drinks, stop illicit drug use, and then they were treated for anxiety, depression, restless legs, and/or sleep apnea. Their doctor took the time to address their health, not just their illness.
A recent article in The Atlantic titled The Triumph of New Age Medicine described the relationship between traditional Western medicine and alternative medicine. It explored why alternative care (a vague term including, but not limited to, acupuncture, homeopathy, hypnosis, and meditation) is not always supported by randomized controlled trial data but nevertheless seems to be a cost-effective solution for improving health. The article included critiques and testimonials regarding alternative and allopathic medicine and elucidated the strengths and weaknesses of both disciplines. Western medicine is extremely successful at treating infectious disease and trauma. We have tests to identify pathogens and drugs and surgeries to eradicate them. When someone is broken we can put them back together. But, when chronic disease management is approached in the same way, we often fall short of our goals. By waiting for the illness to appear and trying to manage it with drugs, we are already too late. We cannot cure diseases like hypertension, hyperlipidemia, obesity, and diabetes as we can cure a case of strep throat; we manage them—hence the term chronic disease. However, through years of practicing this way, we have taught our patients that medicines may be used in place of important lifestyle changes to lower their risk of serious illness. It is also a lot faster for us to give someone a prescription than it is to counsel them on diet, exercise, stress, and smoking.
Alternative medicine visits are lengthier than traditional office visits. Its practitioners are perceived as being more caring than their allopathic counterparts, and patients seem to bond more readily with them in response to this increased amount of attention. Since alternative and integrative medicine consultations frequently include a discussion of lifestyle modifications, providers seem to be more successful at promoting a healthy diet, more exercise, and less stress; the very pillars of disease prevention. This same approach may also translate to improved outcomes for alternative medicine in treating the common complaints of pain, anxiety, and digestive disturbances that are exceedingly difficult and expensive to diagnose and treat from a rigidly Western perspective. In alternative medicine, healing (instead of medicating) seems to be an important goal. That is not to say that patients may not take medicines when being treated from an integrative perspective but, like the insomnia case studies, they may not be taking the medicines they thought they needed.
Can we teach empathy in medical education? No. Can we overhaul the health care system to encourage patient-clinician bonding? I don't know how to begin. Now, if you will excuse me, I have to go take my vitamin D and fish oil and get some sleep.
Amy Klingler practices primary care at the Salmon River Clinic in Stanley, Idaho.This blog post expresses her personal views and does not express or represent the views or policies of AAPA.