I have heard the same lament too many times to ignore it any longer. Every day, while interviewing new patients, I hear the same thing. They tell me – often with sadness, sometimes with anger, and most often with regret – that they’ve come to the end of their relationships with their family practitioners. Most often, the reasons are, “He just doesn’t listen to my needs anymore”, or “She chastises me every time I wish to use non-medicinal therapies”, or “She’s a very good doctor, but she doesn’t know anything about the supplements I’m taking”.
This morning a new patient, whom I’ll call Helen, told me that her doctor of 23 years, with whom she had a close relationship and who had delivered her three children, replied to her questions about alternative therapies with, “Oh, come on Helen, get a grip!” She told me their relationship ended right then and there. I find this situation tragic.
I know how hard my colleagues work, how compassionate and dedicated so many of them are and how accomplished they are at the fine art and science of family medicine. So why is there this huge resistance to embracing the healing modalities that so many of their patients are actively seeking out and benefiting from?
ON THE BANDWAGON
In 1998, the American Medical Association (AMA) dedicated an entire issue of their journal JAMA to alternative medicine.1 Their editorial literally gushed with the promise of alternative medical procedures. The question was raised as to why this bastion of conventional medical, which has vociferously opposed alternative medicine in the past, suddenly jumped on the bandwagon?
According to Dr. Julian Whitaker, a well-known US practitioner and spokesperson for alternative medicine, the answer is simple: “It’s because the public is deserting conventional medicine and flocking to alternative health care providers by the millions.”
THE NUMBERS DON’T LIE
While reliable statistics in developing countries such as South Africa are hard to come by, the figures we see in the first world indicate a growing trend towards integrative medicine among educated, high-income social groups. In 1991, Dr. David Eisenberg, MD, published a groundbreaking study on the extent to which the public had adopted alternative medicine. His follow-up study was the lead article in JAMA, entitled, “Trends in Alternative Medicine Use in the United Sates, 1990-1997”.2 Dr. Eisenberg reported that 46.3% of Americans visited an alternative practitioner in 1997. This is a substantial increase from the 36.3% he reported in 1991, with the American public making 427 million visits. By 1997, the number jumped to 629 million, exceeding the total visits to all conventional physicians.
We know that 3.8 million Canadians consult alternative practitioners, spending about 1.8 billion dollars in the process.3 An additional two billion dollars are spent on herbs, vitamins, supplements, books and courses. A Statistics Canada 1998-1999 National Population Health Survey showed that 19% of women use alternative health care versus 14% of men. Some observations have shown that users tend to have post-secondary education and are high-income earners.
One finding of the study, which must surely be alarming to the medical establishment, was that 60% of people who consulted alternative practitioners didn’t discuss it with their doctors. I have found that this lack of consultation is not because people don’t want a conventional doctor’s professional advice. But most people know in advance what their doctors will say, and thus decide to spare themselves the embarrassment of an unpleasant interview.
Patients want more from their doctors. Not only do they want them to be informed about the latest research on supplements such as saw palmetto or glucosamine sulfate, they also want them to recognize issues more commonly addressed by alternative practitioners. My advice is not to let any doctor get away with comments such as, ‘There aren’t enough studies to recommend their use,” as there are many good quality studies done on a multitude of non-medicinal therapies that just aren’t published
in journals sponsored by pharmaceutical companies, which doctors usually read. Patients are also expressing a profound need for their family practitioners to hear their concerns about the mind-body connection and all that it entails.
Patients are no longer tolerant of alternative medicine being regarded as light medicine. They are taking their worldviews seriously and are expecting their health care providers to assist them. People are realizing that they are more than just a physical body with a set of symptoms. They’re aware that physical disease is often the end expression of long-ignored minor symptoms, which is why they are searching for advice before the minor symptoms manifest as major diseases.
A QUESTION OF COLLUSION
I suspect that some of my colleagues’ resistance to this new medicine my be due to a genuine distrust in what they see as entrepreneurial zeal on the part of alternative practitioners who exploit the gullibility of a vulnerable and ill-informed public. Some of these colleagues may also genuinely believe that alternative treatments are without scientific merit.
But there seems to be more at play here. Unwittingly, I believe that doctors and patients unconsciously collude in an archetypal relationship whereby doctors see themselves as all-healthy and the patients as all-sick. This model blinds both doctors and patients to the reality of the inner physician, that part of within ourselves that activates healing. The medical perspective often depersonalizes the patient, while treating the disease.
I also suspect that my colleagues are afraid of this new medicine because they have not been adequately prepared or trained to diagnose, let alone treat, the full extent of their own private suffering. Hence, they fail to recognize the full extent of their patients’ cries for help.
Alternative medicine is being integrated into mainstream medicine by a patient-driven, educated consumerism, whether the medical profession likes it or not. Viable alternative solutions for virtually all medical conditions will continue to grow in popularity into the next century. As a result, the entire face of medicine will change dramatically. My colleagues had better be prepared, or face the disappointment of ever-increasing patient dissatisfaction. Or worst yet, extinction.
By Dr. Bruce Hoffman