My 48-year-old friend told me he might soon need a hip replacement. I asked if he planned on exploring any holistic treatment strategies before his surgery date, as I know it to be an extensive surgery that requires a lot of strength and conditioning post-op. 

His reply was expected, basically amounting to “not really.” And in truth, he is no different than most patients—those who think it’s easier to take a prescription medication or go under the knife to “fix” a problem. 

 

Are we taking the easy way out?

 

 

We are generally uneducated in the realm of holistic, or alternative/complementary medicine. In medical school, I never learned about nutrition, lifestyle modifications to prevent chronic disease, supplements for joint health, the importance of spending time outdoors, acupuncture, or any other nonprescription remedies to prevent and treat disease. But these types of lifestyle modifications and complementary therapies can be incredibly effective.

 

Our inexperience is a detriment

 

Our medical education does not include training for skills to comfortably talk about nutrition, diet, and weight loss with our patients. Although 80% of chronic diseases can be prevented or reversed by lifestyle modification,

Bansal S, Connolly M, Harder T. Impact of a whole-foods, plant-based nutrition intervention on patients living with chronic disease in an underserved community. Am J Lifestyle Med. 2022 May-Jun; 16(3):382–389.

75% of US medical school curriculums do not include the 25-hour minimum of nutrition education recommended by the National Academy of Sciences.

Adams KM, Butsch WS, Kohlmeier M. The state of nutrition education at US medical schools. J Biomed Educ. 2015;4:1-7.

 

 

Still, our quality metrics tell us we must prescribe beta blockers, PPIs, and statins, even if our patient is already on 12 other medications. 

We are failed by the broken, fee-for-service healthcare system that only allows us 15-minute patient visits. This does not give us enough time to have effective conversations about lifestyle modifications and incorporating holistic medicine for a comprehensive treatment approach. Even if we could have these conversations, we are not reimbursed for these lifestyle preventive services.

We are being manipulated by a healthcare system to pick the quickest treatments: the prescription pad or, in my friend's case, the surgical knife. 

 

Talking to your patients about CAM

 

Western medicine is not bad and should not be put on the back burner, but when we incorporate alternative medicine approaches, we can improve care for our patients.

Studies show that 30% of patients in the US use complementary and alternative medicine (CAM)

Jou J, Johnson PJ. Nondisclosure of complementary and alternative medicine use to primary care physicians: findings from the 2012 National Health Interview Survey. JAMA Intern Med. 2016;176(4):545–546.

—another way to refer to holistic medicine. This number is even higher among oncology patients.

Stubbe DE. Complementary and alternative medicine: If you don’t ask, they won’t tell. Focus. January 24, 2018.

 

Patients who use CAM have expressed concern about discussing it with their physicians, citing their fear of disapproval. They have also expressed a desire for their PCPs to consider CAM approaches and refer them to CAM practitioners. However, research has shown that PCPs rarely initiate these desired conversations.

We should feel comfortable talking about these things with our patients. We can ask if they are currently taking any vitamins, supplements, herbal treatments, or OTC medications, or if they are exploring naturopathic therapies, acupuncture, therapeutic massage, or chiropractic treatments.

We can ask them their reasons behind using CAM—just remember to be sensitive to cultural practices.

Acknowledge your patient’s choices and efforts towards self-care and CAM. The fact they are using preventive medicine means they care about their health and well-being.

 

What is integrative medicine? 

 

Andrew Weil, MD, was the visionary physician and author who helped establish the field of integrative medicine as a specialty.

Integrative Medicine Defined. American Board of Medical Specialties. 2023.

The ideas he promoted about the treatment and care of the “whole person” integrated scientifically validated therapies of conventional medicine with selected practices from areas that we would consider to be CAM.

 

Integrative medicine is powerful, and it can do wonders for chronic disorders.

When these services are combined and coordinated by the PCP, it can have dramatic positive effects to a patient’s well-being and life. 

Joint pain, for example, can potentially be relieved by strengthening the soft tissues around the joint while engaging in nonweight-bearing exercises. High blood pressure, elevated cholesterol, acid reflux, and pre-diabetes can be alleviated with a drastic change in diet and the initiation of exercise. Headaches can be improved with the use of acupuncture, Botox, and a change in diet. 

An unhealthy lifestyle can lead dramatically to poor health—and our answers are often prescription medications to treat the symptoms instead of the root. When we as physicians work together with the patient to address these issues in lifestyle, the reversal to good health can be equally dramatic. This is the power of holistic medicine.