Heroes Not Zombies

I think of myself as a holistic doctor. But what does that mean, and how can I practice holistically?

One way to understand the holistic approach is to consider what we attend to, and what we intend.

By attend to, I mean what do we pay attention to, or focus on. In training I was taught to focus on parts and pathologies and that’s the core focus for most medical care. We create our health care systems around parts and pathologies. That’s why hospitals have a Dermatology Department, a Chest Clinic, a Gynaecology Department, a Gastrointestinal Clinic etc. All of these services focus on body parts (which are members of certain body systems or regions) and on trying to treat the pathologies discovered in those parts. General Practice, in the time of Balint and the creation of GP Training Schemes in the UK, was built around a focus on the person and the relationship between the doctor and the patient. The core of good General Practice was seeing this patient not as another case of disease x, but as John Smith, the 52 year old farmer, whose wife died last year in a car accident, and whose dairy farm is barely paying its way, whose father died of a heart attack aged 52, and who has phoned you to say he has been getting pains in his chest for the last three days. However General Practice has been reconstructed in recent years around pathologies and diseases. Now the average GP Practice has an Asthma Nurse, a Diabetic Clinic, a target to check blood pressure readings and smoking activities and an appointment system created to facilitate fast, problem-orientated consultations.

Holistic care involves a focus on the person, not the part. Any problems or pathologies are considered within the context of the person, not the other way around. Who is this person who I am speaking to? How do they live? And what are experiencing that is disturbing or distressing them? How is this disease experienced by them, and when and how did it appear in their life?

I attend to the person, and the person’s individual experience (revealed through the telling of their story, through their non-verbal communications and through the changes in their bodies)

What do I intend? The therapeutics taught in medical training is intended to manage disease. Doctors might talk of cures (rarely, in my experience) but particularly in the area of non-communicable chronic illness the intention is to control symptoms or limit further progress of pathology. There are no cures for asthma, diabetes, high blood pressure….. or any chronic disease. Diseases are managed by the prescription of drugs, and those drugs are for life, because they are not intended to produce healing.

Healing – there’s another word you don’t hear doctors use much. But surely all health care should be about healing (if healing means moving in the direction of greater health). Health, if it improves in patients receiving these treatments, is a kind of side effect. It appears, hopefully, as the disease or pathology reduces.

In my daily work, I, and my colleagues, intend to heal. Does that mean we try to cure? Well, to answer that would open a debate about what is cure, and I’ll leave that for another day. Let’s say we intend to maximise health. I don’t know any cures for MS, or asthma, or diabetes, but I do know that patients with those illnesses can experience different degrees, or levels of health.

My intention is to maximise health through stimulation and support of self-regulation and self-repair, and in so doing the patient will experience the care as healing. The way we try to mobilise self-healing is through care which is integrative. Integrative care is any intervention or therapy which increases the amount of integration, or coherence, in the person.

I do not believe that holistic = good, and disease management = bad. We need good disease management. Good disease management in acute care will save a life today. Good disease management will improve the quality of someone’s life by controlling symptoms and inhibiting the progress of pathology. But it takes holism to maximise healing and bring the best possible health experience to a person.

If we are providing health care, surely somewhere in the system, there needs to be the intention to heal, and is there ever a case for not attending to the person, but only attending to the pathology?