There is no arguing that medical discoveries and progress have come a long way. Tremendous advances in science, understanding the body and physiology have led us to major medical breakthroughs – antibiotics to treat infection; anesthesia for surgeries. Most parts of the body when damaged can be repaired – from broken bones to fixing a detached retina. People are able to live longer and function better than ever before. Western medicine has given us a huge leg up on our ancestors who faced life and death risks from childbirth and contaminated drinking water.
Traditional medicine as we know it, however, does not have all the answers. In fact, physicians have few explanations for why medical ailments and disease happen to people in the first place. And because we have not spent much effort on the ‘why’, Western medicine can offer little in the way of prevention.
There are many assumptions. We know what we observe. We observe what we think is important or what we have been taught. We do what we think will be most helpful. But how we respond is so influenced by howwe were taught, whatwe were taught, and who we werewhen we were taught. It is fascinating to consider the tremendous psychological influences that affect the treating physician, of which we as physicians largely unaware.
A list of influences that affect your doctor’s delivery of care may include the following:
Convention (what has existed in textbooks for years)
Practices and philosophies of a past mentor or teacher that persist through generations
Lack of flexibility of thinking, inability to be open to other possibilities
Personal insecurity – are we comfortable with admitting ‘I don’t know’ or ‘this is just not working’ and then can approach the problem in an entirely new way
Lack of imagination or enthusiasm to be critical
What is wonderful about this list is that every single one of these generally static and problematic influences can be changed, flung aside and challenged if we actually have the energy and motivation to do so.
The study of medicine is the study of teaching physicians how to make diagnoses. There must be a certain understanding of physiology and biology to help us understand how to make a diagnosis and to recommend a treatment to make the person better. Medicine in its most traditional sense is the following – Learn everything there is that exists about the body, go out and find the sicknesses, make bodies well again. This is in essence what practicing physicians do every day.
But this is robotic. This is not preventive. Why do diseases occur? When a doctor makes a diagnosis does he or she stop to ponder, Why did you get this? How did this happen to you? Most often not. The physician’s focus is on fixing the identified problem, at least the part of the problem that is manifesting itself – the ‘thing’ that we physicians identify as the diagnosis. But the patient is thinking – Why me? Why did I get this? Every single one of us when handed some new diagnosis wants to understand why. It is a natural human reaction to try and understand the why, yet physicians spend almost no time considering this.
Yet, simply accepting this shutting of the door of possibilities makes a person just a little bit uncomfortable. In fact, it is unacceptable. Surely people expect their doctors to know more. Perhaps we don’t see patient dissatisfaction yet because physicians can be intimidating. Years of learning and all that experience. Years of practicing being authoritative and confidence-inspiring. Physicians often have a hardened edge to them that develops with time. All the ‘why’ questions are answered in short responses: ‘We don’t know.’ ‘There is no data to suggest there is anything to cause this.’ ‘You couldn’t have prevented this.’
In the past, knowledge was limited to the doctor experts. But not any more. Anyone with a medical diagnosis can read about it and understand most of what their treating physician may know about it. And that is why the practice of medicine for physicians as we know it, has already started to change.
In the practice of medicine, we usually tell our patients that almost every disease affects a person for these three reasons: 1) age; 2) genes; 3) bad luck.
Or that the cause of disease is ‘multifactorial’ and there are too many facts to properly understand or to do much about.
Yes, it is indeed quite remarkable that we can get away with such simple and ignorant explanations. But we have not ventured into anything more creative. Why? Does it matter? One has a problem and a doctor’s job is to get down to treating it. Sitting around and contemplating why something has occurred to a person, in the absence of anything obvious is not seen as an activity of value and will certainly not help the patient now.
Take for example, primary open-angle glaucoma. This is a common ocular disease where the intraocular pressure of an eye is too high for the eye to tolerate. To the best of our knowledge, this poorly tolerated pressure damages the nerve fibers that are responsible for vision. Glaucoma tends to respond to lowering of the eye pressure, whether with eye drops, lasers or surgery. Physicians make the diagnosis by noticing damage to the optic nerve or if the intraocular pressure readings of the eye seem high.
But what is this glaucoma? Why do people get it? What exactly is happening at the cellular level? And why do some people get it, and not others? It seems to be diagnosed in older people (age), and there is a hereditary component to it (genes). But everything else is bad luck. Yet glaucoma is one of the most common ocular diagnoses in addition to cataract that an ophthalmologist may make. There are countless other examples.
We have identified that perhaps the critical problem is that there is no compelling reason to understand the ‘why’ of the disease. Apart from talking about smoking-cessation, optimizimg blood pressure control, eating better and exercising, the remainder of the focus is treating the disease.
Because prevention is not honestly embraced in the traditional practice of medicine, we are missing real opportunities to recommend lifestyle changes to lower the odds of succumbing to disease. There is a significant body of literature associating disease with stress, and particularly avoidant behavior. Work by psychologists at the University of California, Los Angeles has already identified that increasing stress increases the susceptibility of disease in mice. Much has been published on the association of personality types that stem from early childhood adversity that are associated with for example, ALS (acute , prostate cancer and cutaneous melanoma. But more importantly, it may still be possible for people with active disease to do something to improve their response to treatment and disease control.
If traditional western medicine lacks the information, the solutions, and general interest in better understanding why certain individuals have been befallen by disease, perhaps it may be beneficial for people to explore alternative avenues for health improvement. Adopting practices that lean toward emotional and physical health improvement may be beneficial in preventing medical diseases and conditions over one’s lifetime. If we are to actively prevent the onset of disease and improve health, the current approach to health that relies solely on traditional medicine will not be enough.