The Definition of Holistic Medicine

I’m posting an article written by Dr. David Katz, as I think it is a fantastic summary of what I strive for in my own practice, which is to emphasize healing by relying on both clinical intuition and scientific research, as too much focus on one or the other is not in the best interest of the patient. 

 

Holistic Medicine: How To Define It

 

We are probably all familiar with things that are tough to define,
but that we recognize when we see them. No, I’m not planning on talking
about that one

The term I have in mind is: holistic.

I practice holistic medicine. Specifically, for the past decade, I have directed a rather unique clinic that provides what we call ‘evidence-based integrative care.’ We have published and presented details of the model.

People tend to have a strong sense of what holistic means, whether or not they can actually define it. Detractors see it as an indication of quackery
without looking past the label. Proponents embrace it as an emblem of
virtuous humanism. Holistic is good, and all else … less so.

But if that is really true — if holistic care is better (I’m among
those who believes it is) — then a workable definition is important.
First, so that people who want to sign up for holistic care — to give
it, or receive it — know what they are signing up for, exactly. And
second, and more importantly, because you can’t practice what you can’t
define. Unless we can say just what holistic care is, it can’t be
taught, tested, replicated, or improved.

The medical version of TheFreeDictionary tells
us that holistic care is: “a system of comprehensive or total patient
care that considers the physical, emotional, social, economic, and
spiritual needs of the person; his or her response to illness; and the
effect of the illness on the ability to meet self-care needs.”

I am comfortable with this in theory, but not in practice. In
practice, it begs the question: how, exactly, do you do that? What does
considering ‘physical, emotional, social, economic, and spiritual needs’
look like in a doctor/patient encounter? What is a clinician actually
supposed to do in a room with a patient so that the care that transpires
between them is holistically concordant with this definition?

Let’s acknowledge that platitudes don’t really help. Of course, a
holistic practitioner looks beyond a battered body part to the whole
body; looks beyond the body to the mind and spirit; looks beyond the
individual to the body politic of which they are an intimate part; and,
if responsible, looks at the body of pertinent scientific evidence as
well.

But a devotion to holism does not impart mystical prowess to
clinician, or patient. No one gets a magic wand that allows for a
complex array of medical problems to be fixed all at once. Holistic
care is, in fact, most important when it’s hardest to do — when there
is a lot that needs fixing. I suppose there may be a holistic way to
suture the finger of a healthy, young person lacerated while dicing
zucchini, but I doubt it would matter much. It does, however, matter a
great deal in complex cases of chronic illness, attendant despair,
social isolation, and hopelessness. And at such times, it’s really hard!

Here’s an illustration, based on any number of patients we’ve treated
over the years. Consider a woman of roughly 70, who comes to the
clinic ostensibly to get dietary advice because she wants to lose
weight. She is, indeed, obese — with a body mass index of 32. She has
high blood pressure and type 2 diabetes, and is on medication for these.
Her husband passed away 4 years ago, and she lives alone. She is
lonely, tends toward sadness, and is always tired. She sleeps poorly.

She eats in part because she is often hungry, in part to get
gratification she doesn’t get from other sources. She does not exercise
because she has arthritis that makes even walking painful. Her arthritis
has worsened as her weight has gone up, putting more strain on already
taxed hips and knees. Medication for her joint pains irritates her
stomach, and worsens her hypertension. There’s more, but you get the
idea.

I regret to say that medical practice propagates its own uncouth
vernacular, resorted to in part to relieve the pressure of 30 hour
shifts and life and death crises. Much of the slang is too shameful to
share, but one term is especially germane to a case such as the one
above: circling the drain. A complex array of medical, emotional and
social problems really can resemble a cascade in which each malady
worsens another, and the net effect is a downward spiral into despondent
disability. Circling the drain is crude, but apt.

I present the term here because it actually has hidden utility. If
you can descend one degenerating spiral at a time, you can reverse
engineer the process — and ascend the same way! In my view, that is
what holistic care — in its practical details — needs to be.

For the hypothetical case in question, and innumerable real people
like her, reversing a descent begins with one well prioritized move in
the other direction. So, for instance, it is likely that this woman has
markedly impaired sleep, due perhaps to sleep apnea. A test and
intervention to address this effectively may be the best first move for a
number of reasons.

Poor sleep can cause, and/or compound
depression; poor sleep invariably lowers pain thresholds, making things
hurt that otherwise might not, and things that would hurt anyway, hurt
more; poor sleep leads to unrestrained and emotional eating; poor sleep
leads to hormonal imbalances that foster hypertension, insulin
resistance, and weight gain; and poor sleep saps energy that might
otherwise be used for everything from social interactions, to exercise.

Whether a focus on sleep is the right first step will vary with the
patient, of course. But let’s imagine that in this case it is a good
choice, as I have found it to be on a number of occasions. So, we
intervene accordingly — just to improve sleep. So far, this doesn’t
sound defensibly holistic. But it does sound like something the patient
might be able to tolerate.

But as soon as sleep does improve, the benefits start to accrue. Ms.
Patient has a bit less pain, a bit more energy, and a slightly more
hopeful outlook. So now that she has some more resources, we ask more of
her. We now need her to invest these benefits back into herself! Let’s
use that energy to start a gentle exercise regimen (water-based if need
be to avoid joint strain); initiate some social activity of interest to
get some stimulation and purpose reintroduced; and perhaps begin the
process of dietary improvements to address the weight loss goals
initially espoused. We might also start a course of massage therapy or
acupuncture to further alleviate joint pain, now that Ms. P believes
feeling better is possible.

A little exercise further improves energy, and sleep, and
self-esteem; and actually helps ease joint pain. Less pain further
improves energy, sleep — and willingness to exercise. Social engagement
— perhaps a church or civic group — confers gratification that no
longer needs to come from food. Hormonal rebalancing that occurs with
restoration of circadian rhythms alleviates constant hunger. Diet
improves. Medication doses are dialed down. Helpful supplements may be
started.

Weight loss starts. Energy goes up. Joint pain improves some more.
Physical activity becomes less and less problematic, and increases
incrementally. Energy and sleep improve further, weight loss picks up.
With more hope, and more opportunity to get out, Ms. P establishes, or
reestablishes social contacts that restore friendship and love to their
rightful place in her life. Her spirit rises, and with it, the energy
she has to invest back into her own vitality.

And so on — with many time consuming details left out, of course.
This may sound like wishful thinking — but it’s a rewarding reality I
have been privileged to help choreograph innumerable times over the past
decade.

If the erosion of health is a degenerating spiral, then its reclamation is a spiral staircase.
Which leads to the good news, and bad, about holistic care, practically
— and practicably — defined. The good news is that with real
dedication and a commitment to one another and the process, almost every
clinician and patient can find a way to ascend at least some distance
toward the heights of holistic vitality. The bad news is that I’ve yet
to see a helicopter fly in to get anyone there in one fell swoop. We all
need to be realistic. The climb is made one step at a time.

Dr. David L. Katz; www.davidkatzmd.com