Many years ago, I was sitting in a dark lecture hall on the west side of Chicago with a notebook open in front of me. I was over-caffeinated, shaking my leg, and twirling a pen around my fingers, excited and terrified (but mostly excited) to start medical school. It was our pathology lecture, and the professor walked up to the podium and asked us a question:
“Why do people go to the doctor?”
We all looked around at each other, hoping someone would know the “right” answer I suppose. After fielding a number of guesses, he looked at us and said, “Because they are in pain and they want to feel better.”
It’s obviously not an entirely correct answer but I think it captures the essence of medicine: people want to feel good, to live long, healthy lives, and they look to experts to help them do that. They often come to us at their most vulnerable: in physical or psychological pain, in fear, in denial. Against all common sense, they put their trust in a stranger. So how are we doing? Are doctors living up to that trust?
To tell you the truth, I’ve been struggling to put my thoughts about this onto paper. I want to be direct and truthful, but I don’t want to upset people. As it turns out, we don’t always get our way with these things.
I am passionate about medicine. I love everything about it: the science, the practice, the puzzles, the personal relationships, and finding a way to meld all those things together in a way that helps people. And because of that passion I can get a bit prickly when I talk about bad science, bad practice, and bad doctors.
Which brings me to a recent question I’ve gotten from a few different folks: what do I think of “functional medicine”? My mind is swirling with all sorts of answers, but we’ll need to start with some background and some definitions, so go get a cup of tea and make yourself comfortable. In fact, I’m going to end up splitting this post into two parts to make it a bit more digestible.
First of all, when I think of so-called “alternative medicine”, I’m thinking differently than you (probably). In my mind there’s simply medicine that works, and everything else. Labeling things “alternative”, “allopathic”, “traditional”, etc. is, I think, overly confusing. None of us wants medicine that doesn’t work or makes us sicker. What most of us want from the practice of medicine is a doctor (or other practitioner) who listens to us and then works with us to come up with a plan that actually makes us healthier. If that’s medicine then what’s its alternative? We’ll examine functional medicine in this light. But first, let’s talk about medicine in general and why people seek out alternatives.
My specialty is called “internal medicine”. When people ask me what that means, I tell them that I am an expert in preventing, diagnosing, and treating diseases in adults. From our professional organization:
Internal medicine physicians are trained to handle the broad and comprehensive spectrum of illnesses that affect adults, and are recognized as experts in diagnosis, in treatment of chronic illness, and in health promotion and disease prevention [emphasis mine]—they are not limited to one type of medical problem or organ system. They are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses may strike at the same time.
Medicine is science-based—we can’t simply make it up as we go, and we can’t rely on our common sense to get it right. When you study medicine, you not only spend years learning about human health and disease, you learn how to think. This requires a background in science, statistics, and mathematics, because facts change. You need to be able to pick up the latest journal and understand what’s been written and whether it’s believable. Science matters.
But what about compassion, what about listening?
What is good medicine?(Wikimedia Commons)
This is where I usually give my analogy of “alternative engineering”. Would you want to drive over a bridge designed by someone who went to an alternative engineering program where they are taught that feelings matter more than science? That you need to feel your way through the structural design and ignore what all those fancy books and mainstream engineers say?
But compassion and feelings do matter. Knowledge without compassion is a waste. This is a lot harder to teach, and this is one place we doctors run into trouble. You can go to see the most knowledgeable doctor in the world but most people don’t want a “Dr. House”.
All too often our medical system fails us. Compared to other wealthy countries, we spend more money for worse outcomes. We struggle to find individualized care. Doctor’s visits can be hurried and confusing. I can’t tell you the number of times patients say to me, “no one ever explained that to me before.”
What practitioners of so-called alternative medicine will tell you is that unlike the usual sort of doctor, they will actually listen to you, the patient; they will collaborate; they will be what doctors were meant to be. And when it comes to spending real time with patients, they’re right—studies show that alternative practitioners often spend more time with patients.
Spending time with someone who listens is, in and of itself, therapeutic. But that’s not all medicine is, and as you may have guessed, I have some problems with so-called alternative medicine, including functional medicine. And that’s what I’ll address in part two.
1 An interesting side-note though is that Medicare patients tend to be very satisfied with their care compared to people with private insurance. What makes that especially interesting is that Medicare is essentially “socialized medicine”, a term that is anathema in the US.
