The Yale Journal for Humanities in Medicine
Preparing
Successful Future Physicians to Meet
Emerging Social Needs in Humanitarian Ways
Michael Basso, Jr.
cthha1@ix.netcom.com
There is no doubt in my mind that the successful physician of the future will be a humanitarian, with a bent towards holism and a dedication towards ‘best practices’ from a broad array of possibilities. To be prepared for this daunting task, I believe that a very different emphasis will be required from pre-professional and professional education. This change needs to happen now.
We are in the midst of a paradigm shift in healthcare and wellness, not just in the United States, but throughout the world. The model has changed to a patient-centric one, focused upon prevention, therapeutic alliances, and holism. For most people, powerful drugs and surgery are last resorts. Nutrition, stress management, and fitness are the hallmarks of the emerging model and patients are taking the lead in their own health. In parts of Fairfield County, Connecticut, there are areas where chiropractors are on every block and acupuncturists and naturopathic physicians are vying for office space in professional buildings. More women are going to women physicians exclusively and both men and women are much more educated when it comes to healthcare.
All of these considerations might be lumped into a broad category, one I have been very involved in, called ‘holistic medicine.’ Holistic medicine is a broad term, which implies the best practices, including, but not limited to, conventional and alternative medicine.
The hallmark of conventional medicine is the use of allopathic drugs and surgery, while the term alternative medicine implies the use of other practices to replace drugs and surgery. ‘Complementary medicine,’ on the other hand, implies a partnership between conventional medicine and alternative practices. The focus is on prevention, therapeutic alliances, patient centered approaches, and minimally invasive procedures. These might include minimally invasive surgery and non-pharmacologic approaches to pain management.
Alternative practices might encompass a variety of modalities, including, but not limited to Traditional Medicine (Chinese Medicine, Tibetan Medicine, Ayurveda, African Healing Systems, and Native American Healing), ‘Energy’ Healing (Reiki, Therapeutic Touch, Healing Touch), Bodywork, Nutrition and / or Chiropractic approaches. Another name for Complementary Medicine is ‘Integrative Medicine.’ This name was chosen to imply not only wholeness, but to fix a problem that the name complementary caused. Patients thought ‘complementary’ implied that it was free!
Holistic medicine is the broadest relevant category and implies not only Alternative, Complementary and Integrative medicine, but much more. Holistic physicians (Including Allopathic, Homeopathic, Naturopathic, Osteopathic, and Podiatric) are only part of the story. Holistic nursing and dentistry are coming to the forefront. More esoteric practices, like body-mind psychotherapy, spirituality and health, organizational wellness, holistic architecture and landscaping and even CAM (complementary and alternative medicine) in neuroscience and humanities in medicine are making sweeping changes in the way we think about healthcare and wellness.
There is no question in my mind that Holistic Healthcare is not only the wave of the future, but also the course of the present.
As one of my favorite activities, I am president of the Connecticut Holistic Health Association. This volunteer-run non-profit organization, affectionately called CHHA, has been in existence since the early 1990’s (formerly the Greater Hartford Holistic Health Association). CHHA has played a lead role in professional, academic, and public education regarding holistic healthcare both within Connecticut and beyond its borders. CHHA has 4 active branches (more on the way), and about 400 members, including more than 20 affiliate organizations and many large member groups that comprise one of the 400 members listed. CHHA members practice more than 75 holistic modalities!
The primary goal of CHHA is to support holistically oriented practices while promoting partnerships with conventional medicine, academia, industry and government. CHHA sponsors conferences, symposia, professional health fairs and monthly networking educational meetings throughout the state. CHHA members provide more than 600 annual workshops and seminars annually. The CHHA website is www.cthha.org for those with similar interests.
My interest in Holistic Medicine goes back to my teen years in the 70’s when I had a stubborn bout with pneumonia. I tried conventional medicine, including antibiotics and sulfa drugs, for nearly a year with no success. Both physicians I worked with were at a loss as to how to treat me and the drugs were making me feel awful. Finally, being the rebellious teen that I was, I decided to take matters into my own hands. In just three weeks of using self-applied nutritional approaches, my pneumonia was completely gone and it has never returned. My treatment included minimizing dairy products, eating more fresh fruits and vegetables and taking some vitamin supplements. No one bothered to ask me about my diet. If they had they might have realized that, like many teenage boys of the time, I was into a high-protein diet full of dairy and lacking in fresh veggies (against my parents wishes) and vitamins!
This event may have changed the course of my life, since when I had a chance for a free medical education several years later, I refused to take advantage of this opportunity. Many years later, after I realized some of the great strides that aspects of conventional medicine had made, that decision began to haunt me. Even with four graduate degrees, jammed packed with biomedical and clinical coursework (including neuroscience), and 100’s of postgraduate seminars, I often felt that I was meant to have an MD, too! Even without that important credential, I have always kept up on the best practices from a variety of areas.
There are hundreds of Internet sites relating to health and interested consumers visit wellness and these sites millions of times per month. In fact, many of my physician friends have commented that due to their busy schedules that they often can not keep up with their patients in terms of current information.
My interests in psychology, neuroscience, and electrical engineering gave me a strong appreciation for ways where all of these areas would eventually merge for the betterment of humanity. Interests in East / West spirituality also made me mindful of the many ramifications concerning what we might tap into. This composite view made me mindful of both huge potential mixed with huge responsibility.
Strides in ‘electro-medicine’ including imaging and non-invasive blood testing are only part of the emerging story. Chiropractors now use thermal detectors to assess problems with spinal alignment. Electro-acupuncture has the potential to preserve the best of traditional Chinese medicine while providing new non-invasive ways to deal with not only pain, but also a litany of medical problems. Lasers are rapidly becoming the hallmark many surgical and dental procedures and the huge potential for low-level lasers is virtually untapped.
While attending an imaging conference at the Mayo clinic about ten years ago, I had the opportunity to ask a fun question to Mayo leaders who happened to make themselves available at our conference. The question was ‘what will the future of healthcare look like?’ The answer was surprising. Someone asked me if I remembered the Star Trek series… and went on to say that the future of medicine would have two significant aspects. One aspect was the team-based approach pioneered by the Mayo brothers at the turn of the last century. The other aspect involved electro-medicine. They suggested that light, sound, electricity and magnetic fields would play a major role in prevention and diagnosis. Someone in the panel boldly suggested that there will come a time when real-life healthcare professionals will use tools much like those used on the Enterprise to heal patients!
Researchers also know that ambient lighting, color, sound, music, air ionization and even art and architecture may have significant ramifications on the health of human system.
Physicians also know that spirituality can be most important to patients and that multi-cultural diversity may add significant complexity to case management.
In view of these emerging trends, the physician of the future may play a very different role than the typical physicians of today. The emerging model will be different from a variety of perspectives. In fact, the rapidly emerging healthcare and wellness model is clearly a broad-based bio/psycho/social/techno/spiritual one with many roots and cultural ramifications.
Patients themselves are mostly interested in preventing illness and getting well rapidly with minimal cost. Driven by both intrinsic motivators and societal pressures, physicians of many persuasions, including allopathic, osteopathic, naturopathic, chiropractic, and oriental medicine, while having their differences, are working together to provide total solutions. It is now common for medical and osteopathic students to study alternative and complementary approaches, while students of chiropractic and naturopathic healthcare are most interested in learning about relevant drug and surgical approaches.
It is most likely that progressive universities will have common pre-clinical programs where future MD’s, ND’s, DO’s, DC’s, and OMD’s will take their first two years together, before branching off into their special fields. Further evolution will most likely lead to interdisciplinary programs, such as MD/ND, DO/OMD, MD/PsyD and a variety of special certificates en route to their physician degree. Nutrition, stress management, pain management and acupuncture will most likely be among the mix of many certificate options. Even more comprehensive composite degree programs of a holistic nature are on the horizon. Perhaps these interdisciplinary programs may be called ‘master physician programs.’ In any event, new innovations are likely to have a strong emphasis on prevention.
Stress probably accounts for more than 50% of all medical visits and excessive stress due to intrinsic and extrinsic conflict is among the most prevalent and insidious banes of modern organizations. The responsible physician of the future will certainly need to know more about organizational dynamics of the workplace if he/she wants to successfully understand their patients’ disease processes and how to help them.
While professional curricular innovations are already happening, there is also much room for pragmatic innovation in the pre-professional curriculum. Given the high demands of future professional education, what better place than pre-professional education to set the stage, all while making optimal use of overall educational time? My training as an engineer has encouraged me towards efficient and effective innovation.
With these technological innovations already emerging, the need for memorization in subjects like organic chemistry and physics may have much less value for the future physician. With innovations like the Internet, one may capture the most up to date information with a few keystrokes.
More efficient and effective use of pre-professional educational might include case-based subjects which will best prepare future physicians, nurses, dentists and others for the future. Emerging courses might have names like ‘Holistic Wellness and Healthcare Excellence,’ ‘Anthropological Views of Traditional Healing,’ ‘Organizational Behavior and Stress,’ ‘Spirituality and Health,’ ‘Multi-Cultural Diversity,’ and ‘Humanities, the Arts and Health,’ ‘Nutrition and Fitness in the Workplace.’ A variety of pre-professional certificates may be of considerable benefit to motivate students along these proposed pre-professional tracks.
Published: November 22, 2004