In the last 8 years of working as a clinician in both the Secondary and Primary care system, I come across cases that have been deemed “medical failures”. These are cases that include those which the specialist cannot do anything more for, or a diagnosis cannot be found. More recently, I see more and more of cases which turn up with ‘normal’ results, and in effect we declare the patient as well. Yet these patients continue to have genuine problems.
Super-imposed on such cases, are patients who complain of tiredness, lethargy, “not firing on all cylinders”, “ lacking in hormones”, “needing supplements” and yet do not respond to such therapies. It is not surprising then, that patients are spending more time in the “alternative” field looking for answers to wellness. To every dollar spent in the Primary Health field, there is five spent in the “alternative” field. Some find answers, others return to the Primary health practitioner having had no success. We are left with such patients who eventually are labeled as, “Disability cases”, “ Sickness Benefits”, “Invalid’s Benefits”; who can never contribute to society again.
In the last five years, some clinicians have been trying to find answers to these problems; initially out of curiosity and eventually out of necessity in an attempt to provide care. During this time clinicians in other parts of the world were also seeking similar answers. In 1997, New Zealand presented a Conference on Integrative Medicine for the first time. This brought well known clinicians from all over the world together to discuss Behavioural, Resort and Integrative Medicine. Behavioural Medicine is a field that comprises the broad intersection of behavioural psychology with clinical and preventive medicine. Some call it “Last Resort Medicine” – the term being coined as patients attending such clinics are often at “the last resort”. The Conference also looked at the broadest perspective into the origins of chronic illness and developing a systemic alternative to standard medical diagnosis. This type of Medicine focused on the patient being the best clinician, and using the clinician to guide the patient through their difficulties. It also acknowledges that each person is biochemically unique and so no one formula works. This is the concept of functional medicine. This practice encompasses all of the above and incorporates the biochemistry and physiology of the individual. The slippery nature of medical diagnosis does not necessarily reflect the distress of the patient. Contemporary Medicine approaches illness with a set of concepts and procedures referred to as the biomedical model. The biomedical models at times fail to accurately describe either the form or the substance of modern medical practice. The form is shaped by social forces, the substance by our procedural approach to medicine.
Take an example of a 35 year old who presents with Irritable Bowel Syndrome. They have had pan-endoscopy, been assessed by immunologist, cleared by at least 3 physicians and yet continue to pick up viral infection after viral infection. They have extreme sensitivity to sugar, colouring, diary products, and processed foods. Yet, all the routine medical tests have so far come back ‘normal’. Why then do such patients developed illnesses that most other people do not have at the recurrence rate they have? Immunologists tell us they have normal immunoglobulin function. Where did the reflux come from? We only have to look at the waiting room! Is it form lack of parental intervention? What about the cases of women who present with tiredness that we see regularly. 1 in 3 of such women present with tiredness. Most of them are on the oral contraceptive pill. Their glucose, iron studies, thyroid functions are all normal. They need incredible hours of sleep. They eat well. They exercise well, yet at the end of the working day there is no energy left for household tasks, let alone their sex life. Is it the fast pace of modern living? Why then do some cope and others don’t? Is testosterone cream the only answer? Let’s take the case of KR: a young 23 year old with extreme tiredness. Seen by a physician and fully investigated with every possible test, only to be told there is nothing wrong. Yet she is so tired; she cannot function. There has been no history of any viral infections. Thorough history suggest that commencing the oral contraceptive pill was a cause to her tiredness. Stopping it made no difference. What about patients who are completely incapacitated after exposure to certain chemicals? Such is the following woman’s case where she was the only person in the whole of her department to succumb to such tiredness that she can no longer function and is now on disability cover. Was it an accident? Was it a gradual process and if so what was the precipitating cause? Did the depression come before the exposure or was it the cause? Then there are the patients who drive Drs up the wall with numerous symptoms: numerous allergy related problems, sniffles, tiredness; complaint after complaint. Mrs H who complains of glands that are up, tiredness, sinusy, and nothing specific but really incapacitated by her complaints? These are some examples for which the medical model does not fit. They have genuine problems and we as the Health Care Team, both Primary and Secondary sector, cannot find answers for them. It is this basis that we are trying to formulate new ways of addressing issues of examples given above. There is no clear answer, nor clear protocols that I have come across that can be applied to these persons in a generic form. Detoxification as a means works for some, but not others. Detoxification is looking at the integral liver function. Issues of metabolites blocked at certain stages due to a break in the cycle of energy formation needs to be understood. Investment needs to be made in time to look into other means of helping such patients, and using health products in enabling the patient to take control of their lives.
Integrative Medicine working with both practitioners and patients looks at:
1. the awareness that as a group of Drs we are trying our best to address these conditions that do not fit into the medical module
2. acceptable ways of integrating orthodox medicine with complementary medicine
3. a model that has to be sustainable for both the practitioner and patient