The Nature of Medicine, and the Medicine of Nature

Over time, the nature of medicine has changed. There is ever less time with patients. There is ever more reliance on technology and drugs. These can offer powerful benefits, but at times there are kinder, gentler modalities to get the same job done.
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It is Naturopathic Medicine week. Who knew? As it happens, it is also Drive Safely Work Week. I guess we've planted so many flags of ownership into our annual cycle of weeks and days that we are now obligated to share real estate. I haven't heard the naturopaths complain about it, and as it happens, their proclivity for sharing proves to be germane.

I learned about Naturopathic Medicine Week just recently from my friends at the American Association of Naturopathic Physicians. I have known about naturopathic medicine for a long time, however, and from the rather intimate perspective of sharing patient care.

I have been practicing a particular model of integrative medicine since 2000 that involves the active collaboration of me or someone trained like me, and a naturopath, in the initial evaluation and subsequent care of a given patient. Our model has been

I will note that the basic rationale was the time-honored notion that "two heads are better than one." I completed residencies in both internal medicine, and preventive medicine/public health. That's a pretty expansive domain already. The idea of maintaining any semblance of expertise in those disciplines, and adding the full expanse of natural medicine (i.e., botanical and herbal medicine; mind-body medicine; traditional medical practices; acupuncture; massage therapy; etc.) seemed rather far-fetched to me.

So instead, when the opportunity came along to establish an integrative medicine clinic for reasons I've addressed before, I went looking for the well-filled head with which my own might collaborate. Naturopaths were the obvious choice.

Naturopathic physicians are, indeed, physicians -- earning a doctoral degree in naturopathic medicine (ND). As with us MDs (and our close cousins, the DOs), naturopaths complete four years of college first, and then apply to naturopathic medical schools. Their training spans the same four post-graduate years as ours. After that, some go on to residency training, and some go directly into practice. Before going into practice, naturopaths take board examinations, and are subject to state licensing requirements.

The first two years of naturopathic medical school are much like those in any medical school: countless hours in classrooms learning about basic science. The subsequent two years diverge. We in allopathic medicine spend 100-or-so hours a week in the hospital, rotating through the various disciplines from dermatology to neurosurgery. Our naturopathic counterparts do outpatient care, with rotations spanning herbal medicine, traditional medical practices from China and India, nutrient therapies, lifestyle medicine, and so on.

I embraced integrative medicine because I recognized that as an internist, I simply couldn't make all of my patients better. Sometimes they didn't respond to conventional treatments. Sometimes they didn't tolerate them. And sometimes, I simply was at a loss how to help.

I found that my colleagues in naturopathy often had new things to recommend when I had run out. And more importantly, I found that by working together -- a higher percentage of my patients got better. In particular, we were better together at treating the hard stuff: chronic pain, chronic fatigue, and various esoteric syndromes.

There are, I am sure, naturopaths who inveigh against conventional medicine, although I have met very few. Similarly, there are conventionally trained health professionals who are dismissive about all modes of care not involving some patented drug or technology. They, too, are uncommon -- or at least I hope so.

Most of us are in the middle, recognizing that careful and responsible use of scientific evidence is essential, but also recognizing that no one medical discipline fully addresses all human need.

There should be no need to choose between responsible use of science, and responsiveness to the needs of patients who don't respond as textbooks suggest they will. In my experience, both naturopaths and allopaths can function well as primary-care providers -- and both of us function best when willing to call upon one another's help. Care by a rheumatologist does not preclude care by a cardiologist. Similarly, when we make the patient rather than turf our priority, care by an internist, family practitioner, or pediatrician does not preclude the contributions of a naturopath, and vice versa.

As the president of the American College of Lifestyle Medicine, I am obligated to note in passing that lifestyle is the best medicine we have. In general, naturopaths are better trained in, and more devoted to, its delivery than are we in conventional medicine.

Over time, the nature of medicine has changed. There is ever less time with patients. There is ever more reliance on technology and drugs. These can offer powerful benefits, but at times there are kinder, gentler modalities to get the same job done. The best treatment for any given patient is that blend of what works best, what is safest, and what conforms best to that patient's preference. The broader expanse of options conferred by including naturopathy in the mix means that best choice will be accessible more of the time.

The nature of medicine has changed over time. Naturopathic Medicine Week is an opportunity to consider that more respect for the medicine of nature may help ameliorate that.


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