Sir William Osler was a Canadian physician and one of the founding professors of Johns Hopkins Hospital. Dr. Osler created the first residency program for specialty training of physicians, and he was the first to bring medical students outside of the classroom for bedside clinical training.
More than 100 years ago, Dr. Osler said, “It is much more important to know what sort of a patient has a disease than what sort of disease a patient has.” Unfortunately, this type of personalized approach has become much less common within our modern medical system of isolating and treating a singular problem without focusing on the whole.
Consider an overweight patient with osteoarthritis of the knee who sees her primary care doctor and is sent for an orthopedic consultation, knee x-ray, and then given a steroid injection and a prescription for high-dose ibuprofen. This approach may be effective at treating the symptom of knee pain, but doesn’t address the sedentary lifestyle, poor diet, and underlying biopsychosocial situation of the patient (more on that next). Even worse, consider the fact that the high-dose ibuprofen may lead to gastroesophageal reflux disease (GERD) and even kidney damage under some circumstances, further disrupting the health of the patient.
Did you know that the biopsychosocial model of disease originated right here in Rochester? Dr. George Engel was an internal medicine physician and psychiatrist who trained at Harvard and subsequently worked in the Department of Psychiatry at the University of Rochester Medical Center.
Dr. Engel believed that to understand and respond adequately to patients’ suffering, clinicians must simultaneously consider the biological, psychological, and social dimensions of illness.
He offered a holistic alternative to the prevailing, reductionist biomedical model of isolating and treating an issue without consideration of the whole. He published his thoughts in the journal, Science, in 1977.
The tenets of Engel’s work were simple – caring for the whole patient involves consideration of the following factors and how they all interact with one another:
- Biological : age, genetics, tissue health and injury, physical health/ disabilities …
- Psychological : mental health, level of stress, self-esteem, history of trauma …
- Social : living situation, peer and family relationships, nutrition, exercise …
(I have simplified this for the purpose of the discussion here).
Consider the fact that many pain problems represent a vicious cycle of physical pain and dysfunction, psycho-emotional disturbances, fatigue, and sleep problems. Addressing only one of these aspects is unlikely to affect the whole system and return a patient to full health and function. I was fortunate to have been trained by physicians who worked directly with Dr. Engel and embodied his philosophy of holistic care. This is the type of care that I have provided to my patients in the last ten years of my practice as a medical doctor.
Medical Acupuncture is the practice of acupuncture by physicians, and as a discipline it represents the integration of classical acupuncture with modern medicine. Medical acupuncture recognizes that any presenting symptom is a complex manifestation and disruption in multiple dimensions of wellness – myofascial (tissue), neurologic, psychological, emotional, and genetic. It is this perfect blend of “western” and “eastern” medicine that led me to develop my practice of Mindful Medicine.