The "Real Issues"

Earlier this month I wrote that I'd need more time to think about this issue of what's at the root of our drug problems. The other night I had the privilege of joining a speakers' panel of area complementary and alternative medicine providers at a graduate class of nurse practitioner students. One of the things that came through most clearly from all of us was the multifactorial nature of the human experience of health and disease.

Another thing that came out clearly was the dual nature of our relationships with physicians--I'll note that no physicians were on the panel. To be fair, I don't know if the instructor tried to bring a physician onto the panel, although I know who's who around here: It's likely that there simply wasn't anyone available. Both physicians whom I know actually "get" this are in various stages of retirement. One I know of would speak for one of my classroom panels at Penn State because I wouldn't pay him for it.

So that "dual nature", what about that? Well, we all agreed that physicians are often a key part of the healing journey for many people. Although most physicians I've ever know view themselves as the key part of any health journey--even though they receive little instruction in holism and therapies beyond Western biomedicine. So yes, they can be very important, but they are not the only part, and in some cases they aren't necessary at all. (In fact, sometimes they are an impediment to health!)

Conversely, trying to integrate our work with that of physicians? Well, we all agreed that's a fraught adventure, at best. After all, why would physicians, say, refer someone for Reiki? They don't even collaborate very well amongst themselves! We'd like to work more with them, but they view us as variously as unimportant parts of a plan hatched by eccentric patients, as cranks, or as nuisances. They don't understand energy medicine, chiropractic, spirituality, homeopathy, nutrition, art, dance, or culture.

Ok, ok. I'm painting them here with a rather broad brush, and I know for sure that some docs aren't described by what I'm saying here.

But don't underestimate the acculturation of physicians. Acculturation is the process of beginning with ordinary people and imbuing them with a certain cultural stamp. The acculturation process that physicians undergo is very powerful. Western biomedicine is the most powerful, and most important system. It treats diseases, and when it tries to prevent them, it relies on simple instruction to patients, which patients are expected to follow, and when they don't, physicians can feel absolved of responsibility.

It is prescriptive, and not just in the literal sense of writing drug prescriptions. Students are told they are the final word on matters of health and healing. They're "in charge". They are taught to act.

I have to say that, in person, the outward results of this acculturation are not uniform. Culture doesn't trump personality. But depending on the peculiarities of personality to yield a large crop of physicians who are spiritual, holistic, imaginative, and who think cooperatively with practitioners outside their own discipline is unlikely. Some medical schools are taking an approach closer to that proposed by Dr. Andrew Weil: a curriculum that cultivates such thinking as I detailed in this paragraph. But we're a long way from that being a universal educational goal in American medical schools.

Then there's the practical pressures faced by physicians once they graduate and begin practice. Pressures to produce revenue, pressures to adhere to "evidence-based-practice" guidelines that are based on population models, pressures to conform to a system that demands data, pressures to prescribe the newest, most expensive drugs, pressures to follow the law and also guard against liability, all of these bear on the poor guy or gal in the white coat who now works in a corporate-owned medical office in a gigantic health care system.

It shouldn't come as a surprise that most authorities estimate physician suicide at about 1 physician per day! Drug abuse rates are at or somewhat higher than the general population. So, considering both the social authority and power of being a physician and the expectations society places on our doctors, I don't find it that surprising that younger docs seem more willing to share, to collaborate with others .

Maybe they are just tired of having every-single-thing on their own shoulders. Maybe they want to spread the liability around. I don't know but whatever it is, I'm glad for it.

So like a lot of things, culture changes with time. So maybe the culture of American drug dependency will change with time too. My patients complain that doctors want to "prescribe a pill for everything" and yet so many American do just want a pill for everything. Is it any wonder we've ended up where we are?