By Lisa M. Belisle, MD, MPH
Originally published June 29, 2006, Community Leader

We have reached a low point in medicine. Patients are frustrated with the healthcare bureaucracy, doctors feel overworked and undervalued, and everyone is concerned about the cost of offering decent services. One of my physician colleagues describes our current situation as being in “the valley of medicine.” I like this analogy because it offers a degree of optimism: as with any low point, the only way out is up.

One of the first moves on our upward journey should be to re-emphasize the importance of the doctor-patient relationship. (I am using the term “doctor” instead of the more generic “provider,” but I am referring to all relevant healing professionals.) Studies have shown that 50% percent of patients do not follow their physician’s recommendations. Whether this is failing to take prescribed medication, or not adhering to dietary guidelines, we (as patients) are not taking the advice we have sought. This is due in large part to a breakdown in communication. Often we do not have enough time with our doctors to believe that they truly comprehend our circumstances. According to the PBS series, The New Medicine, an average office visit lasts just six minutes, during which we have approximately 23 seconds to describe our most pressing problem. Yikes.

Physicians need to have more time with their patients and learn more about their lives. Dr. William Osler wisely said “More important than knowing what kind of disease the patient has, is knowing what kind of patient has the disease.” Knowing what kind of patient has the disease enables doctors to make more realistic recommendations. Patients who feel listened to and understood are more likely to follow these recommendations, as they become legitimate members of their own health care team.

The team approach is crucial in modern medicine. Physicians are becoming increasingly aware of this, and of their own limitations. At an acupuncture training course I attended this past June, the room was filled with open-minded physicians who wanted more options for their patients. Healthcare systems are also realizing the benefit of offering alternative choices in combination with more traditional medicine. The Maine Medical Center is home to a progressive Integrative Medicine Program, which combines such therapies as massage and Reiki with more traditional medical care (FMI, call the MaineHealth Learning Resource Center at 207-781-1730).

Patients are, of course, the most important members of their health care team—and they need to make sure that team succeeds. We know that Americans are overweight, and in most cases we know why. We eat too much of the wrong foods, and don’t exercise. It’s pretty simple. When I ask my patients about their weight, they readily admit that they are not making necessary changes in their lifestyles: they are not doing the work. Sometimes this is due to legitimate food addictions, or deeply ingrained habits. There is a delicate mind-body balance. When we are stressed, we don’t eat well, and our activity levels plummet. As individuals, we have to decrease our stressful activities, or learn to adapt, to get ourselves back in balance. If we require assistance with this (through biofeedback, meditation or other practices) we must locate that help. We need to find a team of healthcare providers who can guide us—and we need to do the work.

As we’re working to improve our own health, we should keep in mind that our habits have an impact on others. In Traditional Chinese Medicine, the body is considered to be a microcosm of the universe. When we are harming ourselves, whether it be by eating poorly or ignoring our stress levels, we may be shortening our lifespan. This robs our families and communities of our companionship. On a more global level, when we value our own well-being, we seek changes that make our communities more beneficial to others. We make sure we have healthy food to eat and pure air to breathe. Caring for ourselves is akin to throwing pebbles in a pond—the ripples of impact spread outward indefinitely.

While we may have hit a low point in medicine, there is hope for the future. Wellness is possible, with a strong doctor-patient-healthcare team, a willingness to do the work, and an understanding of our impact on others. Rays of sunlight have begun to illuminate the paths out of the valley. If we follow them, we will find our way.