Conscious Choice: The Doctor of the Future

June 2002 | Health Conscious

The Doctor of the Future

by Rebecca Ephraim, RD, CCN

As a consumer, you may like to use natural approaches for your healthcare. You might take nutritional supplements; see chiropractors, acupuncturists, and massage therapists; or perhaps consult a homeopath or herbalist about health problems with which you are grappling. There are many paths to pursuing holistic therapies. However, when it comes to visiting your "regular" M.D., it’s likely he or she may summarily dismiss all of your experiences with complementary therapies as a venture into voodoo.

For instance, a report in the Archives of Internal Medicine last year found that nearly half (49 percent) of people who regularly use nutritional supplements believe that medical doctors are prejudiced against supplement use. Because of such perceptions, patients can be very reluctant to discuss with their M.D.’s complementary approaches to healthcare they might be using. In turn, the doctors are missing valuable information that may be vital to the treatment of their patients.

So how long will it be before a consumer can confidently stride into a conventional doctor’s office knowing she will be listened to with respect and understanding when discussing complementary therapies?

Ben Kligler, M.D., can give us some clues. Dr. Kligler could very well represent the medical doctor of the future. As an M.D. in family practice, he sees the same sort of patients that all regular primary care doctors encounter. Only Dr. Kligler’s approach is vastly different. As the associate medical director at the Beth Israel Center for Health and Healing in New York City, he will talk with his patients about the conventional medicine mainstays of prescription drugs and surgery but also can knowledgeably discuss the various complementary therapies his patients use. In fact, he practices acupuncture and hypnosis as well as prescribes herbs and nutritional supplements. In addition, if he believes that a patient would benefit from other complementary therapies, he doesn’t hesitate to recommend practitioners who specialize in them.

Dr. Kligler practices in the best of both worlds — the best of conventional medicine but also the best of complementary medicine — which has come to be known collectively as integrative healthcare. I believe the introduction of integrative healthcare could be considered a movement in this country. However, its progress has been erratic as the country’s 125 medical schools have been slow to respond to the consumer demand for complementary approaches. Until recently, the required medical school coursework has all but ignored complementary therapies. This is why forty-one-year-old Dr. Kligler — as well as a growing number of other M.D.s who practice integrative medicine — have had to learn about complementary therapies on their own time...outside of their conventional medical school training.

I’m happy to report that this status is slowly changing as U.S. medical schools are beginning to respond to the demand that medical students be trained to know and appreciate the various natural approaches to healing. Notably, the White House Commission on Complementary and Alternative Medicine Policy issued a landmark report in March acknowledging the value of complementary therapies and encouraging medical schools to boost their training in these areas. It notes that about two-thirds of U.S. medical schools currently cover some complementary therapies in their required conventional medical courses while others offer only elective courses in it. Significantly, the commission’s report also points out that students from the medical schools that don’t offer coursework in complementary therapies were found to have "insufficient knowledge" about such practices as herbal medicine, meditation, chiropractic, acupuncture, homeopathy, and naturopathy.

There’s a movement afoot to accelerate medical school education in complementary/integrative therapies. A group of medical schools that has formed the Consortium of Academic Health Centers for Integrative Medicine is taking the lead. Dr. Kligler, who is a consortium member and also a medical school instructor, describes its mission as "setting standards for what medical schools should be teaching in the area of integrative medicine." More than a dozen medical schools have committed to work together to adopt standardized curriculum coursework intended to familiarize medical students — our future doctors — with the details of complementary therapies.

Renowned integrative M.D. Andrew Weil is also a member of this consortium and has been a cheerleader for its progress. "What we’d like," he says, "is to carefully admit others until we’ve got twenty-five [medical schools on board] and can say we speak for one-fifth of the nation’s medical schools. And then call for significant change. I think there’s a real momentum beginning."

Yet despite this progress Dr. Kligler says there are still tough obstacles to overcome. He laments that there is an entire generation of physicians in positions of authority — those who oversee the medical students in ward rotations and residencies — who rebuke the use of complementary therapies. "They were trained in a different time," he says, "and I think most of us in the [integrative medicine] field would agree that the biggest challenge we have is how to bridge that gap between the practicing doctors who are the clinical faculty, both at the medical school and residency level, and this...new idea that we’re trying to bring the medical students up with."

Another issue that concerns Dr. Kligler is the conventional mindset of hospitals and physicians as it relates to treatment approaches. Our conventional healthcare system is based on a disease model that emphasizes treatment long after the disease process has begun. On the other hand, complementary and alternative approaches highlight wellness with the intention of treating patients’ early warning signs before their bodies go completely out of whack and fall into a disease state. "In a bigger societal realm there’s a real issue that hasn’t been addressed yet," Kligler says, "which is ultimately our goal to keep people out of the hospital and ultimately the hospitals’ need for people to be in the hospitals. I think at that level there is a conflict of interest." Of course this relates to the economic health of hospitals.

So back to our original question: How long will it be before all of us can be confident that when we speak to our medical doctors about complementary and alternative therapies, they will listen with respect and understanding?

Dr. Kligler says the change will be gradual. "We’re really talking about a doctor with a different kind of attitude toward whole-person health. I think it’s going to take ten or fifteen years to really change the orientation that we’re looking for. Who knows how much success we’ll have...it takes a long time to change the way people think."

Meanwhile, most U.S. medical schools are producing doctors who have a vague understanding of what integrative medicine is all about. Until these schools get serious about giving their students a solid foundation in complementary therapies, it appears freshly minted medical doctors will be left to their own devices to learn this "new" medicine.

Disclaimer: This column is for information only and no part of its contents should be construed as medical advice, diagnosis, recommendation or endorsement by Ms. Ephraim.

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