Hippocratic Medicine

Hippocratic Medicine.  It’s time.  Again.

As Dr. Phil would so often say to someone with unresolving issues, “How is it working for you so far?”  The answer is usually,  “It isn’t.”

And so too with primary care medicine, despite the most sophisticated diagnostic capabilities in history, the most advanced medicines ever, more scientific knowledge than ever, the largest amounts of money ever spent each year on “health” (or should that be disease?) care, more doctors than ever, more specialists than ever, more hospitals than ever, we have more disease than ever, some of which are skyrocketing at rates never before seen in human history.  Emergency departments, hospitals, walk-in clinics, are all overwhelmed.  Waiting times to see GPs (if you can find one) and specialists just get longer.  So, how well is it working for us so far?

Diabetes. Obesity. Alzheimer’s/dementia. Hypertension. Depression. Many cancers. Heart disease. Stroke. Allergies. Osteoporosis.  Arthritis. Resistant bacteria. And more.  Much of this list has no cure, only the prospect of “stabilization.”  Is this the inevitable result of somehow flawed human genes?  Or is much of this influenced by environmental factors?  Diet. Sedentary lifestyle. Smoking. Alcohol. Street drugs. Prescription drugs. Stress. Poor sleep. Poverty.

When Dr. Phil asks this question, he is essentially prodding his patient to get out of a comfort zone, and to consider a paradigm shift, to change an approach.  Otherwise, as they say about the definition of insanity, the patient will continue to do the same thing over and over, yet somehow expect a different result.

So when do primary care physicians consider a similar paradigm shift? How bad does it have to get? Is long-term optimism for a healthier population somehow justified? Perhaps physicians don’t feel comfortable about stepping into a realm in which they have had little or no training.  Perhaps they prefer fee-based medicine, given that preventive health care has no fee codes.  Perhaps they are so busy every day,  that there is no time left for such unendorsed esoterica.

Yet don’t all docs take pride in their ability to help people, not only to get better, but ultimately to thrive?  If the community decided it wanted to be the healthiest community in Canada, would not primary care physicians be able to take a leading role in how to do that?  Physicians themselves have many good health habits, so it seems simply to find a tool or skillset to share this information with their patients.

Has medicine lost its way?  We do not have a health care system, as that implies we manage and indeed optimize health.  More accurately, we have a disease care system, where interventions occur only after a disease has been recognized, and the management of chronic disease often follows.  Physicians don’t cure much, and we prevent even less.  Yet, we could do much more with this if we had the right kinds of CME, not the stuff supported by Big Pharma.  Or perhaps the right kinds of resources.  Or simply, the consideration of a paradigm shift.

If we all look carefully, many of our patients are screaming for alternatives—they don’t particularly like the, “for every disease there is a drug” model of primary care.   They read the lay press, and the best sellers on health; They are are nervous about submitting themselves to potent drugs and significant surgeries—they are searching for a better way.  And, although the word “natural” has become so overused as to become almost meaningless, patients often ask for “natural” solutions to their problems; since physicians don’t seem very good at supplying these, they go to naturopaths, chiropractors, herbalists, homeopaths, natural foods/vitamin stores, bookstores, and health websites in the hope they can find something that makes more sense to them, that is somehow safer, cheaper.

And of course, there are patients and physicians alike who love the magic of a pill to solve a problem.  A doctor can write a prescription in 30 seconds, and a patient can take the drug without any real buy-in to participate in a meaningful solution.  As Dr. Joel Fuhrman once said, “A written prescription is essentially a permission slip (for the patient) to do nothing.”  If the patient and the physician are on the same page on this, inertia will reign, until someone gets unhappy with the results, or lack of, and asks the Dr. Phil question.

Yet where modern medicine is today is a far cry from where medicine was some 2400 years ago.  We have been taught to honor the principles of Hippocrates, who established the framework for “clinical medicine”, and who separated the discipline of medicine from religion, believing and arguing that disease was not a punishment inflicted by the gods, but rather the product of environmental factors, diet and living habits.  Hippocratic medicine also brought with it professionalism and discipline, and gave importance to the clinical doctrines of observation and documentation, and to first, do no harm; the Hippocratic Oath remains the seminal document on the ethics of good medical practice.

“To keep a man well, he must also take up exercise.”

So what would Hippocratic medicine remind us of today? Its therapeutic approach was based on “the healing power of nature (“vis medicatrix naturae”);  Hippocrates has been credited with quotes such as,  “Everything is excess is opposed by nature”, “Let food be thy medicine, and let medicine be thy food”, and, “To keep a man well, he must also take up exercise.”.  Yet physicians today are taught almost nothing of the biochemistry and implications of nutrition in medical schools, or the tremendous health benefits of exercise, while paradoxically being trained well in the pharmacological benefits of a litany of purified chemicals, many of which have been elevated to the status of “scientifically proven” by companies that can afford to do the research.

“Let food be thy medicine, and let medicine be thy food”

So what is wrong with prescribing exercise, or dietary changes? Why not take fullest advantage of what is medically possible with exercise and/or changes in diet, before doling out pills?  After all, we are what we eat—almost every molecule that is in a human body got there by the ingestion of food.  And our body was built to exercise–our survival depended on it. Exercise has been repeatedly demonstrated to reduce multiple disease risks, in some cases, dramatically.

And of course, the healing power of nature that Hippocrates noted goes well beyond dietary choices and regular exercise.  Other very important determinants of health include good quality, restful and restorative sleep, a healthy environment, managing stress, healthy self-esteem and balanced mental health, healthy social supports, dental health, and probably most important, an empowered life, with freedom from poverty, addiction, war and/or oppression.  Here too, medical training covers these topics poorly, if at all, as well.

This website will eventually give life to all of these topics, but will begin with the topics of exercise and diet, for those who have the ability to direct their life path.  We hope the information is useful to both physicians and their patients.