Holistic Medicine: A Brief Intro

 One of the first duties of the physician is to educate the masses not to take medicine. — Sir William Osler

Holistic medicine simply means taking a broad view of the patient and disease. Treat the patient as a whole and not as a 'disease case'. In holistic medicine, the aim is the comprehensive care of the patient in all areas, such as physical, mental, emotional, spiritual, social, and economic aspects.

The word is derived from the Greek ‘holos’ which means entire, complete, whole. The word is not related to holy which means sacred or religious. It is not sacred or religious treatment, a common misunderstanding. I have seen an advertisement by a famous epilepsy clinic, which claims to cure epilepsy by 'pavitra' (holy) treatment.

It is not exclusive to any particular system of medicine but how a doctor practices his system. An allopath may practice with a holistic outlook, whereas a ‘vaidya’ (Ayurvedic medicine practitioner) may not.

For example, a person may come suffering from acid peptic ulcer disorder. The conventional practice may involve giving him a drug to inhibit the acid formation or to neutralize it, whether allopathic or of another system, such as Ayurveda. A holistic approach will be when along with drug treatment other factors are also considered and treated such as a change in lifestyle, diet, job, family or job counseling, stress management, etc.

A common confusion is with the term alternative or complementary medicine. These are medicine or therapy systems different from the accepted or conventional system. It may vary from country to country, e.g. Ayurveda is recognized by the government as one of the mainstream treatment systems in India but is classified as an alternative in other countries. Acupuncture is classified as an alternative or complementary therapy in most countries but in China, it is recognized as a mainstream therapy system.

The holistic approach is already enshrined in WHO definition of health given in as far back as 1948:

          "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity".

Therefore ideally we should pay attention to the mental, social and spiritual aspects of illness in addition to just the physical ones.

Although this definition of health by WHO is quite old, why is holistic medicine in so much limelight now? The answer lies in the increasing incidence of lifestyle-associated diseases. In them, even with the best possible medication, there is a ceiling on effect. We need to address the faulty lifestyle for optimum effect. For example, in hypertension or high blood pressure, diet, exercise, mental relaxation, abstaining from tobacco, etc., plays an important role along with medication to get optimum control of the raised blood pressure and prevention of future complications.

There are many problems being faced by doctors in practicing holistic medicine. The most important problem is the lack of time by Indian doctors burdened with caring for such a large population. Another problem is the lack of training. Medical education by and large places most emphasis on the physical aspect of disease and its treatment by drugs or medicines. Some training is imparted in PSM or Community Medicine classes, but there the emphasis is more on maternal-child health and diseases under the national health programs.

The practice of medicine in a Holistic manner should be the goal of all medical practitioners regardless of whether belonging to the allopathic or other medical systems. It does have some concrete benefits for the patient and is not just something exotic or fashionable.

— ND

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DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal, and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

DISCLAIMER: This article is intended only for fun purposes. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use the information herein is at your one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal, and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board norms.

The Long Discussion

Dr. Dev (Fictional Name) was taking the clinical ward round. A patient with some interesting clinical finding was admitted in the ward.

When Dr. Dev reached the bedside of the patient the discussion turned to the various condition or diseases which can give a clinical picture similar to those present in the patient. As the discussion progressed, a look of anxiety developed on the patient’s face. When the discussion reached the point that the patient’s problem can be due to malignancy (cancer) the patient looked absolutely crestfallen.

When Dr. Dev noticed the look on the patient’s face, he understood that being a highly educated person the patient was able to follow the clinical discussion taking place in English and could understand to some extent the nature of diseases being discussed and considered in his case.

Swiftly, Dr. Dev assured the patient that the discussion was purely academic and for teaching and learning purposes of the residents. His disease is quite simple in nature and will be easily cured. There is no evidence of cancer at present in his case. Listening to Dr. Dev’s explanation the patient relaxed and breathed a sigh of relief.

As many patients in India are not able to understand English, doctors think by discussing the patient’s problems in English the patient can be kept in a state of ignorant bliss. But the number of patients who understands English is increasing in India so that the sacrosanct status of English as medical code language is no longer valid. Doctors indulge in long discussions especially in academic institutions like AIIMS, New Delhi, without paying attention to its effect on the patient.

Even if the patient is not able to understand the actual language, a long period of discussion of his problem raises the doubt in the patient’s mind about the seriousness of his condition. Therefore it is better to clarify and assure the patient about the academic nature of any discussion involving his condition to avoid causing unnecessary anxiety to him.

Even non-medico technical persons are sometimes guilty of such behavior. You must have experienced a similar feeling when you went to the garage/workshop with your car for some minor problem (according to you) and the mechanics there raised the possibility of millions of things which could be causing the problem including complete disassembly of your vehicle to find the cause of the problem.

So, whether doctor or non-doctor, when discussing someone’s problem please keep in mind the effect on the mental status of the person whose problems you are discussing. Take prompt step to allay any anxiety if detected by you.

If you are the patient or the client do not get overly anxious over a long discussion of your problem and ask directly and get clarified any doubt you may have after such an academic discussion.

 (Based on true incident)

— ND
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If viewing from Mobile, switch to Webpage view to see a list of popular posts and index of topics of previous posts.
 DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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The TB Patient

This happened in the Ballabhgarh Community Health Center (CHC) Harayan which is affiliated to AIIMS, New Delhi.

Junior and Senior doctors from AIIMS are posted there to get experience in working in a small setup. The doctors keep on rotating with a posting of few months at the Ballabhgarh CHC.

A patient suffering from Lungs tuberculosis (Pulmonary TB) came for consultation to the Senior Resident (SR) Medicine at the CHC Out-Patient-Department (OPD). The patient was taking medicines for tuberculosis (TB) for the last 9 months. 

The SR noted that the patient had completed the recommended 9 months course of anti-tuberculosis medicines and appeared completely cured of the disease.  (The recommended duration may be different at present time and for different patients.) The SR congratulated the patient and informed him that he is now cured of his disease and can stop taking the anti-tuberculosis medicines.

The patient asked, “Sir, does that means I can stop wearing the face mask in my house and start having close interactions with my family members?”

The surprised SR asked him to explain what does he means by this. The SR was surprised to learn that when the man was first diagnosed with tuberculosis, he had been asked by the previous Senior Resident Medicine to wear a face mask and to avoid close contact with his other family members. This was to avoid spreading the tuberculosis bacteria by the air-borne route to them.

The SR medicine was since transferred back to AIIMS, New Delhi. When the patient came for the next visit the SR was not there and the patient was too intimidated to ask the new SR till what time he had to follow these restrictions. So the last 9 months the patient had worn a face-mask all the time in his house and was maintaining a distance from other family members including his wife and children when the restrictions if needed was to be followed only for 15 days!

The SR informed him that he need not wear any face-mask and can lead an unrestricted life like others. The patient went back that day with a smile on his face but returned next day to the OPD with a large packet of sweets (Indian Mithai) and an even larger smile on his face.

Tip: When advising some restrictions to the patients, clients, customers; such as food, diet, activity, etc. it is better to give them the expected time when the restrictions will be lifted or the time when they may be reassessed. Failure to do so may lead to unnecessary hardship for them.  

Tip to Patients: If your doctor advises you some precautions or restrictions, then ask till what time or till what point are they to be followed. If it is not clear at that time, then you may ask on your next visit about stopping or modifying them.  

(Based on allegedly true incident)

— ND
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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The Wrong Prescription — Part 1

This happened in the early part of Dr. Dev's (Fictional Name) career. Dr. Dev had done Barron’s band ligation for hemorrhoids (piles) in a patient. Along with laxatives and antibiotics, Dr. Dev had prescribed tablet Paracetamol 1 tablet SOS (to be taken only when having some problem and not regularly). Dr. Dev informed the patient that he had written a pain-killer tablet to be taken only when he felt pain.

One week later, when the patient came for the follow-up visit, he complained to Dr. Dev that he had not written any medicines for pain relief but wrote unnecessary medicine for fever which he did not had even a single time.

Surprised, Dr. Dev checked the previous prescription. It was clearly written there, Tab. Paracetamol (500mg) 1 SOS. On pointing out this, the patient exclaimed, “What! That was for pain relief? When I asked the dispensing chemist (pharmacist/medical shopkeeper) which medicine to take for pain relief, he told me that you had not written any medicine for pain relief and to take this tablet when I am having the fever.”

Though tablet Paracetamol has both analgesic (pain-relieving) and antipyretic (fever-reducing) properties, the drug is mainly used in India as a drug to reduce fever. Although quite effective for mild to moderate pain intensity, its use as pain relieving drug is not common. Its advantages as an analgesic over other drugs are that it causes less GI (stomach) upset and does not increase the tendency to bleed, which is very important after any piles treatment.

The chemist with his limited knowledge, following the common prescription use, misguided the patient who had to suffer unnecessary discomfort even when he was having the medicine with him.

Tip: Next time when Dr. Dev prescribed any medicines for an uncommon indication, he made sure to tell the patient, that this medicine is normally used for this purpose, but I am prescribing you for that purpose, so that there is no confusion in the patient’s mind and he will take the medicines as prescribed and not get ‘(mis)guided’ by the chemist or some other person.

Tip for Patients: If you think that the doctor has made a mistake in writing some medicine, it is better to meet the doctor immediately with the prescription and the medicines rather than modifying the treatment according to you or the chemist’s advice or waiting for the next visit.

(Based on true incident)

— ND
© Author. All rights reserved. 

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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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The Long Illness

A patient suffering from abdominal pain consulted Dr. Jolting (Fictional Name). The patient said, “I am very worried as I am having this pain for last 5 years.”

Dr. Jolting replied, “The fact that you are having the pain for the last 5 years is a good sign. It is the reason that you should not worried about your illness.”

The patient looked at Dr. Jolting as if he has gone mad. “What is this nonsense you are saying? How can my having the abdominal pain for 5 years can be a good thing?”

“What is important in any illness is the cause and not the symptoms” explained Dr. Jolting. “The abdominal pain is just the symptom, i.e. the manifestation of some disease in the abdomen. The fact that you are having abdominal pain and still alive and relatively healthy even after 5 years means the cause of your abdominal pain is not some serious disease like cancer or tuberculosis. It’s most likely a functional problem which will get relived by proper diet and medications.”

“So don’t worry. Psychological worry sometimes plays a big role in abdominal pain.” adviced Dr. Jolting.

It is indeed taught in medical school that malignancy or cancers have a short duration of illness and benign diseases a long course. A long duration of illness may be paradoxically a good sign from a pathological point of view, although a distressing point for the sufferer.

(Based on true incident)

— ND
© Author. All rights reserved. 

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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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The Architecture Student

A young lady came for consultation in the Surgical Out-Patient Department (OPD). She gave history of abdominal pain in the upper part of abdomen, which was not improving despite taking treatment in Jaipur and in Kota. She was highly worried as no doctor had been able to give a satisfactory answer to reason for her problem.

A young lady came for consultation in the Surgical Out-Patient Department (OPD). She gave a history of abdominal pain in the upper part of the abdomen, which was not improving despite taking treatment in Jaipur and in Kota. She was highly worried as no doctor had been able to give a satisfactory answer to the reason for her problem.

Dr. Dev (Fictional Name), who was sitting in the OPD, examined the patient and went through her old treatment prescription slips.

After contemplating for some time, he asked her, “What are you doing in Jaipur?” The young lady replied, “I am a student of Architecture in a college in Jaipur and live there in the hostel”. 

Dr. Dev next asked, “Was there a party in your college the day before your pain started?” “Yes”, replied the lady after thinking for some time.

“Well”, replied Dr. Dev, “your pain is related to the Alcohol you consumed at the party.” “It appears you have a mild case of pancreatitis induced by the Alcohol. We will do some tests to confirm this, but as it is a mild case you should get well soon.”

For Non-Medicos:  Pancreas is a deep-seated gland in the upper part of the abdomen, which secretes many hormones including Insulin and other digestive enzymes. Pancreatitis is an inflammatory process of the pancreas usually due to gallstones or alcohol intake. In its severe form it can even cause death of the patient.

The young lady exclaimed, “Thank God! I did not bring my mother along to the OPD.”

After the lady had gone, the senior resident looking impressed asked, “How did you guess that her problem was related to alcohol intake and how did you had the guts to ask her that she had taken alcohol?”

Please note: In India, consumption of alcohol by females is still not socially accepted widely.

“If you forget that she was female,” replied Dr. Dev, “then there is history of young person living in hostel away from family, in a creative field, in a urban progressive centre, whose pain started after a party, who has been adequately treated for gastritis and acid-peptic ulcer disease then you will think of alcohol-induced pancreatitis. Don’t let just one factor, the gender, blind you to the other factors pointing towards the diagnosis.”

Tip: If you have excluded the common diagnosis, the uncommon should be considered.

Tip: Don’t let the gender of the patient stop you from considering all probable diagnosis.

Tip: History of the patient is best taken in privacy even from relatives, otherwise they may be shy and hide part of their history which they think may not be acceptable to their family.

Tip for patients: It is better to have a consultation with doctor in private as you do not know what questions the doctor can ask in relation to your illness.

(Based on true incident)

— ND
© Author. All rights reserved. 

If viewing from Mobile, switch to Webpage view to see a list of popular posts and index of topics of previous posts.

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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