Friday, March 20, 2009

Havad Yad.... (Harvard Yard in non Bostonian)

Herbert Benson, MD. Prior to March 15, 2009, I have only heard of this man via the teachings of my idol, Andrew Weil. I decided to take the chance on learning a little on Mind-Body Medicine since it would be a few months until the completion of my wife’s clinic (and when open, I probably won’t have much time short of driving the kids to school). It was a last minute registration but after pleading with the person that takes care of registration, I was told it would be ok. I anticipated that I would be taking more pictures of scenic Boston than listening in on the course. Boy, was I surprised. First there was the awe-struck state of being in an institution where the leaders of medicine have graduated from. Then there was the fact that the man running the course has developed his own passion for a division of medicine that prior to the millennium was considered only catering to hippi boomers that lived in compounds or only ate vegan style. My feeling is that because patients had demanded approval from their doctors of alternative remedies and “eastern” techniques (not to mention that the Rheumatologic community had placed women with depression, muscle pain and sleep disorder into what doctors term a “waste basket diagnosis”) that doctors had to do some superficial investigation of these successful word-of-mouth treatments that they could find no journal studies on so they were placed into the same category as “chiropractic medicine”. This was an all inclusive “non MD” club that was successfully taking care of a lot of symptoms but still considered back crackers and only successful because they saw the patient frequently and placed warm hands on spasmed areas that gave a false sense of security to someone in pain that would have just improved in the same amount of time anyway. (Forgive my one sided theoretical opinion my chiropractic brothers). This was the reasoning that many a medical resident had upon graduation to the real world of getting a paycheck that dwarfed anything ever conceived as a medical student or first year resident. It was still the pervasive thought of many an attending I would run into while in the halls of my previous hospital in the “center” of “Dupage” county. This is not to detract on the talents of my fellow family practice doctors or medical specialists; this is just to reiterate the common feeling doctors had when patients would bring up the fact that a friend or neighbor suggested a local “DC” as a possible suggestion for second opinion when the back pain didn’t get better with physical therapy or injection of steroids. Patients were even apprehensive when interviewed and asked “have you ever tried “alternative” medicine techniques thinking the doctor would lambaste them if the truth was divulged that the previous back problems were gone after one or two visits to the local “manipulator”. I even see patients in the ER at Rush-Copley with a history of chronic back pain prefacing their most recent visits for therapy with; “I know you guys don’t like chiro’s but I went to see one”. … (and usually with good success!) Doctors have adopted an unchallenged bias against a concept of health care that we don’t understand and choose to ignore. Same goes for when I came back from UCLA with Medical Acupuncture certification and the first patient I treated was my nurse who was suffering from carpal tunnel of her wrist and I did the “suggested” needle placement and after 10-15 minutes, the needles had fallen out but the pain for several weeks was no more. Again after seeing a referral from a partner for “Shirley” a lady with chronic headaches that the neurologists and headache specialists in downtown chicago couldn’t help but with a few needles, the pain of several years was gone (albeit for 1 hour but still gone). I stumbled onto a facet of medicine outside the normal realm of allopathic teaching but it gave more immediate relief than any other treatment I have ever tried.
Patients were getting results, they were telling their friends, I was believing there was something to “alternative medicine” and I didn’t require a prescription or a consult. But as the corporation changed, so did the tolerance for anything outside standard operating procedure/protocol. My clinic which had been started by a small group of senior residents from West Sub Family Practice was recorded as being in the red for the last several years (even though we were able to “drop” HMO’s in the 90’s and see less patients per day and yet get reimbursed more than we ever had since the clinic started, all in attempts to not narrow the delicate patient visit down to 10-15 minutes at a time.) Well, I digress. What ultimately drove me to Harvard to learn from the best, was the desire to feel rectified in making those suggestions of nutrition, yoga, breathing, chiro and acupuncture to folks who were coming in with 3-4 pills for one or two medical issues. (Symptoms mostly from stress or anxiety), with only more pills to come in the next 1-2 decades. I knew I was right, the patients would always breath a sigh of relief when I agreed with there need for seeking out alternative treatment plans aside from permanent surgical destruction. The only problem was my insecurity in suggesting and writing prescriptions for chiro, massage or supplements at Whole Foods. I guess I needed vindication for what I was doing now in addition to leaving what was a regular paycheck working for an institution that didn’t acknowledge the trickle down cash that was generated from my continued patient loyalty for the very same practice style that I now am being questioned for since it didn’t make same amount of money as the average family practice doctor practicing in the US. (If you don’t bill what everyone else is billing, you must be doing something slow or wrong-or perhaps “spending too much time with patients who could easily be treated for what they signed up for in less than 10-15 minutes). If you have ever tried to pacify a crying widower or a man let who was just told his prostate may be cancerous, or a lady who has an abnormal mammogram and answer all questions with reassurance everything will be ok then pacifying an angry family member who doesn’t believe this is a correct diagnosis in less than 10-15 minutes and have been successful, you are a great time management person. Don’t get me wrong, it can be done. In a previous blog, I mentioned that there are some man-doctors who take pride in the high volume they can see in one day or the billing they can charge in one day and surely, an office like that has to be running at it’s maximum efficiency. From front desk to triage phone nurses to medical records to clinical nurses to billing staff. Quite a mouthful of people to pay every week just to keep on time and send those bills out to your insurance company. A great production line type of office. Reminds me of those Visa commercials where people are going in and out of a coffee shop all flowing fast and efficiently until one guy wants to pay with cash. At that point the whole system shuts down and no one gets coffee, no one serves coffee and the only way to get the flow again is if the guy uses his visa card. Same with the contemporary medical office, everything flows well with your sick care as long as it’s the usual sickness. Oh, and those are all found to be standard as long as your symptoms fit into a category that was determined by a large research company to be symptom x equals diagnosis y. Did I mention the research companies are backed by drug companies? Finally on your way out of the office, you are given a few scripts that will take care of your sickness, with the medicine that the drug company makes!
Oh oh, sorry, I still hold myself in a defensive posture when I talk about old times. The bottom line is that Dr Benson and his team at Harvard, have been going to the point of DNA and genome expression showing changes with things like mediation. There is no way to argue against DNA as proof that something as easy as “relaxation technique” from the 70’s will work to offset massive symptom lists found in our patients diagnosed with fibromyalgia, menopause, chest pain, anxiety, depression, chronic pain…… the list is endless. On my way back from Boston, I ran into a young newly hired biomechanical sales representative. This is typical, she told me at one point in her life, she was able to get off bronchodilator inhalers, inhaled steroids and oral steroids but had a flare up that put her back on all her meds. She was focusing on the fact that she has to be on inhalers and oral steroids again and her medical problem will never go away and she’s tired of taking medicines (that can lead to early osteoporosis). I told her a simple fact that at one point in her life, she was able to get off medicines and stay off. Perhaps her doc did every test, or maybe dismissed it as “see, you stopped your meds and it flared up”, or maybe no one listened to her cause she was embarrassed to say she found a time in life that needed no meds. I told her not to “poopoo” western medicine right now but after her life is settled a little to give me a call and perhaps we can go through in detail what she did and when she did it to recreate that life success she was able to attain.
I would try omega 3 fish oil, stop exposure to dairy and flour (anything enriched or processed), probiotic to strengthen the gut, might look into adrenal fatigue and medical acupuncture and yoga. With the short time I was talking to her, the high pressure will have to be addressed especially with a new sales job. But that will be another blog………..
The other health professionals I met at the Harvard course were some of the people that will change the way medicine will be practiced in the near future. The great thing was that these folks I met were from; US, New Zealand, Colombia, London, Singapore, Italy, California, Michigan to just name a few places. It’s not just booming in the US…..we’re talking global! I know I’m doing something right!