When speaking with my less “crunchy” peers, I have encountered a considerable amount of resistance to ideas that have initially taken hold in naturopathic or integrative spaces: food as medicine, making “non-toxic” swaps, meditation, or reiki to name a few.
As humans, we certainly love a good “us” vs “them” mentality: tribalism and all.
But the reality is many of us have seen harm done to patients who have sought care in less traditional spaces.
I still remember sitting at a case conference as a 3rd-year medical student learning about a baby who suffered a catastrophic stroke after a newborn chiropractic adjustment.
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Now as an academic allergist/immunologist, it isn’t uncommon for me to see a patient who traded a long list of pharmaceuticals for equally long (or longer) lists of vitamins and supplements in an attempt to rebalance or boost their immune system.
Since neither worked, the patient was referred to me as a 5th opinion.
A Hail Mary pass of sorts given my focus on using the increasing body of evidence supporting lifestyle medicine as part of my practice paradigm for managing misbehaving immune systems.
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Theoretically, practicing evidence-based medicine (EBM) should eliminate the problems with anecdotal medicine, right?
And yet, so often studies are flawed.
Too small. Biased by funding.
Not looking at a patient-oriented outcome.
The population we are studying doesn’t match the patient we want to apply the knowledge to.
How often do the artificial conditions placed on patients and physicians in studies stray far from the “real world” realities of budgets, time, and energy?
Or the cultural bias inherent to relying solely on EBM ignoring the millennia of rich traditions found in non-Western cultures.
So what are we left to do?
- We do the best we can with what we have.
- We assess the strength of the evidence and its limitations.
- We consider the potential harm of action or inaction. The possible benefits.
- We look at practicality. Sustainability.
- And a question we ask a bit less often, what are our own biases?
The reality is many of us have seen harm done to patients who have sought care in less traditional spaces.
When it comes to supplements, I am open with my patients about my biases.
There is nothing like turning yellow and then having a former intern turned hepatologist place a big needle into your side to find out that superfood supplement wasn’t so super after all.
It is hard for me to fully check that bias at the door but I do my best.
When having these conversations, I am often reminded of the saying, “Those who live in glass houses shouldn’t throw stones”. Harm occurs amongst our own: missed diagnoses, an incorrect dosage or drug but more insidious are the clinician-associated traumas. It is easy to see how an adversarial visit or gaslighting could drive patients away from medical care thus delaying diagnosis and treatment.
Sometimes, though, it is the language that, frankly, I wouldn’t have thought twice about until I found myself on the other side of the exam room.
“You look fine to me”,
“Labs are normal”, or
“Do you think your weight/stress may be causing XX”
To someone on the diagnostic odyssey, this language can feel like death by a million papercuts.
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We are humans, not superheroes, not God.
We all have our biases and view our practice of medicine through the lens of our personal experiences and education. We are also increasingly pushed to our own limits by the very dysfunctional system we attempt to function within and hurt people hurt people.
At the end of the day, we all took that oath to do no harm.
Perhaps we need to consider this oath from a more holistic vantage point – one that encompasses our own health, biases, and limitations as we redirect back towards that North Star of nonmaleficence.
