The patient is not a vehicle
Human life can be perceived as happening on three levels: body, mind, and spirit. The diagnosis and treatment should also refer to all of them. In an interview with Preeti Agrawal, a gynaecologist-obstretician of Indian origin who has been working in Poland for over 20 years, Krzysztof Boczek talks about the holistic medicine.
Do Polish doctors really treat their patients as if they were vehicles: machines consisting of parts, which are meant to be serviced?
This does not only refer to the Polish doctors, but this kind of assumption seems to be valid for the Western medicine as such. In this system, the doctors are supposed to solve problems by dividing the human body into parts, pinpointing the fault in the respective part, and repairing them. What they treat are organs defects. If the patient happens to have several health problems, then each symptom is supposed to be treated by a different specialist, e.g., the gastroenterologist treats the stomach, the gynaecologist deals with menstrual disorders, and endocrynologist – thyroid gland.
By using this kind of approach, the doctors do not treat the person as a whole, but they seem to assume that each and every part of the human body is a separate entity that functions without any connection to the whole organism. The patient, on the other hand, has no choice but to visit and consult different specialists.
What, in your opinion, should the treatment look like then?
It’s not my role to judge whether this approach is correct, all I can say is its not effective. The situation calls for a reflection whether this approach is the right way of dealing with health issues. It has already been stated by Hippocrates that “it is far more important to know what person the disease has than what disease the person has.” I literally took this statement to my heart, and I have to tell you that this seems to be what the whole secret is about. When I meet a patient with a particular health problem leading a stressful lifestyle I know she or he needs to be helped physically as well as emotionally.
Apart from prescribing pain killers, anti-inflammatory, antibacterial, and other medicines, we should also help the patient to understand the roots of their illness. The real purpose of the treatment is to avoid the recurence of the illness. Even though our system treats the patient in a way that does not really bring the expected results, there haven’t been much effort put into changing the education of the physicians. There are, however, some open-minded doctors who see the deficiencies of the system and search for some different, alternative methods of treatment. They study homeopathy, acupuncture, Chinese Medicine, etc., and incorporate these methods into their practices.
But there is, literally, only a bunch of doctors like that and the reason is that reaching for new methods requires going off the beaten track. It means that we would have to look for new solutions and embrace a change of the whole paradigm. This is definitely not a convenient and easy way. In my practice, I combine the Western medicine with alternative methods of treatment. I use good quality diagnostics, and I do not exclude the possibility of an operation. But after, let’s say, the myoma has been removed, the question is why it appeared, and how can we avoid recurence. The Western medicine does not provide any answers to this kind of questions.
How can the doctor diagnose then why this, let’s say, myoma had appeared?
A human being does not consist only of the body. We are also determined by our emotions, psyche, mind. Very often it’s the emotions that dictate our body how to act: for instance, when we are in love, our immunity gets boosted, and when we are depressed, we start falling ill very quickly. Emotions play a key role in every illness. According to the Chinese Medicine, we consist of the body, mind… and the energetic system. And this medical system with the last of the mentioned spheres.
Human energy, on the other hand, depends on the environment the person lives in: on social relationships, their jobs, or life situations like divorce or some other stressful events. The basis of the treatment is, therefore, getting to know this particular person and all the factors that may influence his or her health. This is crucial especially for women, as they often suppress and internalise accumulated emotions. This disrupts their endocrine system. Also, if there is a genetic tendency: if the mother or grand-mother suffered from myomas, than the risk of having the same problem significantly rises. The diet is also of utmost importance. If we eat a lot of refined foods or sugar, than this also disrupts the endocrine system and contributes to the appearance of myomas.
All these elements constitute a logical system of interdependence and answer the question why the myoma appeared. The education of the patient is also very important in this holistic way of treatment. When you get to know the person, it is easier to explain and persuade her to change habits so that next myomas will not appear. This way of treatment is beautiful, but it does not provide any ready-made formulas.
Is medicine an art then?
Exactly! The holistic approach is a very demanding one: the physician has to be up to date with the Western medicine news, get to know the patient well, and decide whether a particular way of treatment actually work for him or her. Also, in the medical practice the doctor cannot restrict his or her treatment to only one alternative method: the Ayurveda, Chinese Medicine, or another one. He or she should integrate these systems in a way that serves the highest purpose of improving the patient’s health.
Emotions have an immense impact on our health. If a person is emotionally integrated, the body does not fall ill. The illness is the body’s calling for help to come back to the state of homeostasis. Nevertheless, the Western medicine treats an illness like body’s enemy that has to be destroyed. These are two dramatically different approaches to a human being and to the illness. The problem is that there are no schools that teach this holistic method in practice.
Do you mean in Poland, or, generally, in the world?
There are some schools in the United States, but this is almost nothing on a global scale. There are institutions which teach Ayurveda, Chinese Medicine, homeopathy, etc. The holistic approach though, has to combine these with the achievements of the Western medicine. Also, it is necessary to invite psychologists, psychotherapists, physiotherapists for cooperation. Only then will we be able to create a team of people capable of helping the patient. I believe that there are no incurable illnesses, only incurable people.
If a contemporary doctor wanted to treat all patients in the way you are describing: get to know them, enquire what is wrong with their emotions, he or she would need a lot of time for an interview only. Normally, however, a doctor has about 15 minutes for this, plus a check-up, and the diagnosis. The approach you promote seems to be unreal to perform on a larger scale.
Of course, it does take a lot of time. But this problem can be solved. Before the patient comes to my surgery, he or she has to fill in a detailed form. This might take even up to 30 minutes. When this person comes to me, I already know his or her story and I also know where the crucial issue is.
When the case is easy, 15 minutes is enough time, but in a complicated one, even 30 minutes might not be enough. And, also, it is not possible to deal with everything during this one visit. Even the holistic method has to begin with providing an immediate necessary help to the patient. Only after that there is time for learning more about the person and taking the next steps in the treatment, provided that the patient actually wants to eradicate the roots of the illness, and not only the symptoms.
Do you know any country where the integrative, holistic treatment is a common practice?
There are no places where this kind of medicine is practiced all over the country. One of the most open countries in this respect is Germany though. The Western medicine is on a very high level there, but also, they are more conscious and open to practicing unconventional methods.
The healthcare funds refund treatments like that and the opticians treat many eye diseases with acupuncture. Paediatricians do not prescribe antibiotics straight away, but they use homeopathy instead: these medicines are very common there. In Germany there are many medical practices that use the integrative method. Also, osteopathy has been incorporated into the hospital care in many countries, such as Great Britain, France, or Germany. Switzerland is very open to the integrative medicine as well.
If you could revolutionise the Polish health care system and make it more holistic, what would you do?
I would definitely start with organising trainings for doctors. This would make them more aware of the relationship between the nutrition and health and also encourage them to pay more attention to the crucial issue of the patient’s diet. Later, there would be trainings in specific therapies, such as osteopathy, so that the doctors start recommending these therapies also to the patients. I would encourage physicians to cooperate with, for instance, dieticians. Small changes like that would significantly change the quality of the medical care.
After that I would move on to the education of students at medical universities. In Germany, there is a 6-month course in herbal medicine and homeopathy in the curriculum. Thanks to this, the students are more aware of these alternative methods and more open to incorporating them in their future practice. Still, this would not be a totally holistic approach yet, but only a prelude to this. Because, to become a holistic doctor, one has to perform this job for many years, and also do a lot of work on oneself. But even in this kind of medicine there would be a lot of integration. And the root problems of illnesses would be acknowledged too.
If this integrative approach is more effective, are you able to prove this with adequate scientific research? Did you come across such papers?
There is research evidence that shows that the holistic medicine gives better results. These papers are being published in magazines with the impact factor. The problem is that we cannot prove everything, as the integrative treatment is multidimensional.
If there is scientific evidence then, why are the benefits of holistic medicine not used in our culture?
They are used! In Poland, for instance, acupuncture is gaining more and more enthusiasts. In Germany, many people admit using the Eastern Medicine methods, such as the Chinese Medicine, Ayurveda, or herbal medicine. These methods are becoming more and more popular there.
But one thing has to be stated at this point: using different alternative methods of treatment does make the treatment holistic. The holistic approach reaches even deeper: it looks for problems in the psyche, spirit, and body of the patient.
The integrative approach also includes analysing the emotional states of the patient. How do you check them? With the form that you have mentioned before?
Yes, I ask my patients what is happening in their lives, what has happened recently. And when the patient comes into my surgery, I observe her emotional state: her behaviour, the way she sits, walks, her face expression, etc. But mostly I make use of the information in the form.
How does it influence your clinical decisions?
I help the patient by having a conversation, prescribing specific medicines, vitamins, I recommend different therapies which, for instance, strengthen the body. Also, I often recommend specific books to read as I believe that a person can also heal on their own. By talking to the patient I encourage them towards self-healing. I try to cure them on physical level, show them ways to be more self-sufficient, and help “install” new behavioural patterns. Naturally, all these will not happen during one visit. It’s an ongoing process.
Exactly! Motivating the patient for the treatment… Do you think that the doctors in Poland motivate their patients enough to participate in this process?
This is still limping a little bit. There are doctors who do encourage their patients to quit smoking, start taking exercise etc. Usually though, from a psychological perspective, they do it in a way that resembles the relationship between an adult and a child. In holistic approach, the doctor is the patient’s partner in healing who sees their potential and helps discover them.
I have read some reviews on the Internet about you as a gynaecologist. This has led me to the conclusion that not all the patients accept this holistic approach to the treatment. That, apart from the doctors, the patients would also have to accept this innovative approach. Have you got any ideas how to change this attitude?
I haven’t. I tell my patients that if that’s not the treatment they have expected, they can find another gynaecologist at every corner. I do not aim at changing the patients in this respect. I give the possibility of a holistic treatment to those who want it, who are more aware of it. By doing things in an unconventional way I do realise that the patients will have different opinions about my practice.