Saturday, June 16, 2007

Interdisciplinary health care: a gold mine being ignored?

...Continued from Preliminary Thoughts on Interdisciplinary Health

For interdisciplinarity being the newfangled wave in health care, throughout my time in hospitals and med school, I sure haven't gotten the sentiment that it's put into action very much.

After reading my previous post, my naturopath-student buddy asked if I'm for or against interdisciplinarity. I want to be clear: I'm not against it at all; I think that there's a lot to gain from it, if implemented properly ... i.e. not in the forced way described by the "Anonymous Therapist" commenter on my previous post.

My point is simply, I haven't seen much interdisciplinarity in action or even in theory at this point in my medical training, despite its lauded usefulness.

In fact, even though I'm only less than a quarter of the way in, to date I've felt the sentiment actually leans toward the opposite, almost against interdisciplinarity. I haven't felt much like we're being told to consider all those other professions as peers, equally-valuable limbs and body parts of the conglomerate, undoubtedly creepy-lookin' monster that is the health care industry. Can't function without the others, you can't live without one body part, so the interdisciplinarists might say (I'm abusing that word, aren't I?).

So how might the average medical student who has gone through the same training I have respond to this equal-value-body-part-organism metaphor? They'd probably say, "hey, you can actually live without some body parts. Naturopaths - they'd be the tail! Better off without 'em. You don't need a tail. You can function just fine without one. Humans, the smartest beings on earth: no tail. And we're better off for it...even the dumbest of us can't run in circles chasing it, which makes them look smart, because some people I know probably would chase their tails, if they had one."

Note that I said the average medical student - again let me point out this is not my opinion. In all honesty, I do feel myself and my profession could stand to learn some things from her and her profession. What I am talking about is the sentiment that I've felt to this point in medical school. Given the lack of interdisciplinary discussion at this point in our training, I wouldn't be surprised if a good number of my classmates thought like this.

Where do I get this impression? Experiences like, say, the time when one of my professors actually mentioned naturopaths directly in one lecture: "Sprinkle some herbs over a bunch of white beads and give that to a patient to eat? How will that help the patient?!" Yep, interdisciplinarity in action. That's what we've learned about naturopaths to date in medical school. And you wonder why some doctors look down on naturopaths.

Chiropractors? There's a whole other topic. Based on how some of my colleagues view chiropractors, in this organism of equally-valuable parts they'd rank chiropractors as, say, the appendix (ie. another organ of no known usefulness). One med student asked me, "How come chiropractors get to call themselves doctors?" Clearly subtle hints of superiority are more than evident in that statement. Another med student told me about her experience volunteering in a rehabilitation ward, and told me, "I was shocked at how many of the patients there were rendered paraplegics because of a chiropractic adjustment." Not a shining commendation by any means.

Moving away from hearsay: my limited experience with chiropractors, when I accompanied a friend on an chiropractic visit, was that the adjustments were very much aggressive, near-violent; and the doctor was very much like a salesman, near-slimy. My honest opinion of them, however, is I have yet to see first-hand any harm they have done, and I have read testimonials saying that they have made a huge positive difference in some patient's lives (but so have miracle healers...hmm).

And what about the ol' D.O., or Doctor of Osteopathy? Thanks to ads at test-prep courses and in pre-med literature aimed at pre-professional students and mostly worded along the lines of "Have you considered D.O.?" (which actually come across as "Hey eager pre-med student, have you considered D.O. as a backup plan should you be too dumb to get into med school and yet still crave the feeling of being called 'doctor?'") an impression of this profession among medical students as being a profession for pre-meds not smart enough to get into med school might be understandable. Fortunately, in a random encounter starting a conversation with a stranger on a park bench in London last year, I have met a D.O. student and know that to not be true.

D.O.s claim that they are another type of doctor, "equal to M.D.s in the eyes of the law." So why aren't D.O.s mentioned in medical school then? Maybe it's just because I'm in a Canadian medical school, but I think there's more to it than that...

So would I go see a chiropractor or a naturopath or a DO? Right now, probably not.

Would I recommend patients see one? At this point, I don't think so.

Based on my impression of them (admittedly based on anecdotal comments and impressions from friends) I haven't been convinced they do more good than harm. But would I recommend against a patient seeing one, or try to stop a friend from going to see one? Nope. I might pass on the paraplegic story, but I'm not against people finding what works for them, and I haven't been entirely convinced that these other practitioners do more harm than good. And if my smart friend is convinced enough about naturopathy to pursue a career in it, there's gotta be some merit to it.

Would my preferences change if I were taught the merits and capabilities of these professionals and believed that evidence showed they are medically indicated and make a significant positive difference in certain conditions? Definitely.

Like I said, while the conceptions I hold now may be misinformed or even grossly incorrect, I do believe there's value to be gained from interdisciplinarity, and I consider myself open-minded and willing to change should I be proven wrong.

The thing is, at this point, I haven't had the chance to go look up this evidence on my own. Not because I'm lazy, but because I've been too busy learning the things my medical has deemed important... and this isn't one of those things. But supposing I take the initiative to look this up on my own; what about the other students in my class? How will they know what to think about chiropractors and naturopaths and DOs other than what they've heard from their friends or seen on YouTube? Hopefully you can see why I think that training future doctors should involve discussions about these other healthcare professionals, because I do think that medical professionals have a lot to gain from an interdisciplinary mindset and from each other.

So far by discussing 'interdisciplinarity' I've mentioned practitioners seen as more alternative (the DOs and chiros will hate me for using that term, the naturos have to live with it), but this extends to all sorts of therapists and healthcare workers that don't call themselves 'doctor.' And yet, despite the fact that interdisciplinarity can be a huge benefit, if you were to ask ten people in my med school class what an occupational therapist does all day, I'd be shocked if more than one of them could tell you. Same goes for a respiratory therapist, or a licensed professional nurse, or a naturopath, even. I happen to know in great detail what each one of those does, with no thanks to my med curriculum (up to the end of first year) - I simply happen to have had three friends going to school for OT and have talked to them at length about what they do; I've volunteered for a couple years under a respiratory therapist; my mom is a LPN; and I have another good friend in naturopathy school. But if I relied on what I've learned in med school, well, I'd know nothing about these professions, nothing about how to help a patient access the valuable services these therapists have to offer.

I honestly hope that my school starts touching on these other important parts of the health-care profession as I proceed through the curriculum. But if med school keeps on going the way they've been going so far, and don't explain to future doctors what each of these other healthcare professionals do, "interdisciplinary health care" will just be another Utopian ideal with no manifestation in this world... another untapped gold mine.


Anonymous said...

Interestingly, Samuel Hahnemann who developed the practice of homeopathy, using like to treat like, also eloquently described as the "sprinkling of white beads with herbs", was the one who named today’s prevailing system of medicine as allopathic. Although the research is still lacking to prove the efficacy of homeopathy, drinking a ceasar with breakfast is still the best cure I know for treating a hangover. Anyhow, getting to the point, I would like to quote my psychology professor, "when are you going to realize that this is not about you". It is tempting to sit around and argue about which profession is most important and which practitioner’s are the most intelligent but I really think that it ultimately boils down to looking at each patient individually and accessing what would work best for them. In doing so, I think that it is extremely important that each profession remains within its boundaries and simply provides the services at which it excels. No one medical professional can possibly acquire enough information to heal the world of its ailments. As medical professionals, if our true motivation is to bring our patients to a place of optimal wellness, then it is our responsibility to educate ourselves on the resources that are available. I believe that the alternative health field is changing from a group of med school hopefuls to a group of revolutionaries who declined their seat in conventional medical school in the attempt truly change the system which seems to be failing us…perhaps implementing this theoretical concept of interdisciplinarity would bring about some of the much needed change!

Anonymous said...

As a chiropractor I would like to make a quick comment here. I am agree that no doctor can know everything and that is why there are specialists. I think that both Chiropractors and Naturopaths could be considered specialist since they both have areas of specialty (problems in these professions arise when practioners attempt to treat things that are outside of their scope of practice). However, just like there are good and bad doctors there are good and bad chiropractors. I think that it is entertaining that a med student be horrified to see that there are people rendered parapalegic due to chiropratic adjustment when thousands die each year due to either malpractice or prescription drugs. During my undergrad I worked at an Easter seals camp where many of the kids there suffered from cerebral palsy, my favorite of who is a quadrapalegic because the dr made a mistake during delivery. The problem with medicine is that it is administered by humans and all humans are subject to error. Oh and I have met alot of near slimy doctors too!

Anonymous said...

Vitum: may I ask that you do a little research into why physicians are able to call themselves "doctor" (hint: this has not always been the case)?

I would give you the answer but I am interested to see what you come up with.

Then may I ask that you educate your fellow students when they ask why (for example) chiropractors may call themselves "doctor"? Perhaps your fellow students need to be asking the same question of themselves as future physicians?

It is not my intent to offend any "doctor". Just a called-for reality check.

Anonymous said...

You know that D.O in the united states of america is fully the legal and professional equivalent of an MD right? We are in fact PHYSICIANS and can specialize in everything from internal medicine to neurosurgery. The U.S is the only country where a D.O recieves the exact same education as an M.D. In europe and other places d.os are glorified chiropractors. We may only be 59000 in number here, but we are in fact physicians whose primary modality of treatment is the exact same as mds. yes we do learn omt but only about 15 percent actually use it in practice.