“A Paradigm Shift”

Over my 37 years as a physical therapist, I have come to the belief that our present medical system needs a change in its foundational philosophy. A “paradigm shift.” The buzz words today in health include integrated healthcare, integrated practitioner, and integrated health. These words refer to alternative medical practices. But what do these words really mean and what are the implications of these words to the development of integration within our healthcare system today?

The word integrate is defined as to make into a whole by bringing all parts together; unify. To join with something else; unite. To make part of larger unit. Words with similar definitions include combine, amalgamate, consolidate, and incorporate. According to the National Center for Complementary and Alternative Medicine (NCCAM) it refers to medicine as integrative or integrated when it “combines treatments from conventional and alternative medicine for which there is some high-quality evidence of safety and effectiveness.” According to Andrew T. Weil, M.D., a well known proponent of integrative medicine, “integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” Combining these three aspects of a person, integrated/integrative medicine would then be defined as: the evidence-based merging of conventional and complementary therapies for the good of the whole person.

However, the word integrate cannot only be used in the description of our healthcare system, but also in how the body is viewed. Our conventional medical philosophy is better defined as “reductionist medicine.” The driving principle behind our medical science is the paradigm of physical reductionism, which reduces medical issues to physical explanations and usually prescribes a purely physical solution. In this simplistic view of the body, it would be fair to say that the human body is seen as a machine; every time someone is sick, it’s simply because one of the body’s gears (body systems) is clogged. This reductionist view of the body is not in itself a bad thing and its focus on specialization is preferable to alternative medicine practices in circumstances such as emergency surgery or in triage situations as seen in our nation’s emergency rooms. On the other hand, holistic medicine, also known as alternative or complementary medicine, evaluates the entire person, physical (body) and non-physical (mind) and seeks to heal any imbalances between the two. It views the body as a complex system that is affected by both internal and external factors. It also emphasizes the body’s own ability to heal itself, as well as promoting healthy lifestyle changes and preferring naturally occurring remedies, such as meditation and herbal medicines, to synthetically produced compounds. Because it is not reductionist in nature, holistic medicine can also be used as a counterpart to modern medicine.

The problem with modern medicine is that its science and philosophy purposely excludes anything that does not fit its paradigm of physical reductionism. It cannot, by its very definition, consider that humans have both a physical and a non-physical nature. Because of this, many people feel that the mainstream, western medicine fails to evaluate them as a complete human being.

In discussing these various views of how the body is looked at, there needs to be a distinction made between the view of a M.D. (medical doctor) and a D.O. (doctor of osteopathy). A medical doctor practices allopathic medicine, the classical form of medicine, focused on the diagnosis and treatment of human diseases. Osteopaths, on the other hand, practice medicine that is centered around a more holistic view of medicine in which the focus is on seeing the patient as a “whole person” to reach a diagnosis, rather than treating the symptoms alone.

Early in my career, I worked at Heights General Hospital in Albuquerque, an osteopathic institution. I therefore came to incorporate their philosophy into my own physical therapy practice. That is, view the body as a unit, an integrated organism in which no part functions independently. Also, realize the body has an inherent capacity to maintain its own health and to heal itself. In addition, recognize that structure and function are interrelated in that the musculoskeletal and musculofascial systems reflect changes in and can produce changes in other bodily systems. Finally, rational treatment is based upon integration of the first three principles into total care of the patient.

Patients at my facility will always be viewed and treated according to these principles. I recognize each person as a unit of body, mind, and spirit. I also look at the whole-person which emphasizes learning as much about the person with the disease as the disease itself. Finally, I understand that each body is capable of self-regulation, self-healing, and health maintenance.

Terry Kern, P.T.