How Healing Works

by Wayne Jonas

  The Mayo Clinic—also one of the top health care organizations in the world—has invested heavily in creating new models of healing with both its integrative medicine programs, run for years by Dr. Brent Bauer, and its new multistory Healthy Living Center and programs run by Michael Casey, Dr. Don Hensrud, and others. The Healthy Living Center has taken what we now know from research on health promotion and built a program for facilitating health in everyone, whether healthy or ill. It is this type of integration that is applying what we now know about prevention and the optimal treatment of chronic disease. The Mayo Clinic offers training and delivery to other hospitals and health care centers around the world that seek to adopt these approaches.

  The final program to know about is the Center for Spirituality and Healing (CSH) at the University of Minnesota. CSH has been led for thirty years by Mary Jo Kreitzer, a PhD nurse who is a pioneer in the creation of visionary approaches to healing and well-being. Her Model of Well-being has influenced countless patients, professionals, companies, health systems, and policy makers in thinking more clearly about how healing works. It has had a profound influence on my thinking over the years. The course and educational tools from CSH are available to patients and professionals (for more information, see my website, DrWayneJonas.com).

  Other organizations offer course in integrative health. While it used to be that many of these courses were taught by practitioners far outside the mainstream, they are now becoming mainstream—just part of good healthcare. I will mention just a few. The Academic Collaborative for Integrative Health (ACIH) is a membership organization for complementary schools, including naturopaths, chiropractors (who also have their own academic membership organization), massage therapists, acupuncturists, and midwives. ACIH represents and advocates for these professions. Recently, the Institute for Lifestyle Medicine, founded and led by Harvard Medical School’s Dr. Edward Phillips, is bridging the gap between medical treatment and behavior. Dr. Phillips, along with Yale Professor Dr. David Katz and others, helped organize the American College of Lifestyle Medicine (ACLM), which provides education to licensed health care professionals on how to deliver exercise and nutritional prescriptions. For patients like Trevor, these and other organizations provide physicians with opportunities to acquire knowledge and skills allowing them to bridge conventional care and self-care. While the term integrative health is now being used by many organizations—including the NIH National Center for Complementary and Integrative Health—true integration is still rare. What you should look for from those claiming to deliver integrative health are practitioners and health care systems that integrate all three key areas for healing—conventional care, complementary medicine, and self-care. More information on these organizations is also available on my website.

  For those who get their care in the U.S. military or Veterans Health Administration (VHA), a radical shift toward more holistic, integrative health is occurring. Admiral Mike Mullen, former Chairman of the Joint Chiefs of Staff, launched a program called Total Force Fitness. This framework incorporated all the elements from the dimensions of healing described in this book, but called it “fitness” rather than health. This included behavioral fitness, social and psychological fitness, and even spiritual fitness. The Total Force Fitness framework is now being implemented throughout the military under various names such as the Healthy Base Initiative and Operation LiveWell. The last two U.S. Army Surgeons General, Lieutenant General Eric Schoomaker and Lieutenant General Patty Horoho, created signature programs in integrative health for pain and performance. The VHA is implementing a personalized health plan program that integrates veteran goals and clinical goals in a holistic manner. Led by Dr. Tracy Gaudet, former director of the Duke Integrative Health Center, and Dr. Ben Kligler, formerly of Beth Israel in New York, it seeks to transform the way the VHA treats patients, from one delivering cure-focused treatments to a system that enhances personalized self-care and healing for every veteran. NATO has also begun to explore use of integrative health in the military in Europe. A recent report by NATO summarized integrative health activities and recommendations in the military in that alliance.

  Similar trends toward integrative heath are happening in Europe. While many European countries have long histories of traditional healing—including systems like spa healing, anthroposophical medicine, homeopathy, and herbal treatments—these practices became largely eclipsed with the rise of modern biomedicine early in the twentieth century. A major summary of the current state of complementary medicine was published in 2015 by the European Union (EU). This four-year study, called CAMbrella, described a diversity of CAM practices and regulations in the EU. One challenge in Europe that seems less prominent in many other countries (except perhaps in the United States and Australia) is a strong skeptics movement that challenges CAM, accusing it of being nonscientific. While there is indeed less science in CAM than in conventional care overall, science is challenged to provide certainty in any medical approach, CAM included. We need more and better science in health care all around.

  India had a long history of well-developed traditional systems (and some newer CAM systems) before modern Western medicine arrived and quickly dominated national practice and resources. However, the government has recently invested in developing the science and standards for T&CM in India. These systems include Ayurveda, yoga, naturopathy, Unani, Siddha, and homeopathy. Most of these systems are thousands of years old, except for homeopathy, which was exported from Germany in the nineteenth century and then widely adopted around the world. The WHO reports 508 “colleges” in one or more of these systems in India with over 25,000 undergraduate and nearly 2,500 graduate students per year. There is tremendous experience in these systems. However, having visited, examined, and done research on these topics in India, I can say from personal experience that significant improvement in quality is needed before their approaches can be integrated with conventional medicine. Dual-trained physicians like Dr. Manu are still rare. For the time being, they largely remain separate from mainstream conventional medicine and do not provide an integrative health system.

  Traditional Chinese medicine (TCM) was the major system in China until the modern era. During and after the Cultural Revolution, TCM was largely ignored and even suppressed. However, China has now made major investments in research and the integration of TCM and modern Western medicine. A 2017 report released by the Chinese government describes the tremendous growth of TCM and an integrated TCM/Western medicine industry in China. They report nearly four thousand TCM hospitals and forty thousand TCM clinics. This includes 446 integrated hospitals and 7,705 integrated clinics, where both TCM and Western medicine are practiced together. There are over twenty-five TCM medical schools and two hundred Western medical schools offering TCM training. They report 11.5% lower outpatient costs and 24% lower inpatient costs in these integrated practices versus conventional Western practices. Over 15% of health care dollars are spent on TCM in the country. The government sees TCM as having an important role in China’s socioeconomic influence outside China. The report ends by saying that “The time has come for TCM to experience a renaissance.” TCM does seem to be spreading into other countries. Over 183 countries outside China have TCM programs, and 103 countries formally regulate TCM practices, including 18 that pay for acupuncture in health insurance. Acupuncture has largely been accepted as being safe and effective for pain in most countries, including Europe and the United States. However, based on my experience in China, I can say that the quality of clinical TCM research needs improvement before full integration can occur in the West.

  WORKING WITH YOUR SYSTEM AND DOCTOR

  None of these systems is perfect, but each moves health care in the right direction. Having spent a lot of time in this space, I can say that these systems share a philosophy of healing and self-care, not just curing. As daunting as the list of forces against healing in modern health care sound, you can overcome many of those forces and create healing collaborations that work for
you. Start by creating a healing collaboration with your doctor.

  Recently, a patient in her late thirties came to me seeking a prescription refill. She was married, worked part-time, and was raising three teenaged boys. She came to see me because her regular doctor was on vacation and she wanted a refill of a muscle relaxant medication for chronic neck pain. She also wanted a prescription for a sleeping pill and an opioid pain medication.

  I never automatically refill prescriptions without examining the patient. When I examined her, I found nothing physically wrong with her neck, so I asked her if she had ever had the pain evaluated. She answered, “I know what is causing the neck pain—it is stress.” Every time her husband was redeployed to a new military assignment, she would have to sell the house, organize the whole family’s move, find new schools for the boys and a new job for herself, and settle into a new community. All of this was giving her, quite literally, a “pain in the neck,” she said.

  The muscle relaxants gave her some relief, but the pain always flared up at times of major stress. She also commented on what she thought as an unrelated problem: she had to get up in the night to urinate—sometimes as many as six times. Her previous doctor was unable to find any physical reason for this and had prescribed a medication to inhibit her bladder contractions. I explained to her that the number-one cause of frequent urination, when there is no physical explanation, is stress, and that night is a common time for this to occur.

  I explained to her that stress stimulates the sympathetic nervous system, which often responds by sending signals to the body that create an urgency to urinate. “All three of the problems you are describing—neck pain, frequent urination, and difficulty sleeping—might well have one cause,” I said to her. “It looks like your nervous system is out of balance, with the sympathetic system getting overstimulated. If you could find ways to induce a relaxation response and balance your nervous system, all three of these symptoms might disappear.”

  She seemed interested, so we talked about some simple ways to induce a relaxation response, including the breathing and relaxation exercises I described in chapter 7 (see this page) and summarize in the appendices (see this page). Finally, though, she said with a sigh, “I just don’t have the time to myself to do these things.” She left with the prescriptions.

  About a month later, she was back in my office. “I decided I’d like you to help me induce that relaxation response,” she said. I was not sure what motivated her to change her mind, but I was pleased she was ready to take healing into her own hands. We talked about what she might do, and practiced some simple relaxation exercises in the office. To bring that experience more deeply into her life, she decided to take a yoga class three times a week. “I’ll tell my family that this is time I need for my health—doctor’s orders,” she said. She was creating a healing environment for herself by using me as a health collaborator, not just as a pill dispenser. After two months of yoga three days a week, her neck pain, frequent urination, and sleep issues had all resolved.

  Find the right doctor for you. If you too are looking for a new doctor who is more of a healing collaborator than a pill dispenser, treat it like a job interview—you want to hire the best health care professional for you and your family. Consider the two reasons to see a doctor: one is to find out if a problem is acute, serious, and needs immediate attention; the other is to find a partner who will help you manage chronic illness and the prevention of disease. There is no other reason to see a doctor.

  Acute situations can be handled in either an emergency room, a walk-in clinic, or the same-day unit of a clinic or health plan. But for chronic care and prevention, look for either a primary care doctor, a nurse practitioner, or a physician’s assistant (PA) who is licensed to do family medicine, internal medicine, gynecology, or (if you have children) pediatrics. Interview several candidates until you click with one. This is an important relationship, after all, and could become a lifetime—and life-saving—connection. Show candidates the HOPE assessment at the end of this chapter or on my website and see if they will engage with you in that process. Explore to what extent each candidate already asks patients about the healing dimensions. Your goal is to find someone who will develop a collaborative relationship with you for prevention and healing.

  There are three key aspects to a good collaborative health relationship: caring, competence, and credibility. Look for this combination in anyone you entrust with your health. Don’t be afraid to ask prospective doctors about their education, experience, and special skills. You can also ask about their views on holistic or integrative medicine. If a doctor tells you that all alternative methods are worthless, or that holistic medicine is a waste of time, this may not be the best person for you. However, no matter what a doctor’s opinion of complementary and alternative medicine, if he or she is willing to seriously evaluate the medical research for you and not abandon caring for you, he or she can play a valuable role in the collaboration.

  I also suggest finding a doctor who works with a team or has access to a network of other kinds of practitioners, including lifestyle experts, health coaches, nutritionists, behaviorists, and other conventional and alternative specialists. These collaborators may be in the community or in the doctor’s own health care center or practice. A good indication is if a doctor routinely offers preventive services, integrative medical care, lifestyle and behavioral therapies, and complementary treatments. Ask about the breadth of the candidates’ networks. How many practitioners do they regularly work with? Are all practitioners with whom they work licensed by the state? Do they follow up the care their patients receive from these practitioners and regularly collaborate with other providers to find the best combination of care? Do they make recommendations for self-care and provide evidence as part of the treatment decision process? These are all good signs.

  As part of your search for a doctor, look at the team with whom he or she works. Prevention and care for chronic conditions require constant communication and teamwork to evaluate changes in your health and the services needed on an ongoing basis. When you visit the office, get a feel for the culture. Do people communicate with each other? Is there a caring, respectful atmosphere? Or do staff members bark commands at each other and appear frenetic, isolated, and disorganized? Those may have burnout and may burn you.

  Look also at how the team members treat you. Do they appear competent? Do you trust them? Do you feel cared about and heard? Does a team member, for example, call you prior to or after an office visit to find out any concerns you have? Does the team include you in decision making? Do they prepare you for the best use of the doctor’s—and your—time? And, importantly, are they honest with you about what you need—even if it might not be what you want? A colonoscopy is a good example. After the age of fifty, regular colonoscopies and comparable screening tools dramatically reduce the risk of fatal colon cancer, but most people hate to have them done. A good doctor will encourage and remind you to follow recommended prevention and screening guidelines, even if they are unpleasant.

  LOOK FOR THE FIVE-P APPROACH

  A doctor has five responsibilities in integrative medicine:

  1. Protect. Your doctor should protect you from dangerous, disproven, or toxic practices.

  2. Permit. Your doctor should permit practices that may work and have no harmful side effects—such as mind-body practices, acupuncture, or massage.

  3. Promote. Your doctor should promote proven conventional practices—such as Pap smears, colonoscopies, and vaccinations—and proven alternative practices, such as acupuncture, massage, and yoga for chronic back pain, and exercise, mind-body practices, and nutritional changes for many conditions.

  4. Partner. Your doctor should include you as a partner in the health care team and should be willing to research and discuss with you the evidence for all three of the integrative health arms—conventional, complementary, and self-care.

  5. Payment. Paying for preventive care and health promotion is key to optimizin
g healing. Whether you have employer-provided health insurance or an individual policy, examine your policy or contact the provider to see what it covers. You can ask your employer to investigate health insurance policies that include complementary and integrative medicine, lifestyle medicine, and health coaching. They can purchase insurance supplements that cover these services. If your claim for alternative services is denied by the insurance company, you should either ask your employer’s human resources department to pursue it or have your doctor write to the insurer. Often, contractors who specialize in health care coverage have better success than individuals in pursuing claims approval.

  If you like your doctor, enhance the relationship. Have a discussion with him or her about becoming more involved in your health care. This might involve asking your doctor to do some research about the effectiveness of treatments that interest you. Ask your doctor to advise you about prevention and lifestyle changes, including nutrition, exercise, and stress management. Ask how to prevent or minimize the effects of chronic illness and learn about any screening tests you should have. Encourage your doctor to see you as a whole person. During your visits, talk about your family, your work, your interests and hobbies, and any areas in your life that are giving you problems, including your relationships with your spouse, children, or coworkers.

  Realize that the doctor’s time with you may be limited, so go into the meeting prepared and with an agenda for the visit. Before going into an appointment, think about how your lifestyle affects your health. If you are open to lifestyle changes, ask about available resources. (You could ask, for example, “Do you refer patients to health coaches, nutritionists, or acupuncturists?”) Be forthcoming with your health goals. Proactively share what you are hoping to do and how you want to feel. Don’t wait until the end to provide key information.