Attending an osteopathic school made it easier to find like-minded individuals and to learn more about osteopathic treatments. Osteopathy is a method of practicing medicine that incorporates the philosophy of treating the body systems as a single functional unit and manual medicine (osteopathic manipulative medicine or osteopathic treatments) to precisely adjust the body’s tissues (muscle, fascia, bone, etc.) in order to restore normal function to these tissues. People seek these treatments out mainly to reduce pain but they are useful for other issues as well. These treatments are one more modality that I can offer to keep patients from the possible side effects of medications.
An example of how osteopathic treatments could help is displayed most easily with upper back or neck pain. Other than traumatic injuries, like motor vehicle accidents, the most common factor provoking neck pain is poor ergonomics. Usually, this is from holding your body in a maladaptive position at work for eight or more hours per day. For these patients, in addition to suggesting ergonomic changes, which is the long-term treatment for this issue, I would suggest osteopathic treatment. If this is able to keep someone from using over the counter NSAIDS (which can lead to gastrointestinal bleeding or increase cardiovascular risk) or narcotic pain medication, which is, unfortunately, the most prescribed medication in America, then I feel that I have upheld my oath to do no harm.
In general, I call my treatment philosophy rational medicine. Others call this holistic, integrative or alternative medicine. I prefer more conservative treatments first and if lifestyle changes, vitamins, herbs, or supplements can help you, then these should be used before pharmaceuticals. Sound like a rational way to approach medicine? I suspect that many other physicians feel the same way. However, many other physicians are allowed only 10-15 minutes by their employers for a patient visit and this doesn’t allow time for discussion. It allows time for the physician to write a prescription and a referral to a specialist.
Lysine and its use in decreasing herpes simplex virus outbreaks (cold sores) provides an example why rational care is best for the patient. The herpes virus requires the amino acid arginine in order to create copies of itself, eventually leading to a painful outbreak.
Lysine is another amino acid that can block the path of arginine. However, the body cannot manufacture lysine, humans must obtain it from the diet. Studies have shown that when lysine is supplemented or the diet is changed to increase lysine and decrease arginine, the recurrence rate of herpes simplex virus infections is reduced.
I have changed the way that our office provides medical care so that I can spend the time that’s necessary to explain why a patient with a history of cold sores may want to change their diet or add a supplement so that they can reduce the likelihood of future outbreaks. If I accepted insurance I would need many more employees than the one fantastic medical assistant that I currently have. These employees would spend their time making certain that insurance paperwork was done correctly, and when the insurance company returned our bill unpaid the employee would have to wait on hold to get someone from the insurance company on the phone to explain the issue so that the bill could be re-submitted. Since this same insurance company would also pay only a fraction of the total bill, the doctor is required to see many patients in a day to pay the employees and keep the lights on. This business decision ends up affecting how the physician practices medicine because there is only so much time that can be spent with one patient and still make enough money to pay the bills. Unfortunately, for physicians that take insurance, the doctor is often pulled in different directions. Physicians want to spend more time counselling their patients. However, the physician is allowed only 15-20 minutes for the entire visit, including work done for the patient outside of the treatment room. If they spend more time with their patients the result is decreased income for the practice since fewer patients were seen that day or the physician spends less time with their family because they are finishing charts, responding to phone messages, and communicating about labs at home that night. When patients are pitted against your family, it’s easier to understand why an employed physician’s desire to go the extra mile is waning.
I want the incentive structure at my office to reward quality care for the patient. I also want a reasonable amount of time to talk with my patients and to research treatments that can help them without increasing risks. Direct primary care allows me to reach these goals.
Don’t get me wrong, I believe in pharmaceuticals when the reward is worth the risk. Western medicine is the best available resource for bacterial infections and emergencies. However, for chronic disease I would rather change the cause of the disease, when possible, versus using a pharmaceutical to just treat symptoms. There are many examples of drugs being pulled off of the market after finding that the side effects may be worse than the disease being treated.
I can’t wait until next time, when I will talk with you about why I have a healthy level of skepticism about pharmaceuticals and why you may want a dose of skepticism as well.