We have an amazing series of lessons stemming from one story given to me by my wife regarding her recent experiences in her own Functional Medicine practice.
Buckle up for this blog because there are a lot of take-aways and many nuggets of wisdom and truth to be gleaned.
Earlier this week, my wife, Dr. Linda Matteoli, came into my office and seemed really down and out. When I asked her what was wrong, she explained that her patient who has been struggling with colitis is now having some flair-ups despite Linda's treatment plans. The patient was doing really well for the last couple of years with certain interventions and treatments, but now things have changed. Linda thought that her patient may need to be referred to a conventional medicine gastroenterologist for a gastro work-up. While Linda understands that this is the right direction and the proper way to go about these particular health issues, she still was disappointed to hear that her previous treatments were no longer working.
You need to know that this is not a failure. We in the Functional/Integrative/Lifestyle understanding of medicine must recognize that we cannot be the be-all, end-all stop for every individual. We cannot forget that conventional medicine is great, especially for acute issues. Resources in the conventional medicine world are excellent, and it is dangerous to think that we should ignore these helpful and healing evaluations and doctors. Sending someone back to conventional medicine for a work-up is not a failure.
Thankfully, Linda creates a transparent atmosphere in her practice where she explains that she is not here to replace anyone on the patient's medical team. She is here to provide another perspective through Functional Medicine, one that has worked wonders to heal many, many individuals. However, Linda knows that there are other helpful interventions as well. She, as a functional medicine provider, is just one part of the medical team--including conventional medicine providers--that works together for the benefit of the patient. That being said, the fact that your patient is struggling under your care and that you may need to add another approach is still a bit of a personal letdown.
You must keep in mind, as a Functional Medicine provider, you cannot be your patient's cardiologist, endocrinologist, dermatologist, neurologist, gynecologist, GI doctor. You obviously cannot be everything to one person, even if you have studied medicine for years starting at age ten like Doogie Howser. Even Dougie needed to refer out. So, clearly it is not a failure to send your patient to a conventional care specialist, even though you may still feel let down if your personal treatments are not working perfectly and fully. My wife was feeling dejected -- poring over her notes, losing sleep at night, trying to get to the bottom of her patient's colitis situation. To attempt to help with Linda's anxiety over this, I gave her a sports analogy. (Okay, not what she may have been asking for, but I believe it helped her, and it may help you, too.)
I started my analogy reminding her (and you now) that medicine is art AND science. You have to look at it at several angles. You cannot expect one input to have the same output every single time. I likened this truth to baseball, as I am a big baseball fan. You may have heard the baseball truism that, as a batter, if you fail seven times out of ten, you go to the Hall of Fame. The best of the best have a mountain of failures that actually contribute to their success. Even more-so, take a look at pitchers; the best pitchers in the game lose MANY more times. The Hall-of-Famer pitchers lose a lot!
Get this: the best pitcher in each league of MLB wins an award named after a pitcher named Cy Young. Cy Young is the all-time leader in LOSSES for a pitcher with 315 losses. The greatest players of all time give up home runs, they walk people, and they usually aren't striking people out every time.
I'm impressed by the mindset of pitchers-- they persevere under constant pressure of cameras, media, fans, managers, and the knowledge that they will usually fail. What I have learned is that a lot of Major League pitchers focus on the process and what they can control. They prepare. They review the stats. They make adjustments as needed. They have an extremely consistent routine. They actually only pitch every fifth day, while working hard for the four days leading up to the game to hopefully get out there. Sometimes they only then make it to 2-4 innings when they should really make it to 6-7! They may feel failure for four more work days until they get to their next pitching day when they will try it all over again. However, they stick to it! They keep winding up, they keep studying their stats, and they keep at what they know best.
The next thing you have to remember is that after a pitcher winds up and throws the ball, it's out of their control; it's literally out of their hands. Sometimes the throws may end in a strike-out. Sometimes a pitch is the best ever thrown. Sometimes it doesn't work at all and may even hit the batter, sending him right to first base, which was most likely not in the plan. Sometimes the pitch is fantastic, but the batter hits it out of the park. I tried to relay this message to my wife that while she is the expert and the best in her field, after she delivers her "pitch," the results are out of her hands.
As a doctor, you can only do so much. Medicine is not an algorithm where you put in a formula and get the same result every time. You can prepare, strategize, and implement; you can research, pore over your notes, and examine from every angle, and you still may not provide perfect healing. There are a variety of reasons it may not work out perfectly, even if you are the world's greatest doctor and go down in the Physician Hall of Fame.
Another lesson here is trying to reduce your anxiety, and you can better do so when you realize the logic surrounding your particular situation. You shouldn't be up in the middle of the night worrying about outcomes. You care for your patients, so this can be difficult, but know that you are doing all that you can to help, and you know what you are doing, even though the results may not be absolutely perfect every single time. I tried to relay this to my wife. She can only do so much as a doctor. She cannot expect everything to work out perfectly in every scenario with every single individual. We in Functional Medicine (and probably all humans) need to better manage what is going between our ears and be mindful to stay in control of our thoughts. We also must realize that our perception is not always 100% reality. You may be experiencing anxiety for no logical reason. You may perceive what is actually success as failure. We must take steps to reduce anxiety, reduce risk, and help us sleep better at night.
As an alternative medicine doctor, first look to your tool kit and then see who and what you may need to refer. Also, recognize when you need to refer, and be transparent about it. Your patient may end up needing conventional care. Conventional care is not the bad guy. Talk your patients through the fact that there are limitations for all of us. Putting this out there and being open from the start will lighten the burden for you.
This particular patient with colitis reminded my wife that she had actually done a great job of healing and making her feel better. The patient had received a great sense of relief and health from Linda's recommendations. The patient realized that ONE doctor cannot be everything to everyone and be a universal panacea. She also recognized that Linda gave the advice and guidance immediately and was thankful for it. While the patient may be getting the best-of-the-best doctor, they still may need to be referred out.
The button on the end of this story is that my wife talked to the patient this morning, and the patient reminded Linda that she was previously not able to tolerate foods and that she felt very sick before turning to Linda and Functional Medicine. The patient again reported that after Linda's recommendations, she felt so much better and was able to enjoy life greatly. Even with her recent colitis flair-ups, today the patient still feels much better than she did before coming to Linda. The patient was also very thankful that Linda would recommend a GI doctor. Sure, Linda would have like to single-handedly cure this person, but she should also be proud to send her patient for a conventional work up. That is the sign of a good doctor. Perhaps your patient's issues cannot be detected or dealt with your tool kit. That is okay.
Part of being a good doctor is realizing that you are just a great component of the whole team. You are part of a network who is helping, and that may include referring a patient to conventional care. Never be afraid to refer out, and just be transparent with your patients that conventional medicine can provide an additional, helpful tool kit added in.
So, don't doubt yourself; you know what you are doing. Keep sticking to it and doing your best. Your best is good enough, even with what you perceive as failures, and your failures actually contribute to your success.
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