Keeping and Breaking Tradition
A Quest for Satisfactory Outcomes in Medical Practice
by Joseph Intile, M.D.
I am a 65 year old board certified specialist in internal medicine and a true believer in allopathic medicine. After all, it has been my training, my livelihood and my life for almost 40 years. And in those 40 years I have been able to appreciate the many changes and advancements in the delivery of care. When I started out as an intern and resident at the Armys largest hospitals, intensive care units did not exist. Coronary artery bypass surgery, pacemakers and defibrillators were unheard of. I have seen my patients benefit from these and many other advancements in medicine.
Other things have changed during the past four decades as well. Back in the 50s, the suggestion of naturopathic or chiropractic care was viewed as heretical. Even osteopathic physicians were second class medical citizens except in their own institutions. Nurses wore caps and they stood almost at attention when a doctor entered the area. The term acupuncture was not even in my vocabulary. Weve come a long way since those days.
One aspect of the practice of medicine, which I have noticed throughout my entire career as a physician, is that, no matter how much we have advanced and learned and made innovations, there has always remained a large body of medical practice that defies satisfactory outcomes. Why did the anxiety-ridden patient develop coronary artery disease or have a stroke? Why did people continue to have pain in spite of all the prescriptions for analgesics and narcotics? Why were so many people depressed and how did that impact their physical well being? During my decades of medical service, my best efforts have been confounded by some patients who wouldnt or couldnt get well.
Many things have happened in my professional and personal life over the years. In 1974 I helped to make history in Oregon by being the medical sponsor of the first certified nurse practitioner in the State. Some of my colleagues were ready to tar and feather me for having broken tradition. Working with this nurse practitioner (who did not wear a cap and who addressed me by my first name) demonstrated an approach to handling people with symptoms that, at times, was as effective or more so than mine. Her approach was to take time and listen, and to have genuine empathy for the patient. Frequently it did not require or depend on a written prescription. It was also becoming obvious to me that the alternative providers of care were seeing some success in outcomes because they used the same time-consuming approach. This is not to say that doctors didnt care. I know that I did very much. Rather, there was a basic difference in how this caring was expressed.
At about the same time, I underwent the first of five low back surgeries and began a long siege of chronic back pain. Im an ex-high school and college athlete who despised being in discomfort. I was tough, so therefore my solution was to use nothing stronger than aspirin and to live with it. I continued to work around my place, fly in high performance Air Force jets as a flight surgeon, and, in general, to continue to be macho. In 1991, I underwent a second laminectomy, had another one in 1993 and 1994 and, finally, to avoid being chair or bedridden, had a three-level spinal fusion in December 1994. I was ambulatory again, but my macho days were over, because of persistent and recurring low back muscle spasm. With the passage of time, I became more and more stooped and was actually eliciting sympathy from my family and friends. I didnt like it.
My wife of eight years has always been interested in alternative therapies, Oriental Medicine, herbal remedies, etc. Naturally I listened, but didnt have to hear what she was telling me. I did, however, admire the fact that she was a marathoner, worked out daily with a five mile run (or the equivalent in weight training), and she enjoyed excellent health. She encouraged me to think about other modes of dealing with the pain, if only to join a local gym and use their equipment.
On a parallel track, while I still had my practice in Oregon City, I had referred a few people to chiropractors and more than a few to osteopathic physicians. In desperation, I sent one fellow to an acupuncturist. He had the misfortune of being in a helicopter crash and sustained a shattered spine. After multiple surgeries including the insertion of foot-long stabilizing rods and their subsequent removal, he continued, like me, to be troubled with unremitting pain. To my pleasant surprise, his pain began to abate. I still see him, some four years later, to perform his FAA flight physicals, and he reports that an acupuncture treatment every three weeks keeps him relatively pain free.
Patty, my wife, purchased two massage therapies for me as a Christmas present, and I joined the local Nautilus to use the low back machines. Then she met Toni Gilbert, RN, MA, at a small group meeting and was intrigued by the possibility that therapeutic touch and visual imaging might be beneficial for me.
By this time I was willing to seek out any legal and ethical option to get rid of the pain. I called Ms. Gilbert. During our first session she chided me about my poor but comfortable posture, presented me with the probability that the discomfort was really my own psychology having an effect on me, and suggested I consider a course in Tai Chi. During the next visit she taught me how to visualize the area that was uncomfortable and to listen to what it was telling me. She encouraged me to, somehow, communicate back with it in a peaceful and soothing manner, and to visualize a color or a cool mist.
Whatever, my pain was beginning to abate. I still do not understand all she tells me about energy fields and meridians, but know enough to realize that the Chinese have had documented success with acupuncture as an analgesic and anaesthetic, even for major open heart surgery, as witnessed by some of my very reputable professional colleagues. And I am, for the first time in several years, experiencing days in which I am pain free. In addition, I have been able to return to many of the physical chores that I enjoy. And my friends and associates have noticed a difference in my disposition and my posture.
What I appreciate about where Im at is that no one is making ridiculous claims of success in their discipline. And no one has suggested that I regard their practice as the sole answer to my discomfort. Ms. Gilbert believes in the appropriate use of analgesics, as do I, and, on days when I begin to have discomfort, I certainly will take a couple of aspirin. But now, Ive also learned to communicate with the offending site, to breathe with my abdominal muscles, and to lie on the floor and to get those muscles to respond.
I fear that too many people are programmed to expect miracles and make unsubstantiated claims about the advantages of a new or different therapy. That is where so many alternative providers fall short. Acupuncture is not the answer for diabetes. Diet and maybe insulin are. Manipulation is no cure for an underactive thyroid. Replacement hormone is. In order for the people who provide these services to obtain credibility they need to have demonstrable results and to recognize that herb tea may not be the answer for all that ails us.
There is a place for all types of medical care. This is being generally recognized, as evidenced by the fact that several medical schools now offer alternative medical disciplines as courses for their students, there is a national office under the auspices of the National Institutes of Health that does rational investigation of alternative techniques, the Federal Government has come out with the recent advice that we really do need vitamin and mineral supplements to our diets (weve done it for farm animals for years but refused to acknowledge that humans might benefit), and more and more insurance companies are willing to pay for alternative therapy.
I would have to agree with Toni Gilbert when she objects to the term alternative and regards her practice as that of complementary medicine/nursing. Whatever has happened, I, the long-time skeptic, am feeling better and am more functional. The gym, the Tai Chi, the Imaging and Therapeutic Touch, the vitamin supplements, and the aspirin, may not be for everyone, but its working for me. And a good outcome is what we all strive for.
I have to agree that all of these measures, including the much needed surgery, have been complementary to each other. I am pleased for the opportunity to have approached this with (if not an open mind) a mind that was not totally closed. And I am grateful for my wifes patience with me and the professionalism that I have seen in the other disciplines.
I have lived through some wonderful times in my medical career and continue to marvel at how far weve come. We can only appreciate this when we look back and see where we have been and remember to not discard the tried and true without good reason.
Joseph Intile, MD, FACP, is Medical Director, Oregon Office of Medical Assistance Programs. He is retired from private practice as an internist in Oregon City.
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