Restoring the soul of medicine

BMJ 2001; 322 doi: (Published 20 January 2001) Cite this as: BMJ 2001;322:a

Recently I asked an orthopaedic surgeon how we could make the BMJ more useful for him. “I've no idea,” he answered, “I never read it. You must understand that I'm interested only in elbows.” If my elbow were smashed to pieces I might be grateful to be treated by such a surgeon, but generally I feel that there is more to me than my elbows. “It would be a tragic loss,” writes Prince Charles on p 181, “if traditional human caring had to move to the domain of complementary medicine, leaving orthodox medicine with just the technical management of disease.” This theme issue explores how such a fate might be avoided—for the benefit of patients and doctors.

The issue has been assembled to coincide with a joint meeting on integrated medicine organised by the Royal College of Physicians and the United States's National Center for Complementary and Alternative Medicine. Those many doctors who are just learning to talk of “complementary” rather than “alternative” medicine may find themselves perplexed by talk of “integrated” or “integrative” medicine. Integrated medicine is defined in our first editorial as “practising medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment” (p 119).

But this definition doesn't capture the full richness of what might be achieved through the growth of integrated medicine. It mightn't be too pretentious (although it might) to say that such a growth might restore the soul to medicine—the soul being that part of us that is the most important but the least easy to delineate. Integrated medicine focuses on health and healing rather than disease and treatment. The patient is seen as a whole—complete with dreams, disappointments, stories, loved ones, and enemies— not just “a biochemical puzzle to be solved” (p 120). Even further, integrated medicine is, writes Prince Charles, “about encouraging individual responsibility for one's own health.” It's about healthy communities and environments. There would be no place for the uncomprehending dichotomy between clinical medicine and public health.

“Hogwash. The BMJ has finally flipped,” I hear some readers shout. But please be both open minded and critical as you read the material on what integrated medicine is and how it might be regulated, researched, and incorporated into medical training. Read too about developing countries like China, where medicine is much more integrated than in the West (p 164). Ultimately scepticism will be countered not by princes but by patients, most of whom don't want to be thought of as malfunctioning elbows.


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