Are doctors holistic?

Doctors today are often accused of not being holistic.  Being holistic is generally considered a feature of alternative or complementary health care practitioners such as homeopaths, herbalists, traditional Chinese doctors etc.  At least, this is often how these therapists portray themselves;  it’s their unique selling point.  

People may be sceptical about whether the treatments offered by complementary therapists really work, but may appreciate the more comprehensive approach and the longer time taken with the therapist in the consultation.  

Despite this widely held view that doctors are not holistic, I can remember being taught in my medical school that we should be holistic in our approach.  We were discouraged from describing patients as “the spleen in bed 2”, and urged to assess the patient fully including their psycho-social and family background.  I’ve generally assumed that my modern medical education equipped me to be much more holistic than doctors of the previous generation. 

Recent reports from the Department of Health continue to recommend the practice of holistic health care. 

Are doctors holistic?

What is holistic care after all?

This train of thought led me to look into what is actually meant by the term “holistic”.  A little internet research revealed that the term has a variety of quite different meanings.  Apparently, first coined by the South African statesman, politician and soldier Jan Christian Smuts in a book in 1927, the term was initially used to mean a philosophy which could be applied to physics, society and biology in which systems are considered as wholes and not collections of parts.

When used in connection with health and health care these ideas have been used to mean that illness and recovery should be seen in the context of a person’s social and psychological situation but also has been appropriated by some simply as a synonym for complementary and alternative medicine to distinguish it from conventional medicine.  One article I read suggested that “holistic medicine is based on the belief that unconditional love and support is the most powerful healer”.

As a result, some doctors apparently prefer to say that they are “wholistic” in their approach so there is no confusion that they practice complementary or alternative medicine.

If doctors are not very holistic, why aren’t they?

Several possible reasons spring to mind.  Perhaps doctors are sceptical of the benefits of this approach?  It’s all a bit woo-woo, after all, and many doctors like to think of themselves as cool, rational, objective and scientific.  In defense, some of the major advances in modern medicine are amazingly powerful: anti-biotic therapy and modern surgical practice, for example.  Perhaps doctors can be forgiven for being blinded by the successes in some areas of medicine and assume that this applies to all.

Another possible reason is simply that doctors don’t feel they have the time: a “holistic needs assessment” sounds as though it will take a long time to conduct; and who knows what intractable problems it might uncover.  Writing a prescription is the work of a moment while taking time to explain the benefits of a change of life-style is not.

Does it matter if doctors are not very holistic?

Yes.  Quite simply: Smuts had it right.  And deep down, all doctors know this.  People are not machines that can be taken to a workshop when broken and fixed (though some people seem to wish it was that simple).  Health and well-being are extremely complex concepts and require a whole system approach or you risk making things worse rather than better.

Dr Michael Leahy
Consultant Medical Oncologist
The Christie NHS Foundation Trust

What do you think about doctors and the concept of being holistic in their approach?  We'd love to hear your views.  Please comment below, or contact us at PlanBe@christie.nhs.uk 

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Dr Michael Leahy

Ben Heyworth