Holistic medicine

Definition

Holistic medicine means consideration of the complete person in the management and prevention of disease physically, psychologically, socially and spiritually. It is underpinned by the concept that there is a link between our physical health and our more general 'well-being'.

In an holistic approach to medicine, there is the belief that our well-being relies not just on what is going on in our body physically in terms of illness or disease, but also on the close inter-relation of this with our psychological, emotional, social, spiritual and environmental state¹ . These different states can be equally important. They should be managed together so that a person is treated as a whole. In fact some feel that the word holistic should really be spelt 'wholistic'. An holistic approach means that the doctor is informed about a patient's whole life situation.

Holistic medicine treats symptoms but it also looks for underlying causes of these symptoms. One way of explaining this is by looking for 'the story behind the story'. An example of this has been described in an Accident and Emergency setting where patients may present with one problem and then, having had relief from pain, diagnosis, and care, may explain what led to their problems and attendance. This may reveal, for example, domestic violence, exploitation, or danger. The same can be applied in a General Practice, or any other medical consultation setting.

Holistic medicine is something that alternative medicine practitioners traditionally use as a basis for their treatments. However, it is a common misconception that holistic medicine is just 'alternative' or 'complementary' medicine. It is true that holistic medicine allows for a wider range of treatment approaches to be used together and encourages open-mindedness for these different approaches. Some of these approaches may include the use of complementary and alternative medicine but holistic medicine does not dismiss conventional medicine or the importance of a scientific approach¹ . It uses conventional medicine as part of the treatment approach. Nutrition, exercise, homeopathy, prayer, acupuncture and meditation are just a few other treatments that may be used together with conventional medicine as part of an holistic approach. Holistic principles in medical education and nursing care are also recognised as important concepts^{2 3} .

Some history⁴

Clinical holistic medicine actually dates as far back as Hippocrates. An holistic approach to patient care was also suggested by Percival in his book - the first textbook of medical ethics - first published in 1803. Percival stated: "The feeling and emotions of the patients require to be known and to be attended to, no less than the symptoms of their diseases."

In the twentieth century, John Macleod in his book 'Clinical Examination', first published in 1964, also commented that "we should aim to be holistic in our care". Also, the seminal work by Michael Balint, 'The Doctor, the Patient and his Illness', first published in 1957, represents an important landmark in seeing the patient as a whole rather than as isolated pathology. Illness is not just an isolated physical disorder or random event. Perhaps bad habits start in medical school, referring to a patient as "the mitral stenosis in bed 7" or "the lobar pneumonia in bed 13".

An holistic approach is good practice and has been strongly advocated by the Royal College of General Practitioners for many years.

Consultation skills and an holistic approach

The consultation can be used as a tool in holistic healthcare. There is a separate article called Consultation Analysis but it seems that doctors no longer see patients as walking pathology as mentioned above.

Techniques can be used within the consultation to help find 'the story behind the story'. In 1984, both 'Doctors talking to patients' by Byrne and Long and 'The Consultation: An Approach to Learning and Teaching' by the Pendleton group were published. These approaches, and also the work of Balint, sought to ask questions such as:

• Why has the patient decided to consult?

• What does the patient think is the problem?

• What does the patient fear may be the problem?

• What is the patient hoping to achieve from the consultation?

Those who use such questions and consultation techniques will be taking a more holistic approach.

Good listening and communication skills during the consultation are essential qualities for a doctor using an holistic approach. Holistic medicine encourages patient participation in the doctor-patient relationship and patient empowerment. House calls - both by doctors and nurses - are also seen as being important in the process of achieving an holistic view of the patients, their social circumstances and their individual conditions. This is particularly useful for patients living with multimorbidity⁵ .

In a survey of Swedish GPs, the GPs put an emphasis on the consultation process as being an important tool for achieving an holistic view of patients and their problems⁶ . In the same survey, GPs found an holistic view both meaningful and present in their daily work. Of note, they seemed to be practising holistically but not necessarily labelling their practice as 'holistic'.

The British Association for Holistic Medicine and Healthcare⁷

This was established in 1983 by a group of medical doctors and students. It now has members who include mainstream doctors and healthcare professionals, complementary and alternative medicine practitioners, and lay people. The aims of this association are to promote holistic practice in healthcare as well as holistic well-being in individuals and communities. The Journal of Holistic Healthcare is published three times a year. This focuses on evidence-based holistic practice and includes research and service developments.

Conclusion

All healthcare practitioners should aspire to holistic medicine and try to practise it. However having physicians leading this process is insufficient, primarily because of the strong biomedical focus of the physicians⁸ . Although physicians can be educated to place more emphasis on the holistic outcome, holistic care delivery requires greater integration and teamwork in the care chain. Recognising the 'whole' person in the prevention and treatment of disease may hold the key to some diagnoses for doctors. It may also allow valuable and important help and guidance to be given to the patient. Patients tend to be more satisfied if a doctor takes an holistic approach, feeling that their doctor has time for them and their problems. However, in General Practice with only 10 minutes allocated per consultation, time constraints may sometimes make this difficult to achieve⁹ .