What does “Taking a holistic approach” mean? - Part 1

People frequently ask me if I take a holistic approach to medicine.  I feel this may mean different things to different people, and I’ve stumbled over my answer in the past.  After some reflection, I can definitively say, “Yes – absolutely.”  Let’s start to unpack what this really means to me.

According to the Merriam-Webster dictionary: “Holistic” – adjective – relating to or concerned with complete systems rather than with individual parts.

This should be the default approach in medicine.  Every good doctor should take a holistic approach to their interventions or recommendations.  Unfortunately, this is often not the case, for one primary reason: Time.  The average Primary Care Physician (PCP) is required to care for more than 2000 patients.  PCP offices in standard insurance-based systems are pushed to see patients in as little time as possible, and in corporate settings, make as many referrals to in-network specialists as possible.  This means that each individual visit is so short (often under 10 minutes), it is nearly impossible to make holistic recommendations.  Let’s unpack this further with one common problem: Hypertension. 

The medical assistant rooms a patient, and the blood pressure is 145/95.  This may or may not have been on the radar to discuss.  A non-holistic approach to this situation would be, “Your blood pressure is high.  You need to start a new prescription.”  What does a holistic approach look like?  These questions come to mind: 

🔵 Was this reading accurate?

🔵 What was going on prior to the blood pressure reading?  Was the patient under some sort of stress preceding this, like in a stressful traffic situation or social situation?

🔵 What has been the blood pressure pattern?  Is this new or chronic?

🔵 If chronic, are there already any complications, such as kidney, eye, or heart problems?

🔵 What lifestyle factors are there, such as exercise habits, diet and specifically sodium consumption, and stress management?

🔵 Are there mental health or social stressors contributing? If so, is there anything I can help with?

🔵 What are the patient’s healthcare goals?

🔵 How does the potential of high blood pressure fit into this person’s other medical problems? 

🔵 If I’m considering treatment, then what are all the reasonable options?  In presenting the options, which one am I going to recommend, and which ones are reasonable alternatives to present as well?  Each treatment deserves time to discuss risks and benefits.  Are there dangerous or annoying side effects?  What to look out for? How to monitor? Are there drug-drug interactions or drug-disease interactions?  Does the intervention fit with the patient’s healthcare goals?

🔵 Are there other “cooks in the kitchen” (specialists) to consider when making treatment decisions?

🔵 How are we going to monitor this over time?

To me, “taking a holistic approach” to hypertension in this scenario involves at a minimum an accounting of all of these questions – and likely more.  Obviously, this takes time –more time than PCPs are allowed in traditional settings.

At Dune Shores Health, patients are given 90-minute initial visits and 30-60 minute follow up appointments.  This, plus increased frequency of visits when necessary, allows the doctor to “take a holistic approach.” 

Part 2 will look at “Taking a Holistic Approach” in light of diagnosis and prognosis. 

📣 Stay tuned!