What’s Wrong With Holistic Healthcare?

As a holistic psychiatrist I was deeply disturbed by the treatment provided at my first visit to a holistic primary care doctor. It made me really question if I should even call myself a “holistic psychiatrist." If what that doctor was doing was holistic, I don’t want to be at all associated with the word "holistic” anymore.

I call myself a “holistic psychiatrist” because what I aspire to do is to treat my patients as a whole person. The word “holistic" comes from the Greek word “holos” that means entire or complete. When I see a patient, I want to know about their mental, emotional, physical, and spiritual health. I ask them about their lifestyle habits including their eating and exercise habits, screentime, social life, spiritual practices. I want to know how they function in multiple environments- home, school or work, with friends, in hobbies. For me being holistic means looking at the whole person across all aspects of their life and then partnering with them to decide how we want to expand their health across all aspects of their life. 

Unfortunately, this “holistic” doctor that I saw didn't look at any aspects of my life except for my physical health. The physician I saw is an MD who has multiple glowing reviews on Google, mostly from late middle-aged women, and his approach was very much like a traditional MD’s except he had a set of hypotheses about what might be causing my symptoms that don't align with mainstream evidence-based healthcare.  When I arrived, a nurse took my blood pressure, height, weight, etc. Then I was ushered into a typical looking examination room, and the nurse asked questions about my physical health symptoms, which happened to be headaches. I had already filled out paperwork prior to seeing this doctor that were the standard medical history forms. At this point, there was nothing “holistic” that I noticed, but I was hopeful all that would change when I saw the doctor.

When the doctor came into the room, I met a casually dressed, fit, older gentleman with kind eyes and a firm handshake. He asked me a few questions about the timing and frequency of the headaches that I had previously shared with the nurse. He listened carefully, he took notes, he had good eye contact and gave the impression that he understood and cared. After listening and taking notes, he said that the headaches can be accounted for by “chronic candidiasis.” He then went through a long explanation of what chronic candidiasis is and how it affects the entire body and can cause a myriad of symptoms. Quite conveniently, he had pre-printed worksheets that had his protocol for combating candidiasis which included 6 different herbal and vitamin supplements. 

Have you ever heard the expression if all you have is a hammer everything is a nail?  It seemed to me that this is what was going on here. He has a protocol for chronic candidiasis which can cause many different symptoms including aches, pains, fatigue, etc. He listened, he made me feel listened to, but then he whipped out his readily available protocol for chronic candidiasis. I didn’t have any of the symptoms commonly associated with chronic candidiasis by the mainstream medical world, no itching, burning, or redness anywhere. His explanation as to how I ended up with chronic candidiasis was very much lacking. I’ve not had any need to take antibiotics for over 20 years, I’m not immunocompromised, and I’ve been taking probiotics every day for years.  Sometimes people do have candidiasis if they have a weakened immune system or if they've had to take antibiotics repeatedly, but this is definitely not the case for me. I have no symptoms related to Candida or yeast overgrowth and it was just bizarre and illogical for me as a physician to think that I could even have this condition much less that this condition could be causing my headaches. However, I was desperate because nothing seemed to be helping. So I thought to myself, well this doesn't make any sense to me, but maybe I should have an open mind and maybe it's worth a try. 

I was quickly ushered out and advised to go to the pharmacy to buy all these supplements. Quite conveniently he happens to sell all of these supplements in his store which is attached to his office. He strongly advised me to buy the supplements at his store, because then and only then we could be assured of the high quality of the supplements. He also gave me handouts for a diet that he recommends for all of his patients which was basically what I’m already eating anyway, but he hadn’t asked me about my diet so how would he know. 

Even though I have been a physician for 20 years, I still find myself feeling overwhelmed when I'm in a doctor's office. For some reason when I’m in the patient role, I still revert back into my childlike, obedient, “good girl” younger self who just sits there and nods and takes in information and tries to remember it all even though I'm a double board-certified physician.  I somehow go into this passive, receptive childlike mode where I just take in what they say and feel overwhelmed. I know this is something I need to work on-  being more assertive, being more aware, and asking questions. Maybe it was because he’s an older man, and I've been conditioned to respect my elders. Maybe it was the male-female power dynamic at play. I don't know what it is, but I felt like I was almost in a trance and just nodding and accepting his very authoritatively stated explanation for everything. And there was a part of me, a big part of me, that wanted it all to be true. I wanted it all to be that simple, and that if I could just take all these supplements everything would be better. I wanted everything to be easy and fixed. So, almost in a trance I took my piece of paper that he gave me with all these supplements that I was supposed to take to his shop in his office and spent about $300 for all of these supplements.  As I got in my car, it hit me that the visit was over $300 so the total for all this came to almost $700. 

Then as I drove home, the physician in me gradually came back. I had to admit that there was absolutely no evidence to support taking these supplements, that it's highly unlikely that I have chronic candidiasis much less that it would be causing headaches, and that it is risky to start anyone on so many supplements at once. In my own practice of psychiatry, I have never started a patient on six medications or supplements at the same time. My approach in prescribing to outpatients is to only start one thing at a time so that if there are side effects or benefits, I know that it's due to that particular medication or supplement.  When I was working in psych hospitals, I would often start multiple medications at the same time, because these people were in a hospital and by definition had severe symptoms that needed to be addressed rapidly. However, I was in overall good health and just having occasional headaches, so why should I start on six different supplements at once none of which are FDA regulated or approved. This seemed positively irresponsible to me. 

Some of these supplements were fairly benign. Probiotics, yes, we know that's all good. The rest of these supplements were things I had never heard of before, various mushrooms and herbs. When I Googled them I could find very little evidence to support their benefit or safety. What most people don't understand about supplements like this is that there's minimal testing to see if they work or to see if they might kill you. Pharmaceuticals have to undergo testing through the FDA to prove that they work to some degree and to prove that they're not going to kill you at least in the short term. There's also more oversight by the government of pharmaceuticals to ensure that what you're taking is actually what is on the label.  These nutraceuticals and herbs are not closely monitored by any government agency, so whatever is in the bottle may not actually be what's on the label. There is no testing to ensure that what you think you're paying for is actually in there. There have been incidents of various nutraceuticals and herbs that also have contaminants such as lead, mercury or other contaminants. This is why he said that we needed to buy these supplements from his shop. 

I also felt uncomfortable that this “holistic” doc is profiting off of what he's telling me to take. This seems like a conflict of interest to me. When I prescribe medication to a patient, I ask them where they want the electronic prescription sent. I don't care what pharmacy they use, because I don't get a cut of it. Likewise when I recommend a nutraceutical or herb which I do, when there is significant evidence to suggest that it will result in minimal harm and significant benefit, then I often recommend certain name brands to my patients.  I recommend specific brands, because there is a great variety from brand to brand in the safety and formulation of these products. I sometimes tell them where they can buy it. Whether they buy it on Amazon or their local health food store, I don't care, because I'm not making money off of them getting it at all.  I know that when I recommend a specific med or supplement to my patient, it is based solely on my medical opinion and there is not even a subconscious bias in my medical decision making based on any potential financial gain.  

The public needs to recognize that it is a real conflict of interest when doctors of any type recommend supplements that they also sell. In the past,  I used to see this more from naturopaths, chiropractors, Chinese medicine doctors, but I see this trend more and more with MD's and DOs selling vitamins and supplements in their office that they recommend. I see this same conflict of interest when physicians offer multiple other somatic treatments in their office. For example, they have a medical spa in their office. You see them for blood pressure and hypertension, and then they tell you you can get botox or facials in their office. In psychiatry, one of the latest treatments for depression is called TMS (Transcranial Magnetic Stimulation). I’m not going to get into detail about how it works, but psychiatrists in private practice (myself included) are frequently approached by businesses selling or renting TMS machines which are all very pricey. Their sales pitch is how it's a great way to increase your practices revenue. The psychiatrist buys or rents the machine and now has to pay for it, and then suddenly it seems that so many people in his practice desperately need TMS. If you have a very expensive hammer that you are still paying off, then everything is a nail. 

These examples represent what I call “dual relationships,” meaning you are both the prescriber and supplier of the treatment.  Patients may feel pressured to buy the products or services from the doctor they just saw and put their trust in. Generally, patients are not feeling 100% great or else they would not be seeing a doctor. They may be struggling with serious physical and mental health concerns, and feel a sense of desperation and be willing to try anything. The patient may not even consciously be aware of feeling pressured, but they often feel a sense of social obligation to do what their doctor tells them to do. They also may worry that if they don't buy the supplement or get the suggested services from their doctor, then the doctor is potentially going to be displeased in some way and potentially not continue to provide good medical care to them.

In psychiatry, we are trained that having a dual relationship compromises the doctor-patient relationship severely. We need to have only a doctor-patient relationship, and we are not supposed to provide psychiatric care to people that we have any other sort of relationship with such as our family members, friends, or business associates. I want my patients to know that I am 100% there for them as their physician, not for my own interests or profit. I want them to know that my recommendations for their treatment are 100% about helping their symptoms improve and have nothing to do with me making money from selling them supplements or additional services. 

There are anti-kickback laws so that doctors can't get a payment for referring patients to see a doctor buddy. This used to be a big problem. For instance, let's say Dr A is friends with Dr B. Dr B is a radiologist and Dr A is a primary care doctor. The radiologist might say, “Hey, Dr A I'll give you 10% of every patient you send to me for an x-ray.” Then suddenly Dr A starts referring everybody for x-rays, and makes a lot of money ordering unnecessary x-rays. Meanwhile, people get exposed to unnecessary x-ray radiation. This was a significant problem in the past, and so there are now laws that make this kickback relationship illegal now. However, there are no laws about doctors telling people to buy the supplements or the add-on, expensive services that they sell in their office. I don’t understand how profiting by referring to a different doctor is so different from profiting by referring to your own store/pharmacy or services. 

With insurance reimbursements not keeping pace with inflation, I think more and more doctors are looking for ways to keep their practices afloat. It's not about getting rich so much as just staying in business for many doctors. They may feel that they have to pedal additional products and services to survive. Additionally, they are frequently solicited by companies selling TMS machines, vitamin and herbal products, aesthetic laser makers, etc. Doctors are told that having these add on services will help their patients and unlock new revenue sources. I see these pitches in booths at many medical conferences. I was harassed by a sales person trying to sell me a TMS machine via endless calls, emails, and mailers. 

These types of dual relationships are one of the factors eroding trust in physicians in our country in my opinion. As physicians, we need to look at ourselves and ask if the profit that might come from selling products and services to patients is worth the risk of damaging the doctor-patient relationship. The doctor patient relationship was once held sacred. This has been largely replaced by a consumer model in which the patient is buying the services and products that the doctor is selling. Is this really where we want medical care to go? Is this really what patients want? Is this really what doctors want? Or is this just where we are being pushed by the capitalistic forces that shape our country? Should we go with the flow or change course? Should there be laws about doctors selling products and services that they provide similar to the anti-kickback laws? 

I’d love to hear from doctors and patients how they feel about all this. 

If you're a doctor who sells products and services in your practice I’d especially love to hear from you. Do you feel that this has changed your practice of medicine?