Standardized clinical practice guidelines have become the norm in modern medicine. The National Heart, Lung, and Blood Institute publishes guidelines for the management of cholesterol; the American College of Rheumatology publishes guidelines for the management of arthritis; and the American College of Gastroenterology publishes guidelines for the management of inflammatory bowel disease. The list goes on. There is certainly merit to these (and other) practice guidelines. They set quality standards and make the practice of medicine more consistent. Published medical studies inform practice guidelines and establish what has become known as “evidence-based medicine.”
I am an advocate for science, for evidence, and for quality care, but I do not believe that all patients are best served by following algorithms. Individual circumstances do not always allow for cookie-cutter solutions, and treatment recommendations must be individualized. In addition, the functional medicine movement often embraces cutting edge advances that fall outside of the traditional medical model. There is more money for research on pharmaceutical medications than on natural therapies, so the natural treatments are easily dismissed. But this does not mean that natural treatments do not work. I have seen patients with severe cases of inflammatory bowel disease that improve dramatically with our nutrition-based leaky-gut protocol even after conventional medications and surgeries have failed. Patient success stories like this help build an evidence base for my practice and other functional medicine practices.
Observation and experience should be considered quality evidence (in addition to research studies) to guide clinical decisions. Not all skills can be learned in the classroom or by reading research. This is one reason that I am so passionate about having students rotate through our office. We routinely have medical students, nurse practitioner students, and medical assistant students in our office. I often ask students to review and synthesize complicated patient histories, a collaborative effort that has occasionally uncovered mysterious or rare disorders. Together, we collect information and do what is best for the patient, even if that means going outside of the conventional medical box. Students learn alternative ways to provide patient care and can attest to the many successes that we have using more natural approaches.
I strongly believe that it is important for experienced physicians to pass along their medical knowledge and skills to the next generation of health care providers. The clinical setting offers learning opportunities that the classroom cannot. I enjoy helping students hone their interview skills and learn to understand the whole patient. While teaching is both professionally and personally fulfilling for me, it also makes me a better clinician myself. It is a bidirectional and interactive process that helps keep me informed of the latest medical advances.
Good health care providers are not merely technicians who can follow practice guidelines and algorithms. Using natural therapies that are not necessarily recommended by practice guidelines is similar to the notion of off-label medication use. We consider patients in all their complexities and—based on scientific evidence, observation, and experience—determine a protocol to best help each.
About the Author: Dr. Gerard Guillory, MD is Board Certified in Internal Medicine and has published two books on Irritable Bowel Syndrome (IBS). In 1985, he opened The Care Group, PC. Today, his clinic is a Primary Care facility that is a hybrid of functional and traditional medicine treating patients with digestive disorders, autoimmune disease, and other conditions. You can learn more about Dr. Guillory here.