• Paul McGovern

Occupational Health – reclaiming holistic medicine

Google “holistic medicine” and you get a list of websites that talk about alternative medicine. There are many links to worthless 'treatments' like homeopathy, guff about unhindered free-flowing life forces, and other nonsense. A real clinician, of course, has no place paddling in such ultra-diluted pools.

However, despite giving advice as accurate as a flat-Earther’s world view, peddlers of this sort of thing seem to be doing alright. Depending on your source, ‘alternative medicine’ is an in

dustry worth between $30 - $200 billion per year. People spend a lot on this, despite many of the treatments not actually working. Some are actively harmful. The naturopath who reportedly ‘treated’ a 4-year-old boy with behavioural problems with saliva from a rabid dog is one case in point. The 9-month-old baby who got lead poisoning after chewing a ‘homeopathic magnetic hematite healing bracelet’ is another.

It’s a shame that holistic medicine as a concept is so often slicked with snake-oil. To look at that Google search list, you’d think the definition of holistic medicine included words like pseudoscience, placebos, chakras and crystals. It doesn’t. All holistic means when talking about medicine is that it's “characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease.” (OED)

It makes sense. If you break your left wrist and have an operation to fix it, who you are and what you do makes a huge difference to how you recover. If you’re right-handed and work in an office giving technical support over the phone, you might not be too inconvenienced. If you’re a left-handed single mum working as a data analyst, it might be a different story. You type a lot in your job, your wrist hurts, so you can’t work as much. At home, you can’t pick up your child to breastfeed; they’re cranky, you’re exhausted. You don’t have time to do your physio exercises, so it takes longer to heal. This is depressing – so it’s not surprising that you feel pretty low after a few weeks of this.

Medical students are trained to think about each patient ‘as a whole.’ Practically doing so can be difficult when they qualify as doctors. Medicine is complex, and only getting more complicated as science advances. Clinicians are therefore far more specialized than they used to be. This is a good thing. When I have a hip replacement, I’d rather have a surgeon that does hip replacements every day, rather than someone who does one every three months.

But ever more specialized practice does narrow the focus somewhat, and it’s human nature to think about problems in terms of one’s own expertise. A patient with a veritable shopping list of complex heart problems, lung problems and liver problems might be treated by the most brilliant medical minds in their own fields. However, those specialists might not speak to each other, and they may not know how to answer questions about a new excruciating neck pain.

Enter the general practitioner. They know a lot about a lot of things, rather than everything about one thing, so they can either treat you themselves or refer you to someone that can. Traditionally, the patient's GP was their doctor for life, and would know a great deal about them: what advice they were likely to follow, what job they did, what their hobbies were, and the impact of an illness on their life.  This happens still, but it’s increasingly rare.

GPs are under such pressure that they can often only talk about one condition per 10-minute appointment, and a patient will often see whichever doctor is available rather than ‘their’ GP. In terms of looking at patients as a whole, there’s only so much a GP can do with the time and resources they have. When people have complex problems, or even simple problems which aren’t immediately obvious, a holistic approach can really make a difference. It lets the clinician draw together, and start to make sense of, the disparate things that affect our health.

Occupational Medicine can play a huge part in helping in this way. An appointment is long enough to allow time for the clinician to sit down with a patient and talk to them about who they are and what they do. What medical conditions they have, for sure, but also the stuff that affects them in their everyday life. How their health relates to what they can actually do. And if there is a difference in what a patient wants to do and what they can do, how to get there. Holistic practice in occupational medicine is not an add-on – it’s inherent to the specialty. The person’s occupation frames the conversation, but to give useful advice about work and health, the clinician must get an understanding of the whole.

This, perhaps, is part of the reason why homeopathy continues to exist and why people keep spending money on it. Before prescribing a placebo, a homeopathist will often spend plenty of time speaking with their client, gaining a real rapport. This itself is enormously reassuring, even if the distilled water they dish out at the end has no effect in itself. The impact of feeling listened to by someone in a position of apparent authority is difficult to overstate. How much more valuable that time is when spent with a doctor who can suggest something genuinely useful instead of closing the deal with a sugar pill and an invoice.

A great asset that clinicians in occupational medicine have is the time to listen in this way. Occupational health reports don’t contain a load of medical jargon, because they are written for non-clinicians to read. They focus on practical advice that considers the person, that can realistically be implemented.

Each of us is more than an organism with diseases that can be fixed. We shape, and are shaped by, the world around us: our families, our friends, our community, and our jobs. Occupational medicine looks at health in the context of work, but also in the context of the rest of a patient’s life. As clinical disciplines become ever more specialised, we now – more than ever – need the input of occupational health clinicians. They not only keep people in work, safe and well; they help people with medical problems to live their lives as they wish.

The more people have access to this type of medical support, the better. Increasing access to Occupational Medicine should be a national priority.

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