"Feel Good" Medicine

As a doctor, I have discussions every day with my patients who are interested in getting off of their prescribed medications and taking something holistic instead. I consider it my job to listen to my patient's frustrations and arguments and to try to accomodate their needs as much as possible without compromising my training, mandate and role as a licensed physician. Evidence based medicine is the cornerstone and the foundation of our science and art. Our professional articles and citations script for us the standard of care that we try to convey to our patients as we prescribe our medications to heal their illnesses. Chronic health conditions are often asymptomatic and convincing patients to embark on a daily therapy is challenging. After one heated exchange last week in which one of my patients tried to convince me of the validity of his holistic treatment over the therapy I was advocating to control his hypertension, I suddenly realized why we were not communicating. While this patient and I were repeating the same phrases and examples to each other, we both were expressing very different meanings for those same words.

My patient would repeatedly demand, "I feel good on my supplements so why should I take your medications?" It occurred to me that the phrase, 'I feel good' is a catch all or umbrella term which is synonymous with 'I feel well'. The patient was trying to communicate to me that their internal monitoring system was not detecting a health problem. The patient was, in fact saying, 'I feel well so I must be healthy so why are you prescribing me this medication?' This particular patient was well versed in the alternative medical literature and understood that since his supplements and vitamins left him feeling good, he must, therefore be free of danger from disease or medical disaster.

This is a fine point because doctors, especially family practitioners are trained to look for potential medical land mines that might loom up and strike a patient in the future.

"I feel good." is a construct which implies total wellness since the signals the body gives are looked upon as a good indicator of health and we all expect that our personal energy and sense of well being should act as a diagnostic screening tool or health barometer for each of us. To a medical practitioner it is, of course important to feel good but it is more important to be good.

Three of the deadliest health conditions we Americans face are all but impossible for our own internal diagnostics to detect; adult onset diabetes, high blood pressure and high cholesterol. Even many forms of cancer cannot be detected except by certain tests and are often discovered late. If a person comes to me for advice but are in the mindset that "feeling well" equals "being well" then the alternative health world of supplements and extracts makes perfect sense. If you are a trained health care practitioner then the patient in front of you whom you have been entrusted to safeguard is not truly well until that patients relative risk for long term disasterous health consequences have been checked and corrected even at the expense and risk of taking a prescribed medication. We, health care practitioners know we have done a good job for our patients when they die of old age and with the minimum of therapeutic interventions.

The next time one of my patients wants to know why they should take a risk and sacrifice their interpretation of wellness (feeling good) with my interpretation (lowering the relative risk of future catastrophic illness) I will simply tell that patient that while we both want the same things, as a physician, I am trained to help them attain goals for their health that go beyond just 'feeling good'. A good physician wants each patient to be able to go kayaking and mountain bike riding with their great grand children.....and feel well at the same time.