Philosophy of Medical Practice

My current focus on hormone balancing, metabolism, nutrition, and preventive medicine, has been a work in progress. Under the guidance of my patients, it has been a process of introspection on not only the way I practiced medicine, but also on myself over the past several years. I have come to realize that focusing on these areas, because of their integrative nature, has allowed me to practice specialized medicine in a manner which was most applicable to and needed by the general public. I practiced conventional western medicine for many years because of my training, dating back to 1988 when I attended medical school at the University of Texas Health Science Center at San Antonio and subsequently at the University of Michigan Medical Center for internship and residency in the field of internal medicine. I was under the impression that I was practicing fast, effective, and evidence-based medicine. I had been involved in helping patients miraculously survive injuries, heart attacks, strokes, burns, poisonings, broken hips, burst brain aneurysms, and was impressed that prevalent symptoms such as acid reflux could disappear with just one medication, such as Prilosec.

After I relocated to Santa Cruz in 2001, I began to encounter many patients wanting to utilize alternative approaches, such as acupuncture, herbs, chiropractic, hypnosis, homeopathy. Many of them were suspicious of conventional western medicine. I had not encountered this sentiment much in Michigan, likely because of the outreach of the University of Michigan's academic reputation to the surrounding population. At first, I looked down on such requests, as my traditional training had taught me that such methods were mostly not evidence-based. Gradually, my patients taught me to be a better listener through their persistence in bringing books and information they wished me to review. They had obviously already come to the realization that most medications led to side effects, and that the sum of the "body parts" do not necessarily equal the whole person. I became curious as to why "alternative" methods such as acupuncture and herbology had survived thousands of years of practice in other parts of the world, including Taiwan, where I was raised. Just because they had not be "proven effective" by science, was I automatically to assume that they were dangerous and/or ineffective? I acknowledge that science has greatly expanded our knowledge, but also recall its limitations. As an example, I remember being told by my mentor that, through nationally televised messages, obstetricians used to encourage pregnant women to smoke in order to reduce baby weight, thereby limiting complications of delivery!

These early interactions with my patients laid the foundation for my current approach to medicine, which I believe to be integrative. This involves looking at the whole patient and paying attention to all the clues provided by the body and mind. We live in an era of many technologies that are rapidly changing us and our society. This is especially true in the United States, where we tend to look for faster, more powerful solutions in technologies. This has led to the general expectation that we can change or eliminate our symptoms quickly, thereby "curing" our illnesses. For example, if a person has a headache, and aspirin takes it away, is the person "cured" of the headache? Perhaps, but if the headache resurfaces, we need to see if there are other factors at work, such as monthly hormonally-mediated headaches; psychological due to stress situations; anatomical, due to tumors/aneurysms, etc. We are not born with an aspirin deficiency, and simply taking away the symptom with a drug does not really get at the root cause of the problem. I take symptoms as clues provided by the body that something is off-balance. The symptom will abate if the underlying imbalance is corrected. Simply suppressing the symptom with a drug is doing away with the important clues needed to solve the mystery. Integrating all the clues is systems thinking, which dictates that changing something in one part of the body can and does affect another more distant part of the body, as the body consists of many organs which are linked by an extraordinarily complicated web of communication channels which possess interrelated connectedness on multiple levels.

Reflecting back to my earlier practice style, I was simply "curing" symptoms with medications and looking at the patient metaphorically as the sum of many "body parts". If the patient complained of heart symptoms, I would send them to the cardiologist, who had mastered the "heart body part"; if the patient complained of gut symptoms, I would refer them to the gastroenterologist, who had mastered the "gut body part"; if the patient complained of eye symptoms, I would refer them to the ophthalmologist, who had mastered the "eye body part", and so on. Looking back, I now understand that despite having a whole team of specialist physicians working very hard on their symptoms, patients fail to achieve a state of health because no one is looking at the whole person. I continue to be grateful for conventional medicine's extreme effectiveness in dealing with acute medical situations, such as acute injuries, heart attacks, etc., and realize that for the right person, drugs can be keep a person functional or be potentially life-saving; but I now have a new-found respect for utilizing it appropriately. Such appropriate use should be based on thorough evaluation of each individual, and with ongoing surveillance, keeping systems thinking in mind.

My interests in hormone balancing began in 2002, shortly after the results of the Women's Health Initiative (WHI) were publicized in the media. Like many physicians practicing the standard of care, I took many women off their hormones at that time. Gradually, many women returned to me, complaining of head-to-toe symptoms such as foggy memory (some even feared that they were developing Alzheimer's dementia), hair thinning, night sweats, hot flashes, poor sleep, achy joints, no sex drives, painful sex, weight gain, no energy, palpitations, anxiety, depression, loss of bone mass, and many other symptoms. I tried using supplements such as black cohash, and other herbal remedies, which did not help much for the majority of my patients. Certain drugs such as "Effexor and Neurontin" were being promoted to treat the hot flashes, but I knew they were simply suppressing symptoms while not addressing the true underlying cause. Under the conventional medicine model, I would probably prescribe a whole host of "anti-" drugs, including an anti-depressant for the depression and anxiety, anti-inflammatories for their achy joints, an anti-hypertensive beta-blocker medication for the palpitations, Fosamax for their bone loss, Ambien for sleep, and just tell them that it is aging-related, and work on reducing stress. Once again, I began to question why women needed to suffer when it was obvious that we had the technology to literally "cure" these problems with bio-identical (i.e., human-identical) hormones. The results of WHI were being applied to all women across the board in sweeping generalization, propelled further by media sensationalism without respect to each individual woman's medical situation or careful analysis of the study's details by medical providers. Thus began my research into the use of hormone replacement therapy and specifically, the use of bio-identical hormones. I am grateful to the numerous women who "experimented" along with my recommendations in the beginning, looking for the right balance - a process which has now been greatly refined and customized.

My interests in metabolism and nutrition stemmed out of my curiosity when a patient handed me a book over 4 years ago which explained that metabolism was really much more complicated than just calories in equals calories out. In fact, there are multiple factors which are often over-looked, such as hormonal imbalance (which may include sex hormones, thyroid, stress hormones such as cortisol, to name a few), stress, poor sleep, inappropriate exercise, and ingestion of toxins, to name a few, with each of these factors clearly affecting the others. Further reading led me to equate food as the most important drug that any person could take, and that often, physicians lack the time and knowledge to properly address this critical contributor to a person's health. In this day and age where fad diets come and go, and weight-loss aids constitute a billion dollar industry, it can be extremely confusing for a patient to decipher the basics of even what to eat. The basics of good nutrition are more important in light of the fact that over 90% of all diseases we see today are preventable, starting with a good diet!

The knowledge I gained in researching metabolism and nutrition pushed me towards preventive health, which literally starts with a healthy diet and lifestyle - factors which only the patient can control. By simply pointing out their importance and guiding patients in the right direction, I have been able to successfully remove or reduce many drugs from their regimen while simultaneously improving their health. I feel that patients are underserved with the conventional medical motto of "early detection of disease", which is often promoted as preventive health. It does absolutely nothing to truly prevent disease. This viewpoint assumes that the body is prone to disease, so that we must catch it earlier if we are to defend against it. This model of susceptibility to chronic diseases also conveniently makes drugs an effective tool. While I believe in the importance of early detection of disease, I take the approach that the body is a miraculous, complex system that generally works quite well, but that we need to do a few basic things (like eat a healthy diet, manage our stress and lifestyle, etc.) to keep it running well, much like tune-ups are needed to keep a car running well. These "tune-ups" are much more important and become more complex as we age. I also realize that not everyone is blessed with a healthy genetic make-up or social network, and in those people, early detection of disease and appropriate medications can be powerful tools in keeping them functional.

I feel strongly that we, as consumers of health care in this technology-driven era, have a choice, and that we need to look out for our own best interests. This process of making the right choices takes time, and really paying attention to oneself--our symptoms, body, mind, and relationships, which few people are willing to spend in our fast-paced American culture. Rushing through this important process results in excessive testing, over-medicating, wrong diagnoses, and generally pigeon-holing patients when we find nothing objective or conclusive on tests results. I firmly believe that we should make the system work better for the patient rather than make the patient fit into a rigid health care model, as no two individuals are alike. I believe we should be able to "cherry-pick" the best of conventional western medicine and alternative/complimentary medicine in an integrative fashion to treat the whole patient, as clearly each has many beneficial treatment and strategies to offer the whole patient.