My Journey to Becoming a Holistic Physician: An Essay                                                                                                            

 

In retrospect, the start of my journey was in 1988, in the second year of my residency.  During the mandatory rotation through the outpatient department at Millard Fillmore Hospital, Dr. Bruce Middendorf assigned each resident a reading assignment – Love, Medicine, and Miracles by Dr. Bernie Siegel.  I found this book interesting at the time but was unsure how to integrate the ideas in the book into patient care.

 

I decided after completion of my residency to travel before entering private practice.  I did locum tenens work to support myself while traveling. I got the “travel bug” and what I initially thought would be 6-12 months of domestic travel and locum tenens gradually evolved into 2 years of travel not just in the United States and Canada, but also in Australia and New Zealand one winter and Taiwan, Hong Kong, Singapore, Malaysia, Thailand, Nepal, and India the next winter.  I had lots of opportunity to read a variety of books during this time from 1989-1991, including several by Dr. Bernie Siegel and Dr. Deepak Chopra.  This was the first chance I had since high school to read books not assigned as part of course work, and I enjoyed reading for pleasure.

 

After a brief stay in Millard Fillmore Hospital as a patient with what was eventually determined to be Hepatitis A contracted somewhere in Asia, possibly while swimming in the Ganges river while in Benares, I entered private practice. I joined a small group practice in Cheektowaga.  Approximately 6 months after starting practice, as I began to realize how limited I was as a physician at treating most chronic conditions, and also at treating symptoms of unknown etiology, I “discovered” Dr. Andrew Weil on a snowy winter afternoon.  I was supervising medical residents at Millard Fillmore Hospital in their continuity clinic.  It was not my turn to stay late that week, but the other supervising physician had several admissions and a wife and young child waiting for him at home, and one resident was way behind, so I volunteered to switch with my associate and stay late.  Thumbing through the weekly AMA News while waiting for the resident to finish his clinic, I happened upon an article on the Lifestyle page which caught my attention.  I was intrigued by the ideas and the practice of Dr. Andrew Weil. I purchased and read one of his books, Health and Healing, and was even more intrigued.  Next I read his books Natural Health, Natural Medicine and The Natural Mind.  His approach to health and wellness resonated with me. 

 

Over the next couple of years, when spare time from my conventional internal medicine practice allowed, I began to read other books and journals and newsletters on nutrition and herbs and complementary modalities of therapy.  In July, 1993 I gave a Grand Rounds at Sisters Hospital on “Holistic Health and Mind/Body Medicine.”  The turnout was small, but the usual exodus of doctors during the presentation was absent – virtually everybody who came stayed until the end.  In February, 1994 I taught a one hour class to the D’Youville Physician Assistant students on “Contemporary Medicine.”  In August, 1994 I traveled to Feathered Pipe Ranch in Montana for a week long seminar “Nutrition with Dr. Andrew Weil.”  In November, 1994 I was invited to speak to the Lancaster Civic Women’s Club on “Holistic Health.”  These presentations were in the days before the term Integrative Medicine was popular, so I always struggled with titles for my talks.

 

In January, 1995 I changed jobs, taking a salary position with Sisters Hospital which involved primarily clinical practice of Internal Medicine, but also medical teaching responsibilities and some administrative responsibilities.  I submitted a paper for publication in JAMA, entitled “Alternative Healing Modalities: An Overview.”  The paper was not accepted for publication, but I was not discouraged.  I continued to give a number of Grand Rounds and community presentations on topics such as “Nutrition,” “Exercise,” “Vitamins, Minerals, and Herbs.”  I appeared a few times briefly on the television news, talking about my office practice. I began to specifically market my practice to the community as a holistically oriented primary care practice.

 

In addition to reading books and journals in order to expand my knowledge of complementary modalities of treatment, I began to attend medical conferences as another way of expanding my knowledge and, in retrospect, beginning to network with other like-minded professionals.  In 1996, the medical school paid for me to attend a “National Conference on Nursing and Medical Education in Complementary Medicine,” sponsored in part by the Office of Alternative Medicine at the NIH.   In 1997, I attended a conference at Harvard Medical School, “Alternative Medicine: Implications for Clinical Practice.”  In that same year, I attended another conference with Dr. Andrew Weil, this one at Canyon Ranch in Arizona, entitled “Examining Integrative Medicine.”  The other conference I attended in 1997 was “Clinical Applications of Natural Medicine” in Chicago, sponsored by Bastyr University.  In 1998, I resubmitted a revised paper to JAMA for the theme issue on Integrative Medicine.  This one, entitled “Complementary Treatment Modalities: An Overview,” was also rejected, but the assistant editor was impressed enough by my effort and knowledge that I was subsequently asked to peer review a different article submitted to JAMA.

 

In August, 1998 I left the employment of Sisters Hospital and joined Buffalo Medical Group, a multi-specialty group.  At this time I named my practice “Center for Integrative Medicine.”  My goal at the time was by the year 2000 to work in an office setting in collaboration with a naturopath, chiropractor, physical therapist, massage therapist, acupuncturist, and behavioral medicine specialist.  I launched my web site in 1999, www.acsu.buffalo.edu/~shlevy/.   By this time many articles on herbal medicine and complementary modalities of treatment were appearing in the mainstream medical journals, with references.   As I would read these, I would regularly update the web site.  The web site now contains approximately 200 pages of text, all in outline form, and the information is extensively referenced.  It is a way for me to organize my expanding knowledge; it is also an educational and informative community resource to which I regularly refer during office visits and community presentations.

 

I continued to give community presentations, several each year, and continued to attend one or two medical conferences devoted to Holistic Medicine or Integrative Medicine each year.  All of my presentations and formal continuing medical education in holistic medicine are listed in my Curriculum Vitae, which is posted on my web site.

 

Personally, I married in 1997 and our first son was born in 1998, the second in 2000.  We purchased a dog and adopted two cats from the SPCA.  My efforts to “walk the talk” and practice what I preached by continuing to find time for exercise and relaxation and to balance home and family life with an expanding primary care medical practice became a struggle.  In primary care, the overhead is so high, and so much of the overhead is fixed, that unless one has a practice sharing arrangement, it is impossible to work less than 45-50 hours per week at ones job and make a decent living.  Part of the reason for this is that much of the counseling and coordination of patient care in primary care occurs between office visits, and this is not paid for in most instances by the patient or the insurance company.  Financially, the longer patient visits which are required as a part of the practice of patient-centered holistic primary care are not as well reimbursed by insurance as shorter visits.  In my office practice, I had created a “monster that I could not manage.”  By this I mean that despite several years of effort and modifications of my office practice on my part, I could not create a situation whereby I could work approximately 40 hours per week in the office, practice my personal standard of high quality medical care, and make a decent living to support myself and my family. 

 

In terms of my desire to achieve balance in my life amongst office practice, community presentations, teaching and mentoring medical students, involvement in community organizations, personal time for exercise and relaxation and occasional vacations, and quality family time, I made a difficult but positive decision in June 2003 to discontinue the practice of primary care, effective 12/31/03.  I will obtain Board Certification in Holistic Medicine and after a year or so of intense self-study, including attendance at many national conferences, I will open a consultative practice in Integrative Medicine in 2005.  In this new practice I will not accept any health insurance.  While this will limit my practice to those with disposable income, I will give back to the community in other ways such as ongoing community presentations and involvement in community organizations. 

 

I have learned from my study to date that Holistic Medicine is a very broad field and it is impossible for any one practitioner to master more than a few complementary modalities of treatment.  Based on a combination of my personal interests, my intellectual strengths, scientific research to date, and the needs of the local community, I intend that the primary focus of my Holistic Practice will be a biochemical approach to common disabling conditions such as osteoarthritis, fibromyalgia, chronic fatigue syndrome, multiple sclerosis, chronic sinusitis, chronic prostatitis, hepatitis C, and cancer.  I will prescribe a variety of herbs and dietary supplements along with therapeutic diets as part of a holistic approach to these conditions and others. 

 

In the short term I will practice solo, to minimize overhead while the practice grows.  I will continue to refer to other practitioners as indicated, both medical specialists and complementary practitioners.  Over time I will strive to achieve my goal of a Center for Integrative Medicine in which a variety of practitioners see patients in adjacent offices under one roof, providing comprehensive care.  Novel ideas for the Center include fitness equipment in the waiting room and group visits. Ideally, the Center will also include a fitness club and a snack bar selling nutritious foods.

 

[Last Updated October 1, 2003] [Return to Home Page]