-about humanistic medicine and holistic health care is nurtured by ... Center, Bakersfield, California. Refer to: .... tients' health maintenance, then medical schools.
medical school, they shed or lose that show of concern that they earlier seemed to have. The increasing writing and talk-not clamor -about humanistic medicine and holistic health care is nurtured by those many patients who feel a lack of personal concern on the part of physicians. This is real and is based on a felt need. As such a movement gains credibility it attracts a deluge of hocum artists who profess concern for patients as whole persons, who are quick to decry good medicine, who have little or no basic knowledge and who display a pseudo-concern, claiming that they are humanistic or holistic. To those hangers-on or shirt-tail riders, I would say you are dangerous to your patients. To the profession I know and belong to I would say let us give thought to the whole spectrum of qualities that we think doctors should have-and let us bring such people into medicine. And to you serious students and practitioners of humanistic medicine I would say I wish you well and thank you for highlighting the unbalanced view of the needs and qualifications of physicians.
Holistic Medicine for Neurosurgeons ROBERT RASKIND, MD I READ WITH INTEREST the several articles on holistic health care, humanistic medicine and orthodox medicine, and I must say that I am not fully able to grasp the concepts implied. More specifically, I have been criticized by several persons who are proponents of these dogmas both in my community and in the surrounding communities for my rather naive and, as they state, "inappropriate" approach to diseases of the central nervous system. We deal with a number of intracranial spaceoccupying lesions from which, without their removal, a patient would either be dead or seriously impaired neurologically. As an example, I have one case of a 38-year-old man with a 3½/2-year history of what looks like an infiltrating glioma both on CAT scan and the subsequent angiograms. Needless to say, the standard neurosurgical advice Dr. Raskind is Chief, Division of Neurosurgery, Kern Medical Center, Bakersfield, California. Refer to: Raskind R: Holistic medicine for neurosurgeons, In Orthodox medicine, humanistic medicine and holistic health care-A forum. West J Med 132:251, Mar 1980
in such a situation would be craniotomy for excision of the lesion. My critics tell me "that we should not treat the tumor, but should treat the patient." This makes it very unclear to me as to exactly what my role in this patient's care should be. They have strongly advised the patient and his family against operative intervention, and the questions I ask are (1) How can we go about preserving this patient's life and (2) how can we go about alleviating his symptoms and preserve what neurological function is left without a direct attack upon the neoplasm? There have been some equally vehement criticisms about the methods of dealing with lifethreatening head injuries. It would be helpful indeed if some of the advocates of holistic and/or humanistic medicine would give me guidelines for management of these life-threatening conditions.
Teaching Medical Students to Stay Healthy GEOFF GOLDSMITH, MD KWESI NGISSAH, PhD JEANNE WOOLSEY, MSPH MUCH
OF THE DISCUSSION
in the forum on "Or-
thQdox Medicine, Humanistic Medicine and Holistic Health Care" in the January and December issues actually dealt with the widening gap in Medicine between technological treatment of disease and promotion of health. An interesting and important aspect of this division occurs within Medicine: the health status of medical students. Medical students are like the shoeless sons and daughters of the cobbler-so close to the institutions devoted to the study of health care, yet denying their own mortality, and living a lifestyle which places them at high risk for many diseases. They work exceedingly long hours, eat an abundance of convenience and fast foods, and study under constant stress. As a group, they usually getfinsufficient sleep and do not have enough time for exercise. This lifestyle is more destructive Drs. Goldsmith and Ngissah are Co-Directors, Undergraduate Program in Family Practice, and Ms. Woolsey is a Health Educator, Department of Family Practice, School of Medicine, University of California, Davis. Refer to: Goldsmith G, Ngissah K, Woolsey J: Teaching medical students to stay healthy, In Orthodox medicine, humanistic medicine and holistic health care-A Forum. West J Med 132:251-252, Mar 1980
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than we would recommend even for the most robust of our patients. It is to the students' benefit that they are able to seek psychiatric counseling during their four years in medical school, and many of them are indeed compelled to utilize psychiatric services. Clearly, they are learning from us, their teachers, that this type of lifestyle is required for at least four years of medical school and an additional three to four years of residency training, and perhaps is acceptable in practice. Often these students are in the position where they must divide precious few hours between study and time with their loved ones. Believing that one must begin with an ideal to end with an ideal, w6 are certainly missing the mark in producing physicians sensitive to the role of lifestyle and health promotion in their patients. Physicians find themselves at greater risk for suicides, drug addiction and alcoholism. Perhaps starting to teach medical students about health promotion could give them an opportunity to learn new coping skills. It has been said that medicine is the only profession that labors to destroy the reason for its existence. Yet the average person might think that modern medicine acts quite the opposite in building more expensive and sophisticated machines to keep the critically ill alive. With medicine's incessant striving to find better diagnostic techniques and more effective treatment we have become almost fixated on technology and curing and have largely ignored prevention and health promotion. At the Department of Family Practice of the University of California, Davis, School of Medicine, we are very interested in restoring a balance to the medical education process between learning about disease and exploring methods to keep
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people healthy. We believe it is essential for both patients and medical students that a strong health component be included in the medical school curriculum. We believe that in teaching students about taking care of themselves, they will learn to apply these lessons to their patients. Encompassing this idea, we developed an elective course for second year medical students called "Health Promotion for Medical Students and Their Patients." The course begins with a thorough health inventory of each student. This includes diet, stress level, fitness, health risk assessment and psychological status. We also gather information on how their work (medical school) affects their health. The resulting health profile is then used in formulating a health prescription for each student. This includes relaxation, stress reduction, improvements in diet, exercise program, weight reduction and the like. Over the 12 weeks of class, the students are required to follow a monitored personal health promotion program. A health educator works with each student to assist them in their individual programs. We also provide each student an opportunity to practice what he or she has learned with a patient and family. Our goal is that the students will learn about health maintenance for themselves and their future patients. After the class has been completed, the students are reassessed. It is our contention that if physicians are to play any significant role in their patients' health maintenance, then medical schools should provide opportunities for students to practice healthful behavior themselves. We hope that teaching medical students about health is an idea whose time has come. Perhaps this attitude is too optimistic but "there is no sadder sight than a young pessimist" (Mark Twain).
