3 minute read
The history of medicine is a massive and fascinating subject. It shows that, over time, the goals and locations of doctors have changed. From the bedside to the library and from the hospital to the laboratory, doctors have sought out the innovation and evidence that compose our healthcare system today.
In the beginning, doctors visited patients in their homes and provided basic medical care using the available knowledge. Doctors then began to congregate in libraries during the Middle Ages to learn from each other and organize a body of knowledge. In the 19th century, doctors moved to hospitals to treat large numbers of patients and develop new diagnostic and therapeutic tools.
Later, doctors became involved in public health efforts toward clean water, waste disposal, and vaccination programs. Finally, laboratory medicine became more prominent and successful as doctors pursued pharmacological interventions.
Integrated care is part of a new chapter in the history of medicine. Instead of doctors changing locations, integrated care brings other clinicians to where doctors work. Behavioral health and occupational health clinicians, nutritionists, pharmacists, physical therapists, and others join the healthcare team. Integrated care represents an effort to expand the medical team and make healthcare more holistic.
In a way, integrated care represents a return to the first chapter of medical history: medicine at the bedside. This was a time when doctors worked to understand the needs of their patients, looking at secular causes for disease and offering pragmatic solutions geared toward wellness and recovery. Hippocrates is the star of this chapter. Much of his legacy was transmitted to the West through the writings of Galen, who dominated medical thinking for more than a millennium.
Amidst the multiplicity of themes and points of view is one strand that runs through the whole Hippocratic corpus: Hippocratic medicine is holistic. The Hippocratic approach is always to the whole patient and the current yearning for integrated care finds a natural resting place there. This was not a novel idea; ancient Greeks also espoused holistic medicine.
Also, Hippocratic medicine values naturalism. “Natural forces are the healers of disease”, states one aphorism. The patient will improve by assisting the natural processes that make the body work. The extension of this idea is that the body is wise and can adjust or heal itself if given the right support.
There are limitations to this exercise. Hippocratic medicine did lead to ideas like humors and bloodletting that have little or no place in Western medicine today. But that is how science works: we advance the ideas that stick and discard the rest. Also, the mission of integrated care to provide the right care at the right time matches the spirit of early, patient-centered bedside medicine.
What would Hippocrates think of integrated care today? Perhaps he was to observe a primary care team strive to deliver comprehensive and timely care to a patient with co-morbid health needs. Hopefully he would see a team involving the patient in the screening and assessment process and treatment planning and use interventions that seem natural to the patient.
Maybe Hippocrates would also see a student observing the whole process. Hippocrates had many pupils.