Doug Wilson Interview

While contemplating a career in medicine, Doug Wilson recognized quite early that something was missing from the conventional allopathic approach. Hitch-hiking across the U.S. as he considered his future, he spent a considerable amount of time thinking about health and healing at the Gesundheit institute, where he met Patch Adams. Dr. Wilson shares his perspective on integration, discusses what motivates referral to an AOM practitioner, and contemplates what it means to be a healer. His experience as a rural-based allopathic doctor illuminates some of the factors that influence the future of integrative medicine.

What convinced you to become a doctor?

Probably in part the fact that someone once told me I couldn’t ;-) More importantly, I’ve always been a curious, natural-science type of person (my heritage includes farmers and scientists), and because I’m reasonably gregarious and feel a deep empathy for people. I studied biochemistry because it interested me. I loved high-level physical chemistry and that sort of thing. Later I found out that what really seemed important was valuing and supporting life, which includes us human beings and the absolutely astounding natural world that we’re a part of. Eventually I found myself working in a research pathology lab at the Fred Hutchinson Cancer Research Center in Seattle, and I became friends with several doctors who flat out told me I should be a doctor. They figured it out before I did. Turns out they were right on.

You have mentioned that curiosity is an important component of healing. Could you explain what you mean by that?

This is a great lesson eloquently articulated in a paper by Faith Fitzgerald, MD, former dean of students at the UC Davis School of Medicine. She came to speak during my residency in Ventura. She said that encouraging the gift of curiosity in medical students would not only improve patient care but also would enrich “the lives of these physicians and the vigor of our art and science.” I take this to mean that true caring is demonstrated by taking an interest in someone, not to change them necessarily, but to find out why they are the way they are. How did they arrive at their current state? Why do they choose to live as they do? If it’s someone who smokes cigarettes or eats in a certain way, or fails to exercise regularly, what is it that they are seeking through these activities, and how well does it meet their needs? Of course in these instances I’m also curious about whether they’re interested in changing these behaviors, and, if not, what might make them change their mind. Ultimately I’m curious about what kind of help they would like from me.

A person, and especially a patient in a health care setting, can often tell whether someone they’re dealing with is truly curious about them—willing to listen to their unique story—or just interested in pushing some kind of agenda on them without taking into account their special perspective and circumstances as an individual. I think this kind of receptiveness is a crucial part of what you might call a healing relationship.

It also gives me nourishment. I’m always learning things from my patients. They inspire me, teach me, remind me to be humble, and of course constantly (I hope) make me a better doctor.

You are currently teaching doctors how to listen more effectively. How does that program work?

It’s currently a work in progress. My small rural (some would say frontier) family practice clinic is organizationally a branch of a larger group of nearly 200 physicians based about 100 miles away. The leaders of our organization want to encourage a culture of self-reflection and ongoing development of communication skills. The mechanism is part didactic lectures and workshops, part role playing, and part peer-peer observation of one another working in the clinical setting. We’ve been working with Larry Mauksch, a psychotherapist at the University of Washington, whom I met while I was in medical school. Larry has been doing some great work describing the key aspects of patient-centered communication and in using video recording to teach it to students and physicians.

As an allopathic physician, under what conditions would you consider referring a patient to an acupuncturist?

In my region, the first prerequisite is that I would need to know such a practitioner exists. I think the closest acupuncturist is at least 30 miles away, and there’s very limited public transportation in our region, so geography is going to limit access. Economic considerations are probably next, because most of my patients don’t have a lot of discretionary income or health insurance, for that matter. Beyond that, I’d like to get to know a practitioner a little bit before making referrals, especially when I know so little about the kinds of training, procedures, and knowledge that an acupuncturist might have. I feel that my patients come to me because they trust my advice, and I can’t in good conscience refer them to someone I don’t know anything about.

When I refer a patient to another (allopathic) physician, I’m interested in where that individual went to school and so forth, but I probably won’t know how to interpret that for an acupuncturist. Most importantly, I’d want to know that the acupuncturist isn’t going to give the patient what I would consider to be bad advice, to tell them to stop taking medication that I prescribed or otherwise interfere in the relationship and treatment plan that I’ve developed with the patient. I realize it may sound offensive to some that I would even think this would happen, but I take the care of my patients extremely seriously, and I would expect another practitioner to do the same. Probably a simple phone call when something significant is going on would go a long way toward building this kind of trust.

Are there situations where you would feel hesitant to integrate acupuncture and Oriental medicine treatments with allopathic care?

Right now I can’t think of any. Maybe I can answer the opposite question, which is what kinds of conditions would I consider referring a patient for? A quick answer to that would be for pain, especially of a chronic nature, chronic fatigue, and perhaps for addiction problems and mood symptoms. Of course, I would probably consult the medical literature to look into what types of conditions and treatments have been evaluated in a randomized-controlled manner, although I wouldn’t necessarily strictly limit referrals to conditions with that level of evidence. I have to be circumspect about the available evidence in my own field!

What defines the word “healer” for you?

A healer devotes energy to help another person optimize their well-being. This is a vague statement, I realize. It might mean being vibrantly active and inspiring to oneself and others. To another person it might mean being at peace or at least not too afraid of an impending death. Maybe to some it means simply getting through the day despite having a very upsetting past or a body that seems to complain constantly and to refuse to cooperate.

Do you see the future of medicine moving in an integrative direction? What barriers do you envision to this happening?

I think probably, eventually yes, at least to some degree. There’s clearly a need for a “small is beautiful” attitude to health care these days. It’s widely felt that the cost of health care has become a negative influence on the U.S. economy, and I suspect there will be more and more efforts to cut spending. Partly as a result of this, the pressures on patients and physicians in my field anyway are incredible. I think at some level we in primary care have been letting patients down by not taking a more comprehensive approach to wellness. At the same time, sometimes patients expect too much of the health system, assuming that we’ll be able to diagnose and cure everything, even if the patient doesn’t do a very good job of living healthfully. So I think an argument could be made that maybe a more natural, less invasive approach to health care might make sense on a large scale. But right now, many of us in family medicine feel like underdogs trying to fight for basic healthcare for our patients, and we’re getting buried. While we might seem like natural allies for the integrative medicine community, we’re also fighting for our own survival in a sense.

Before you went to medical school you spent some time with Patch Adams. What was that like and how has this influenced your approach to patients?

Patch is quite a character, and he left a big impression on me. Patch encouraged me to go to medical school. I had been concerned that the training experience would be somewhat demoralizing and dehumanizing, and I thought that I shouldn’t pursue it unless I had a strong external support system that, at the time, I didn’t really feel I had yet. Patch said to me, “Consider the world is your community, and everyone is a member.” I’ve tried to live by that attitude ever since. Like Dr. Fitzgerald, he also spoke a lot about curiosity. And he taught me about end of life care, that even death can be a beautiful time of healing. Plus he’s an excellent juggler, clown, and reciter of poetry. He puts on a great show. Through this, he encouraged me to embrace all the arts as healing forces in my own life.