The Evolution of Medicine: Join the Movement to Solve Chronic Disease and Fall Back in Love With Medicine

Book Title: The Evolution of Medicine: Join the Movement to Solve Chronic Disease and Fall Back in Love With Medicine

Book Author: James Maskell

Publication Information: Bedford, MA, Knew Publishing, 2016, 152 pp., $15.99, softcover

Burnout! A pandemic seems to be spreading across primary care.1 For most physicians who have sacrificed considerably to become practitioners in the current system, a “holistic,” “complementary,” or “lifestyle medicine” approach often represents a philosophy at odds with the science of traditional western medicine. Some progressive physicians, however, are rekindling professional fulfillment while overcoming stress and exhaustion through the abandonment of conventional medicine. In The Evolution of Medicine, James Maskell proposes that physician burnout is rooted in our inescapable and increasingly antiquated system of medicine—a system that has not evolved in concert with the changes in environment, culture, and chronic disease. To overcome this inertia, Maskell describes exceptional systems and innovative leaders who have reversed primary care physician burnout through novel changes in how they influence health and wellness.

As the founder of the world’s largest integrative medicine conference, “Functional Forum,” Maskell has become a force inspiring a move from the current western medicine model toward a functional, wellness-centered approach. Maskell is not a physician, but holds a certificate in secondary education and is faculty at George Washington University’s Metabolic Medicine Institute. Maskell describes how the paradigm of functional medicine can be transformative to both the provider and the patient, and therefore simultaneously address physician burnout and patients’ chronic diseases. He does this in three distinct sections of his book.

In the first, Maskell provides a present-day exploration into the “functional medicine” model. Affirmingly to family physicians, he evokes how “early physicians were the centers of their communities, not only tending to disease but also educating patients in self-care, wellness, and disease prevention” (p. 15). He then efficiently, if not cuttingly, depicts a health care system that has evolved to increasingly value proceduralists and subspecialists focusing their narrow expertise on the all-hallowed diseases of an apportioned differential diagnosis. Furthermore, he states, “Though prescriptions, surgeries, and treatments can ‘cure disease,’ they aren’t designed to be creating health” (p. 28). In Maskell’s view, this industrialization of medicine and increased devaluation of the holistic care has created unintentional side effects exemplified by the aforementioned burnout and dissatisfaction of primary care physicians. Indeed, multiple studies attest to a situation where approximately half of primary care physicians would not repeat their career tract if they had the ability to do so. He positively reframes the challenge stating, “what doctors notice in and around hospitals and clinics is a lack of congruence between the way medicine is practiced and what they know to be health, which is cause for concern” (p. 27).

Quickly building from there, he goes on to illuminate the numerous areas where modern technology and communication systems can prove integral in synergizing both provider and patient wellness. He describes Dr Leroy Hood’s conception of “P4 Medicine,” modeled on predictive, preventive, personalized, and participatory health care.2 Maskell then inspires with multiple examples of high-level systems that have successfully incorporated and made reproducible P4 principles resulting in improved health for both patients and providers. These rock-solid anecdotes positively frame alternative ways to address chronic disease, and may even persuade curmudgeons that functional medicine might be more than just a touchy-feely pipe dream.

In the second section, Maskell describes effective ways for establishing and troubleshooting a functional medicine practice. This starts with chapter 4 where multiple educational resources are shared to assist a physician aspiring to a functional medicine path. In the next chapter varying business models are discussed, identifying their pros and cons in relation to starting a new functional medicine practice. Chapter 6 briefly addresses patient education and business marketing tools. These chapters are fairly brief, but effectively offer nuts and bolts solutions to building this type of practice framework.

In the last chapters, Maskell ties up some loose ends and recommends various next steps and inspiration for providers wishing to join the functional medicine movement. Reminding you that this section of Family Medicine is indeed “Book and Media Reviews,” further examining functionalforum.com at this point is obligatory. If, as claimed, Functional Forum is indeed the world’s largest integrative medicine conference, you can quickly see from the website how invested and professional this community has become. Opportunities for encouragement and networking abound through webstream events (with and without locally-scheduled meet-ups), podcasts, videos, newsletters, and resource links. Indeed, I find my dated definition of “conferencing” improved by the multiple clear, concise, inviting, and well-visited tabs within functionalforum.com that strongly support the motivated minds of inspired physicians through modern modes of communication and networking.

Ultimately, time will tell whether functional medicine will radically transform conventional medicine. For classically trained physicians who still find fulfillment in their work, Maskell’s message may be viewed as a radical sales pitch for micropractices, organizations, and technologies that he promotes. Yet, for bold, forward-thinking physicians who are burning out on the current mode of practice, investing in a wellness-focused practice may become a personally life-saving venture if not a tipping point for the entirety of health care. For this type of physician, Maskell’s straightforward guidance and motivation could prove motivational (at least) and positively life-altering (at best).