A GP's experience with integrative care
Meet Dr Maya Marza, General Practitioner and integrative care advocate. Maya shares with us her experience. She answers all the question you might have on the best way to approach integrative care and what to expect from it. Starting with thoughts regarding its benefits and the role of evidence in such care.
Hi Dr Marza, thanks for speaking with us today. Could you start with telling us a few words about yourself? How did you become interested in integrative care?
Thank you for having me here today. I'm Dr Maya Marza, born in Tahiti to a Spanish father and Chinese mother. Growing up in such a culturally diverse environment has strongly shaped my interest in integrative medicine. I studied general medicine and family medicine and also began to explore spirituality and alternative healing techniques. I initially wanted to pursue acupuncture as it is commonly practiced in France, but while taking a gap year I discovered integrative medicine in Hawaii and realized it was a better fit for me. Eventually, I also became interested in hypnotherapy and the psycho-emotional sphere. Currently, I specialize in a pathology of the connective tissue, known as the syndrome of Ehlers-Danlos.
What's your experience with integrative care?
My experience is that perception around integrative care is changing a lot. In the past, people weren't necessarily motivated or consistent in their efforts to get better; they weren't really conscious and involved on their healing process despite years of illness. Because of this, integrative care wasn't really an option. Now patients are becoming more committed and there is awareness around integrative care. In big cities I see a lot of integrative medical centers popping up. In rural or semi-rural areas, like where I'm located, it's still difficult. So there are discrepancies. But overall I sense an emergence. In the basque country, people are connected to nature which leaves them open to the idea . There is a latent moral strength and people are not resigned to living with their condition without looking for complementary options. The remaining issue is that when patients are interested or using integrative care or holistic medicine, they don't always talk to their doctor about it.
In your experience what are the benefits of an integrative approach?
Well in my case, what motivated me explore integrative care and how I generally present it to patients, is the ability to provide hope. Conventional medicine has its limits in terms of diagnosis and treatments. By opening up to other medical studies, we open up to the possibility of a diagnosis where conventional medicine might have failed. Or at least provide an understanding of the pathology. So for me, the keyword is hope. I want to practice medicine to help people, to be, if not a savior, at least present in the moment.
I spent time with healers from the Philippines and Brazil where, if a patient will not heal or worst die with absolute certainty, it's all about a patient's journey. Truth is, even if we're doctors, we cannot say whether a patient will heal with absolute certainty. In such context, I believe that integrative care opens opportunity for positivity in the patient journey and that's crucial. I also think the word 'integrative', which refers to the scientific framework, provides a certain level of safety and security to the practice. So for me, integrative medicine is about hope and security. Those are the two keywords that I emphasize when talking about integrative medicine.
Is there room for evidence in integrative medicine?
It does hold an important place. But it will hold more or less importance depending on a practitioner's view of our world and on circumstances. For example, I had a patient who had cryoglobulinemia related to hepatitis. It was improved by acupuncture, and Chinese pharmacology. When I looked into the related scientific litterature I only found an article speaking about occidental phytotherapia to treat liver's condition so I couldn't rely only on this scientific article to accompany my patient. Chinese medicine was already working for her. On my end, I chose to focus on the psychological part, which I knew acupuncture wouldn't address specifically. So in this case, I'm delving into an approach, acupuncture, that is not proven by science but because of my experience I'm confident I can handle and I'm focusing on the areas where I can still help. One thing to add here is how hard it is to be up to date with the latest evidence. So much is happening these days. That's why decision support apps in the space are so valuable.
Did you ever encounter clinical conclusions that went counter to your experience?
It does happen. Overall I find that research conclusions in the integrative space are often too severe. Way more severe than for more conventional approaches. I remember reading research papers on NCCIH and finding conclusions to be harsh, specially for small studies with obvious limited dataset. On the other hand, I've been surprised by the HAS (Haute Autorité de Santé) giving the strongest recommendation for using probiotics to treat acute diarrhea, despite a lack of data on the mid and long term effects. You rarely see this leniency with alternative therapies which is detrimental for further experimentation. Another example is the effectiveness of hypnosis for phobias. I've heard about a lot of successful hypnotherapies. I also had positive experience with a few of my patients. However study recommendations and science are still saying proof are insufficient or negative in the matter. I believe the studies were conducted in very different conditions than in my practice. Thus, it will not stop me from offering hypnosis to treat phobias.
Another thing is that some medicines, such as Chinese medicine are hard to turn into protocols. It's been talked about by leading practitioners. It's likely to be one of the reasons why Chinese medicine observed outcomes have decreased over time.
Despite all this, I will always base myself on what science tells me first, then consider what the patient needs and can access. The benefit-risk ratio assessment is part of the Hippocratic oath.