I work at the Mayo Clinic in Scottsdale, Arizona. Mayo Clinic has been around since the early 1900s starting in the small town of Rochester, Minnesota but has grown to be the largest medical clinic in the US. It built a reputation as a place to go when no one else can figure out what is wrong with your health; the last resort.
As a general internist, I am often assigned to evaluate patients for whom no one else has figured out what is wrong; often times they have chronic pain and fatigue. Conventional Medicine focuses on physical disease which is defined by measurements, blood work, x-rays, examinations, etc. The results of testing give us the name of the disease which we then treat. Many people feel bad but all their tests are normal, which means by definition they do not have a “physical” illness. The only other possibility then is they have a “mental” illness, depression, anxiety, stress, etc., and since there are no abnormal tests to fix, these patients are treated as though their illnesses are not real. I realized early in my career that conventional medicine doesn’t have all the answers, so I received extra training in “Integrative Medicine” which is loosely defined as using the best of both conventional and unconventional medicine to help the patient. My practice now is to see patients who, even after a Mayo Clinic evaluation, still do not have a defined disease. I am the last resort at the last resort.
Most of the patients I see have had every test in the book; many of them have had tests repeated over and over even though the results are normal. My diagnostic and therapeutic tool is listening. It is the one “test” they have not had during all their evaluations. I ask them about their present health issues but also about what their lives are like with the disease. My appointments are two hours long which may seem extraordinary but often times is barely enough to let patients tell their stories from beginning to end. Rarely do I find a patient with chronic pain or fatigue who does not have a story that goes back even into childhood of physical and sexual abuse, neglect, fear, abandonment etc. At least half of the women that I see in my practice were sexually abused as children and at least a quarter of them have never told anyone before, and virtually none have ever been asked by their doctor about it. Daniel Seigel M.D., advocate of “interpersonal neurobiology” calls this “feeling felt.” The patient needs to feel that someone else truly understands what they are experiencing, and once that happens they begin to heal.
There is not a bright line that separates our physical, mental, emotional, and spiritual health. For chronic health problems, each area is important to help a person become well. There are no blood tests that give the answer, only talking and listening.
Dr. Larry Bergstrom is a general internist who practices integrative medicine at the Mayo Clinic in Scottsdale, Arizona.