Why I left a successful clinical practice to become a herbalist

Posted by Dilis Clare on

"I consider myself a conventional doctor after all herbal medicine is very conventional. As a herbalist, I follow the same path as Hippocrates and take the same clinical history and use the same language and clinical examination as taught to me in medical school. This is shared ground with all western medical herbalists. Herbs and Pharmaceuticals have shared history and science; many drugs originated as plant derivatives and a number can still only be produced from plants."

Dilis

Curiosity is a wonderful celebration of engagement with life and the question I am asked most commonly is why did I change the path from ‘conventional’ medicine and become a herbalist.  The question is interesting in itself for the assumptions about both herbal medicine and conventional medicine and how they are viewed. I consider myself a conventional doctor after all herbal medicine is very conventional. As a herbalist, I follow the same path as Hippocrates and take the same clinical history and use the same language and clinical examination as taught to me in medical school. This is shared ground with all western medical herbalists. Herbs and Pharmaceuticals have shared history and science; many drugs originated as plant derivatives and a number can still only be produced from plants. But it is true that there was a fork in the road and I took ‘the road least travelled’, and this is the question you are asking. It was the love of gardening that engaged my herb doctor awareness. A London suburban garden was my creative outlet when I was immersed in Family Medicine Practice. I would often go to garden centres at weekends where my basket became a herb magnet. This went on for several years and without ever making a decision to have a herb garden I ended up with one. 

"In my work life, I was becoming uneasy with the Hippocratic principle of ‘first do no harm’ and was finding it difficult to square up to issues facing me day to day in current medical practice.
While I was becoming more of a gardener I was practising what I now call pharmaceutical medicine. I was increasingly concerned about the balance of benefit to harm for my patients."

My concerns were:

  • That over-prescription of drugs that are excellent for serious disease were being prescribed for mild conditions e.g. antibiotics for mild acne, six months of anti-fungal medication for the cosmetics of toenail disease
  • Concerns about the dangers of polypharmacy (taking many drugs at the same time) particularly for my older patients 
  • I was prescribing powerful drugs for chronic symptoms where there was no structural damage to tissues or organs. An example of the latter is prescribing the contraceptive pill for premenstrual syndrome or using steroids for asthma symptoms. Another example is the use of statin drugs for high cholesterol for people with no evidence of heart disease.
  • That drugs were not working well enough (or at all) for many of my patients, examples include irritable bowel syndrome, osteoarthritis, migraine and acne
  • That many of the drugs I was prescribing I would not take myself or give to my family
  • That drugs controlled symptoms but healed nothing; steroids suppress inflammation e.g. eczema subsidies with topical steroids but recurs when you stop applying the creams
  • My patients were falling through the gaps of ‘bit part’ medical specialities. They were attending a different department for every body system e.g. an Ear, Nose and Throat doctor, a Urologist doctor (for kidney complaints), a Cardiac Doctor (for heart complaints) etc. Because my patients did not have ‘bit part’ complaints I found this very frustrating, so I was ‘open to’ a more narrative, story-based, self-awareness approach for patients so that they could help themselves. 

I am aware that these specialities evolved in response to the needs of organising public health provision, as well as a professional career path and remuneration for doctors. They also protected patients from unscrupulous claims of professional expertise. With the volume of research, this specialisation has exploded further in the last twenty years.  In my practice, it seemed clear that many medical conditions were related to brain chemistry and hormone balance. A good digestive function is a core foundation stone. Whole body medicine requires whole story medicine, whole heart medicine and is a useful example a broken heart produces symptoms of illness that would be alarming if we didn’t know that palpitations are common with heartbreak. 

"As I was looking for a system of medicine that caused less harm than drugs, I had little expectation of any significant clinical benefit beyond limiting harm. In fact, I was downright sceptical of health claims for natural medicines. I remain sceptical about exaggerated health claims for drugs, herbs and supplements."

I pondered and debated these issues for several years and I fought the inertia that happens when contemplating change. One day while sitting in my garden I decided to follow my creative hint to find out if they would provide some answer to my professional dilemmas. To my surprise and amazement, there was a BSc in Clinical Herbal Medicine offered at the Middlesex University, N. London. The campus was in the neighbourhood of my medical practice. It seemed that the road led to Herbal Medicine. 

"When I started to learn about herbal medicines I heard one very inspiring herbalist say that herbalists are chosen by the herb fairies, and if they have you in their sights “you can run but you cannot hide”. 

This was the kind of nonsense I expected from ‘these people’ with their ‘holistic’ self-congratulation. It was only several years later, when I had calmed down, that I reflected that this was exactly what had happened to me. 

By this time I had learned a little humility."

I went from sceptical to sufficiently convinced to move country and give up my well established London practice.Believe me when I say it happened very slowly. I explored the benefits and limitations of pharmaceutical medicines and of herbs as medicines over several years. 

  • Herbal medicines more closely address the altered physiology of illness
  • With herbal medicine, there was a high profile of positive associated health benefits for my patients. For example treating osteoarthritis often reduced cholesterol, treating irritable bowel syndrome relieved not only the digestive symptoms but also the associated fatigue and underlying anxiety
  • The side effects of herbs are often health promoting e.g. many herbs are high in anti-oxidants that help prevent chronic degenerative diseases
  • Herbal medicine necessarily involves patients in their own healing. As a herbalist, I leave the responsibility for healing squarely with the patient. I describe the herbal practice as mentoring with specialist expert knowledge of herbal medicines; these must be taken consistently by patients. It is a collaborative engagement but the work needs to be done by the patient
  • I enjoyed the ‘thinking’ needed for herbal medicine practice. I was no longer trying to pigeonhole patients into disease algorithms. These are flow charts often used recommendations for drugs for diseases
  • There was enough scientific evidence for me to trust that expert evidence over thousands of years was credible
  • The safety profile for herbs was very reassuring; it meant I slept better at night
  • The consistency of herbal practice and high standards of the professional association (The National Institute of Herbal Medicine) in the UK was reassuring
  • The herbal medicine approach was more sympathetic to the human condition, it was more in tune with the constitutional terrain which is the basis of herbal medicine practice. From the beginning, the herbal medicine therapeutic approach was a good fit for my patient’s stories.

There were several factors that broke through my staunch resistance; I was no pushover:

I am a doctor that does not come from a medical family. I am one of eleven children and the only doctor in the family. 

As the middle child, I always had to stand up for myself and fight my corner, there was precious little point in doing things for approval because there was not enough to reach down that far, this has had advantages and disadvantages.

I went to medical school so that I would always be financially independent. At the age of sixteen this was a firm feminist perspective, all around me I saw the consequences of economic dependence.

My father was an entrepreneur who encouraged independent thinking.

As a lesbian ‘coming out’ has been a lifelong challenge to a dominant belief system. If social dominant beliefs are always true, well somehow some wires got crossed, and once one fundamental belief system crumbles none seem so sacred that they can’t be questioned. Like all relationships, lesbian loving can range from nurturing to disastrous, but to label them as ‘wrong’ as a belief system clearly needed to be analysed and I learned to make my peace with the judgment of others. This same process meant that I could hold my ground with both herbal medicine and pharmaceutical medicine belief systems and bring them together as collaborative medicine.

"Since medical school, I realised the superficiality of medicine as a science. We know so little about how the mind-body-spirit blends as unique human awareness in our larger communities and the ecology of the world. To claim superior knowledge in the face of the gaps in our medical knowledge displays the depth of our ignorance. The older tradition of medics being gardeners, artists, astrologers, poets and learned in matters outside medicine appeals to me."

Because I have learned to respect the healing power of herbs and I see the benefits to my patients on a daily basis. I appreciate that herbs act in keeping with our understanding of body chemistry, rather than divisions of disease systems.  Using herbal medicines has re-ignited my enthusiasm for therapeutic medicines based on normal cell function and seeing the person as a whole organic entity. The science and logic makes sense to me, but that is not the whole story. Herbal medicine is part of the ritual, sacred healing and energetic medicine. I could say that herbs are kind to us when we are hurting, and kindness is not a science. Yet it is healing energy. Herbal medicine helps us in an increasingly ‘nature deficient’ urban environment. Along with using herbal medicines, I encourage patients to walk in the park, to sing and to laugh. Of course, these are also to be encouraged if you take pharmaceutical drugs but with herbal medicine, they are mutually sympathetic with each other. Herbal medicine practice prioritises sufficient time in consultation to include wider aspects of deficiency and balances appropriate to the individual patient. 

When I was looking for less harmful medicines to help my patients I became increasingly uncomfortable prescribing drugs I knew I would not use myself or prescribe for my family. Much of the demand for drugs was patient driven, but I was not comfortable with my practice. The aspiration ‘first do no harm’ was becoming a nagging awareness that was growing year on year.  I have no hesitation in using herbs for myself, for my family and for my friends. Not all of them are open to this view of the world of health and wellness, but more and more of them are coming around to this choice, where appropriate. One of the questions that led me to study herbal medicine was ‘is there anything that will help relieve symptoms that is not harmful’? Herbal medicines answer this question, with a very positive thumbs-up, they nourish and support healing beautifully. I have since become more aware of the side effects of drugs even when prescribed for structural tissue problems such as moderate to severe osteoarthritis, especially when I have researched the evidence supportive of natural medicines.

The final letting go of the rigidity of pharmaceutical medicine came when I came to distrust the mantra of ‘evidence-based medicine’, what group of thinking professionals would trust evidence produced by commercial interests where the raw data of evidence is withheld, understandably, for commercial reasons. At the very least this should be described as ‘evidence influenced medicine.

All systems of medicine have a role and they also have limitations, in my opinion, it is timely for herbal medicines to play a more significant role in medical care.