Wednesday, June 2, 2010

Honoring the Biology in Family Medicine

Our usual patient engagement in the office is scheduled for fifteen minutes.  This involves a facilitated engagement between two or more individuals for the mutual benefit of all.  As a family physician, I sometimes marvel at the relationship between patient and physician, it's simplicity, complexity, humanity, imperfection and beauty.  The biology of what's behind the people in the relationship is phenomenal in a different way.  Each person contains close to 100 trillion somatic (body) cells and a similar number of blood (including immune) cells.  Each somatic cell contains their entire genetic code (back to Adam and Eve or the worm in Africa, depending on your beliefs).

Every day, we humans each get one billion new somatic cells and lose another billion through a process called apoptosis (yes, that will be on the quiz).  Statistically, one of the new cells each day is a malignant mutation.  It has to be eliminated through being defective or the immune system has to find it and destroy it.  A proverbial needle in a haystack!  Somehow, the malignant arrival is usually eliminated. As we age and undergo degenerative processes (starting at about thirty years old) our ability to eliminate the malignant mutation diminishes.  Our genomic predispositions (did we pick the right parents?) may play a large role in the ability of our DNA to ward off the cancer that may eventually arrive.  We are usually powerful protectors of ourselves, up to a point.

As our cells duplicate, they slowly wear out the buffers at the end of DNA strands (telomeres) after which the cell duplications are flawed leading to the eventual demise of the owner.  "Wow, Thelma has aged a lot since I saw her last month.  What happened?"  Maybe Thelma's telomeres aren't protecting her DNA.  She might be nearing the end of her biological life.  In addition to age, radiation may damage telomeres.  Vitamins, such as vitamin D3 may serve as DNA repair agents, extending the number of cell duplications.  Many research studies in recent years address telomeres and telomere repair, hoping to deliver strategies for longer, more healthful lives.

The biology of the body is geared to self repair and healing.  A good example is how the human immune system kills thousands of viral infections,such as the common cold.  This usually results in an assault on the virus by white blood cells, which burst and release their contents including pyrogens that cause fever.  They also release interferon which may cause malaise, fatigue, myalgias (muscle aches), and a desire to be alone (leading to decreased spread of the infection, if heeded).  Time is a key ingredient needed for the body to heal from the infection.

As we learn to recognize and honor how the body heals, we better understand the role of medical care, which often is used to dishonor the natural healing processes.  The misguided sense of urgency that pulsates in American lifestyles and American board rooms drives people, including physicians, to try to artificially impact the natural resolution and recovery from illness.  Too many people are trapped into pushing for unnecessary medical care for self-limited infections or forced to "get a note from a physician" if they miss more than three days work.  The unnecessary exposure to physicians may expose the patient to unnecessary medications or other well intended measures that end in disappointment or extended illness.

The medical profession plays an important role in our society by understanding the natural history of diseases and  knowing when to intervene with reassurance, symptomatic therapy and/ or focused intervention.  Knowledge of the biology of the patient moves the physician to honor it and recommend fewer unneeded medical interventions.  The complexity of the biology helps both patient and physician to remain humble.  As both patient and physician regain their sense of awe about the incredible processes of the human body, their work together will serve more to honor those processes and allow natural healing to occur when possible.

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