Integrative Medicine vs. Functional Medicine: What 26 Years in Practice Taught One Physician

Intellectual Humility: Why Doctors Stop Questioning What We Know

Medicine rewards knowing.

From the first day of medical school, we learn that there is usually a right answer and that someone will eventually ask us for it. We memorize enormous amounts of information, sit for examination after examination, present cases, defend our assessments, and learn quickly that "I don't know" should usually be followed by "but I will find out."

Eventually, something changes. We become the attending. The consultant. The person someone calls because they do not know the answer and hope that we will.

Expertise is hard earned, and it should be. Our patients depend on it. But after twenty-six years as a physician, I have begun to wonder what happens when knowing becomes so familiar that we stop questioning what we know.

In Think Again, Adam Grant writes about intellectual humility, the ability to hold what we know with enough confidence to act on it and enough flexibility to reconsider it. That is complicated for physicians. Our knowledge is not merely intellectual. People trust us with their bodies because of it. Over time, expertise becomes part of who we are.

A few years ago, well into an established career in internal medicine and rheumatology, I decided to become a fellow again.

I expected to learn new things. I did not expect to reconsider some very old ones.

The Roots of Integrative Care: Traditional Remedies vs. Modern Training

I grew up in India, surrounded by traditions around food, plants, breath, and healing. Turmeric and honey and ginger with black pepper for a cold or a sore throat. Turmeric again, on a wound. My grandmother tying warm ajwain seeds in a cloth and pressing them to my stomach in the middle of the night.

Some of this I absorbed without thinking much about it. Other parts I came to disregard as I moved more deeply into the world of Western medicine.

Years later, I would learn that some of those ingredients contained biologically active compounds. But I had been asking only what the turmeric did, or the ginger, or the ajwain. There was also heat and touch and the comfort of being cared for. There was a grandmother awake at two in the morning with her hands on my stomach, and nothing I was later taught had a name for that.

Medical training gave me an extraordinarily powerful way to understand the human body, but it also shaped, more than I realized at the time, which forms of knowledge I regarded as medicine.

Still, from my earliest days as a physician, I believed that the body could not be separated from the life it lives in. Fellowship did not teach me that. It gave me a larger vocabulary for something I had long believed, a way to study its physiology, examine its evidence, and look again at some of what I had dismissed.

Reductionism vs. Whole-Body Care: Why Patients Look Beyond Modern Specialties

More than two thousand years ago, in Plato's Charmides, Socrates recounts the teaching that the eyes should not be treated apart from the head, the head apart from the body, or the body without considering the soul. The language belongs to another time. The idea does not: the part cannot be separated from the whole.

Modern medicine has become extraordinarily good at understanding the parts. We divide the body into organ systems, specialties, receptors, cytokines, pathways, and molecular targets. That reductionism has produced some of medicine's greatest achievements. I practice in a field transformed by them.

But the body never agreed to our divisions.

Sleep does not belong neatly to one specialty. Stress does not confine itself to the mind. The lines we draw are useful, sometimes essential, but they are ours.

The Science of Self-Repair: What Conventional Training Overlooked

And all the while, the body is doing a great deal on its own.

Wounds close. Bone remodels in response to load. Muscle strengthens when it is asked to work. The brain changes with experience. The cardiovascular system adapts to exercise. Sleep alters immune function and pain.

I knew all of this; I had simply learned it in pieces. Somewhere in becoming proficient at recognizing pathology and intervening when physiology went wrong, I had become so focused on what medicine could do to the body that I had spent far less time thinking about what the body was continuously doing for itself. I had stopped being astonished by it.

Fellowship brought some of that astonishment back. Breath became physiology again. I began looking differently at sleep and stress, at the ways the nervous, endocrine, and immune systems respond to the lives we live. I found mechanisms and evidence behind ideas I had long held about the inseparability of mind and body, along with new questions.

Evidence-Based Integrative Medicine: Balancing Skepticism With Real-World Data

This did not make me less skeptical. It made me more careful about where I directed my skepticism.

Could a practice be useful before we completely understood why? What had modern medicine dismissed too quickly? What had traditional medicine accepted too easily?

I found myself reading differently, changing my mind about some things and remaining unconvinced by others. Increasingly, "we don't know yet" felt less like an unsatisfactory answer and more like an invitation.

This year, at forty-nine, I graduated from fellowship again.

There was something unexpectedly moving about becoming a student at this point in my life. I studied botanicals and nutrition, breath and meditation, acupuncture and other healing traditions. I read the evidence. I experienced some of the practices myself. I encountered ideas that challenged me and others that felt strangely familiar.

Somewhere along the way, medicine became surprising again.

A Dual-Trained Perspective: Bridging Molecular Targets and Whole-Person Healing

I had traveled from a childhood in India, where healing sometimes looked like turmeric and ajwain and my grandmother's hands, into a profession capable of targeting a single cytokine and changing the course of a devastating disease. I am not choosing between them. I want to remain curious enough to ask what each can teach me and rigorous enough to ask what is true.

I still want evidence. Perhaps more than ever.

But I also want to be astonished.

After twenty-six years in medicine, changing my mind is sometimes less about letting go of what I know than looking at it again.

And sometimes, it is remembering.