Holistic Medicine: It Isn’t Herbal. It’s Hard.

I want to take a moment to rehabilitate the word holistic.

Because for a long time, holistic was the kind of word that made my teenage eye twitch. Holistic was what people said when they meant herbal teas and chakras. It was the fluffy stuff — the “alternative” to real medicine, the stuff with poor evidence and great branding.

And look, let’s just get this out of the way early: if an “alternative” medicine works, it’s called medicine. Thanks, Tim Minchin. End of discussion.

But here’s the twist: holistic medicine got caught in the crossfire. It was guilt by association. Branded flaky and unserious. The granola end of clinical reasoning. But it’s not. Or at least, it shouldn’t be.

Holistic medicine — real holistic medicine — is some of the hardest stuff you can do as a doctor. Because it’s not about being vague. It’s about seeing the whole, holding nuance, and being comfortable not diving into your favourite organ system.

And that’s a bloody ask.

Generalism in a Silo World

We’ve gone through waves in medicine — generalism to specialism and back again. And right now, probably out of sheer desperation, we’re drifting back into generalism. Everyone’s mucking in because the system is broken and there aren’t enough bodies to hold it up.

But generalism isn’t just a staffing strategy. It’s a philosophy of care. It’s about refusing to let a patient be reduced to a liver or a lesion.

Which is hard. Because our system rewards silos, especially in secondary care. It loves them. You’re a nephrologist? Welcome to the kidneys. Don’t stray beyond the cortex. You’re a surgeon? Great. We’ve got some tendons for you to play with. Just don’t ask the patient why they fell.

So when an FY1 stands on an ortho ward and the patient starts vomiting coffee-ground mess, they do what they’ve been trained to do. They call somebody. Then that somebody calls somebody else. Gastro. ID. Geriatrics. Renal. Everyone squints at the problem from their silo, takes a quick swing, and ducks out. The patient doesn’t improve. The FY1 gets quietly crushed.

No one owns the whole picture.

That’s what holistic medicine is supposed to

Holistic Is Not ‘Soft’

The danger of the term is that it sounds… indulgent. Holistic care. Warm vibes. Soft hands. It’s the opposite of that. It’s blood, sweat and second opinions. It’s time-consuming. It’s high-stakes. It’s messy.

Because the holistic view takes everything into account — the pain, the social context, the polypharmacy, the psych, the adverse childhood experiences, the six missed appointments, the “bad vibe” the nurse got from the family. All of it.

It’s playing Where’s Wally, except Wally’s a sniper and if you miss him, someone dies.

And in that frame, holistic isn’t some wishy-washy notion. It’s strategic clinical practice. It’s the ability to look someone in the eye and say, “I know this is what you came in for. But here’s what I’m seeing. And here’s what we need to talk about.”

It’s being willing to float the difficult conversations, to say, “Let’s park that scan idea for now. I think we need to talk about something else first.” And then still be standing when they threaten to complain.

The Illusion of ‘Care’

Here’s the brutal bit: patients often define holistic care as feeling cared for. That’s it. You could be doing the most harm imaginable with steroids, overdiagnosing, overprescribing, spinning their story into medical poetry — but if they feel listened to, it feels holistic.

And that’s a problem.

Because then we start calling physicians “holistic” when they’re just good at people-pleasing. When they say yes to everything because it’s easier than the fight. When they reinforce maladaptive beliefs, label non-conditions, or over-invest in hope for conditions we don’t yet have evidence for.

I’ve done that. I’ve floated those leaflets. I’ve buttered the bread before I cut the crusts off the bad news. I’ve bought time with words. Sometimes it works. Sometimes they read the leaflet, cancel the follow-up, and go find someone else who’ll tell them what they want to hear. And sometimes they come back ready to talk properly. And that’s worth it.

Holistic Care Isn’t Just About Saying “Yes”

True holistic medicine must include the word “No.” Or at least, “Not yet.”

It’s saying, “I know this scan might reassure you, but the evidence says it won’t” (see NICE on unnecessary imaging). “And I don’t want to send you down a rabbit hole for an answer that doesn’t help.”

It’s saying, “We’ve had this conversation three times now. I’m worried we’re circling. And I want to help, but I think we need to change tack.”

And it’s knowing that saying that might get you reported, shouted at, or walked out on. That it’ll trigger complaints. That you might get scapegoated in a broken system where people are dying for answers and you don’t have them.

Because that’s the other bit they never tell you: real holistic medicine makes people angry. Especially when it doesn’t end with a solution, but a strategy. Or a safety net. Or a reality check.

Holistic Care in a System That Can’t Hold It

The irony is, our system is structurally opposed to holistic practice. It takes time. It needs continuity. It needs bravery. And what we’ve got is ten minutes, three complaints, a stack of bloods, and the looming threat of litigation.

We’re not set up to do this properly. And so, more and more, we either do it badly — half-arsed and patchy — or we don’t do it at all.

And then people complain about how doctors don’t listen, don’t understand, don’t see them as people. They’re right. But they also won’t wait 45 minutes while I try to explain that their migraines are stress and the MRI won’t help. So what do we do?

We survive. We pick our battles. We get called uncaring, and we shrug it off, because the next patient needs us not to fall apart.

And slowly, the idea of holistic care starts to feel like a luxury. A relic. Or a con.

But It’s Not

Holistic medicine is still possible. But it’s not touchy-feely. It’s not woo. It’s not steroids for everyone and hugs at the door.

It’s saying, “I see the whole of you. And I’m going to tell you what I think, even if it’s not what you want to hear. Because I care.”

That’s the bit that matters. And if you’re a patient — or a med student — or a junior doc trying to figure out how to survive this job with your soul intact — remember: being holistic doesn’t mean being soft.

It means being brave.

Stay Herbal, man

— DW