“The patient is not a problem to be solved, but a mystery to be met.”
— Rachel Naomi Remen
M was a mother of two, in her mid-50s. She booked an appointment because profound exhaustion had descended on her like a fog. She ate intentionally: fibre, fruits, and vegetables. She usually slept well. Recently, she started experiencing abdominal distension and a feeling of fullness. She read about intermittent fasting and decided to try it: skipping breakfast.
Her family doctor had ordered blood tests and called to tell her everything looked fine. I requested a copy and found that she had high triglycerides and liver enzymes. She said her doctor had mentioned something like that, but said nothing could be done. They advised her to keep eating well and exercising, and to repeat the tests in three months.
Within three months, the liver enzymes returned to the normal range. Her doctor offered her a statin drug for her elevated “cholesterol.” M declined, still feeling tired and bloated, but preferring to focus on lifestyle factors before trying medication.
L was in her 30s. She lived alone and worked from home—a repetitive and unfulfilling admin job. As a teenager, she was diagnosed with major depressive disorder and prescribed medication to correct the “chemical imbalance” in her brain. The medication might have helped a little; she wasn’t sure. Her depressive episodes would often last for weeks, during which she was unable to get out of bed.
When she booked her first appointment, she had tried more medications than she could remember and was currently taking three, her psychiatrist trying to get the cocktail right. She was still experiencing a chronically low mood, cloudy thinking, and troubling memory loss. Her doctor had recommended electroconvulsive therapy for her “treatment-resistant depression,” and suggested that her symptoms were worsening because of peri-menopause.
She wished she could pursue a more meaningful career, but with her depression, she didn’t think she could handle something challenging. She also needed the job security and health benefits to cover the medications for her chronic autoimmune disorder.
H was in his 40s and suffered from gastrointestinal bloating and erratic bowel movements most of his life. As a child, he was diagnosed with ADHD and generalized anxiety disorder. He remembers horrible stomach pain that would keep him home from elementary school. In many ways, this was a saving grace because he remembers the chronic bullying and devastating boredom he dealt with there.
His doctor ordered colonoscopies and gastroenterologist referrals, but when nothing showed up on testing, he was diagnosed with Irritable Bowel Syndrome (IBS), linked to stress.
To find relief, H researched alternative therapies like meditation, red light therapy, cold plunges, and ketogenic diets. Could his mental health issues be connected to his gut health? His doctor said that diet was unlikely to shift his symptoms and that his anxiety, ADHD and IBS were separate and unrelated.
These examples are from various patients I’ve seen over the years—their names and identifying details have been changed and combined with other patients to represent overarching patterns in everyday healthcare experiences. There are differences in the details, but they, I, and hundreds of other patients, have all found ourselves in a similar space: leaving an unproductive and invalidating healthcare encounter in tears, feeling utterly alone, unseen and unheard.
M, L, and H all presented with a constellation of symptoms affecting various body systems, including their digestive organs, brain and nervous system, hormones, immune system, muscles, and metabolism. Their doctors were supportive and well-meaning, ordering blood tests and imaging, making referrals, and providing solutions within their scope of knowledge.
However, when their tests were normal, medications failed to provide relief, or symptoms escaped defined diagnostic categories, they and their practitioners hit a wall.
Like many others, these patients are victims of a medical model that overlooks the broader context in which people seeking healthcare solutions often find themselves. Symptoms may be dismissed, data is prioritized over experience, mental health is either minimized or overmedicalized, and care is separated into systems: brain, body, digestive system, hormones, or heart.
What was the significance of M’s elevated liver enzymes on her bloating and fatigue? Did her history of caloric restriction and people-pleasing predispose her to the burnout and exhaustion she was experiencing? How might intermittent fasting and overfunctioning have perpetuated her condition? How did the absence of a clear and defined disease negate her experience of being unwell and prevent her from finding the tools and strategies that might have helped?
What is the connection between L’s longstanding untreatable depression, autoimmune disease, and inflammation? How did carrying her diagnostic labels since adolescence impact her identity, hope for the future, and career aspirations?
Is it true that H’s anxiety, ADHD, and IBS were unrelated? How might bullying have impacted his physical and mental health? How might biohacking give him a sense of agency, or even creativity (May, 1983)? When does striving to understand slip too far into micromanagement, health anxiety, orthorexia, and self-punishment?
One of the reasons I became a naturopathic doctor is to work within the space and framework to ask these questions: Who is the person in front of me? What is their story? How can I serve?
For all three case examples, their family doctor’s office was the first place they sought help. Patients in the current healthcare system are fragmented into signs, symptoms, diagnoses, and labels. They are offered reductionistic linear solutions: one drug, test, or treatment per problem. When solutions are exhausted, practitioners throw up their arms: “It’s peri-menopause/aging/stress.” The system leaves little room for curiosity, meaning-making, transformation, growth, or uncertainty.
The result is a breakdown in the doctor-patient relationship and a lack of faith in the healthcare system. For patients, this can lead to a sense of powerlessness and mistrust of their bodies. Practitioners can feel frustrated, compassion-fatigued, and burned out.
In 1977, the journal Science published a seminal paper by George Engel entitled “The Need for a New Medical Model: A Challenge for Biomedicine.” In it, Engel outlines the limitations of the biomedical model and introduces a new approach to healing: the Biopsychosocial model, a holistic framework that acknowledges the interplay of biology, psychological, and social factors on health and illness.
Even nearly 50 years after Engel’s paper, modern medicine still largely adheres to the biomedical model. The model is based on the tenets of reductionism and dualism, which offer relative simplicity and a sense of certainty. These dogmas are difficult to release in favour of a more complex, flexible, multifaceted, and interconnected holistic framework.
Reductionism is a philosophical approach that seeks to understand the whole by breaking it down into its constituent parts. Health and illness can, therefore, be understood at the molecular and chemical levels: type I diabetes is a disease characterized by insulin deficiency, and coronary artery disease results from high cholesterol levels. However, a Lego sculpture cannot be recreated by turning over and examining the little coloured plastic pieces; the human organism is more than the sum of its parts. Our bodies are layered, interwoven, and interdependent dynamic systems that depend on and interact with the social world and environment.
We are wild, magical, and endlessly puzzling, with pieces and parts that weave, knot, and untangle in molecular dances that connect, disappear, and remanifest from the unseen depths of the mysterious beyond. The truth is as horrifying as it is accurate: despite the degrees, papers and expert-level bravado, we understand very little about ourselves.
Emerson M. Pugh puts it famously and beautifully: “If the human brain were so simple that we could understand it, we would be so simple that we couldn’t.”
The Human Genome Project is a prime example of the limitations of reductionism. Launched in the late 1990s and early 2000s, it aimed to decipher the body’s genetic code to understand the language of disease. While the project helped advance science in many ways, it failed to provide significant breakthroughs in disease research. It turns out that there is more to understanding Shakespeare’s works than reciting the alphabet.
Some diseases are caused by specific mutations in individual genes. Still, the reality is far more complex, with the relationship between genes and health involving combinations of mutations and epigenetics —interactions with the environment, life experiences, and behaviours that impact our DNA.
The second feature of the biomedical model is mind-body dualism, developed and promoted by Descartes in the 17th century. He postulated that the body is a material entity that could be dissected, examined, and altered without impacting the mind, which was considered ethereal and non-physical. The body might have been considered a temporary vessel for the mind, but the two were governed by different principles and troubles of the mind were not thought to impact the body, and vice versa.
The healthcare system still presumes mind-body dualism. We have psychiatrists for the mind and neurologists for the brain. Dead-end symptoms that evade disease categories are hand-waved as “stress” or “psychosomatic” (which paradoxically assumes a connection between mind and body).
Centuries of adopting this ill-fitting assumption have led to the obvious and pervasive mind-body problem: if the mind and body are distinct, then how can anxious thoughts quicken our heartbeat, trauma impact our immune system, stress lead to indigestion, and a placebo produce a healing effect?
The biomedical model views the body as a machine, with diseases representing deviations from normal functioning, and healing involving the restoration or replacement of broken parts. But, despite the comforts of certainty and control, biomedicine is no more scientific than leeches, bloodletting, and celery juice. It provides us with rituals in the form of tests, diagnoses, and prescriptions. The amulets we hold onto to ward off the demons of disease are chemical fixes for depression and ADHD, antibiotics for viral infections, and medications to lower lab values.
The biomedical model is the folk medicine of our time. It promises answers to the more complex questions of what is wrong and what can be done about it, while failing to address the why, how, what for, and, importantly, what this means (for me, my life, my family, my future).
On the other hand, the biopsychosocial model invites us to see the person as a constellation of living systems: interwoven body, mind, relationship, and spirit. It considers the rhythms of our biology, such as blood sugar, hormones, nerves, and neurotransmitters, inseparable from our inner world of thoughts, emotions, defences, and longings. It honours how we move through the world: in families, communities, and systems that shape our choices and burdens. It also asks how we make meaning through purpose, ancestry, connection, and the implicit possibility that links others to our suffering: we belong to something larger than ourselves.
The biopsychosocial model rests on a web of interconnected pillars, each supporting and shaping the others in a living system of feedback loops and resonance. No part can be isolated and touched without creating ripples that contact the whole.
Even a single intervention, such as a medication, sends ripples through the entire system because a pill, even a placebo, is not inert. It holds our beliefs about healing and medicine, our relationship with the prescriber, the meanings we attach to illness, and the social stories we carry about being unwell.
In “Why Make People Patients,” Marshall Marinker (1975) distinguishes between illness, sickness, and disease. The medical establishment diagnoses and treats diseases based on symptoms, signs, and lab tests that fit into neat categories, with defined biological treatments.
Illness is the experience of dysphoria and dysfunction that brings people to the doctor. It is the interpersonal and subjective experience of how unwellness is experienced or lived. Therefore, it is possible to feel ill (or unwell) without meeting the criteria for having a disease.
Sickness is a social role that an individual adopts when they are seen or see themselves as unwell. Those with chronic illness may experience being sick (and ill) without having a disease.
Within the biomedical model, disease receives the most attention. Its cause and course are known, and its treatments are rational and specific (Engel, 1977). Biomedicine can offer patients disease labels and treatments. The biological, psychological, and social dimensions of suffering are medicalized and collapsed into the narrow definition of disease. Care is often dehumanized, and people are treated as problems to be fixed (Marinker, 1975). People with chronic, invisible, or unexplainable symptoms or conditions that have yet to be classified and recognized as diseases are often dismissed, a phenomenon identified as “medical gaslighting.”
The Latin root of the word “patient” means “one who suffers” or “one who endures.” Life is suffering, and in this way, we are all patients. However, patient is a half-word, like confidant or lover (Marinker, 1975). A patient exists as one half of a dyadic whole, the doctor, physician, or healer forming the other half. This therapeutic relationship is the unit from which healing occurs.
The patient enters the therapeutic relationship because either they are unaware of what is wrong or, if they are, they don’t know how to help themselves (Engel, 1977). In this therapeutic dyad, the physician is not just a mechanic, identifying and fixing the broken parts, but also a teacher, mentor, and psychotherapist, requiring knowledge of body systems and medicine, as well as psychological and interpersonal skills. Their task is not only to diagnose, but to soothe uncertainty, offer meaning, and strengthen the patient’s trust in their body.
The physician is an agent of hope.
Research has shown that the biopsychosocial model can be used to treat pain and improve mood and life satisfaction in patients; it enhances clinician skills and improves disability outcomes ( Dossett et al., 2020; Fricchione, 2023; Kusnanto et al., 2018; Mankelow et al., 2022; Nakao et al., 2020).
Though decades of research and clinical evidence support the biopsychosocial model, conventional medicine, shaped by hierarchy and tradition, has been slow to integrate it, preferring power and old dominance structures over change.
Furthermore, the limitations of time and attention in holding space for the biopsychosocial model, the nuance of taking a thorough history, and systems thinking make it difficult to standardize into a rigid and overly complex system.
We need practice to bring the biopsychosocial model to healthcare. Below are real-world, grounded examples of how practitioners and patients can embody the model.
For practitioners:
Listen to Serve. Rachel Naomi Remen says that the doctor’s role should not be to fix or even help, but to serve.
She says, “If helping is an experience of strength, fixing is an experience of mastery and expertise. Service, on the other hand, is an experience of mystery, surrender and awe.”
In her book Narrative Medicine, Rita Charon (2006) recommends that doctors invite patients to speak without interrupting, asking them, “What do you think I should know about your case?” She listens for symptom onset, location, duration, and so on, but she also listens for nuance. How do the patients describe their symptoms? How are their lives impacted? What is important to them? Sometimes, she asks a patient, “Tell me about your scars.” Then, she listens.
In the biomedical model, where the doctor is on a hunt to uncover the broken or missing piece, patients are interrupted an average of 18 seconds after they begin speaking.
In many naturopathic consultations I’ve conducted, patients speak for thirty minutes or more, while I quietly listen, reflect nonverbally, and take notes before asking a single question.
In medical school, we were taught how to take a case, including mnemonics to help remember the key questions to ask. Now, 10 years in, I find that simply listening to patients provides me with the information I need to know, and more.
Perhaps this is why naturopathic doctors are often referred to as “Physicians Who Listen.”
According to Engel, doctors must learn to be high-level interviewers, versed in the cultural determinants of how patients communicate disease symptoms. How we talk about our bodies reveals our relationships with them, our experiences with symptoms, and the early life experiences that shape our bodies.
In the doctor-patient interview, the doctor must listen to understand and validate the unfolding story that led someone to feel unwell and seek help. This means identifying biological symptoms and holding space for the psychological and social elements shaping how the person suffers, and healing might begin.
Charon posits that a medical interview must allow for a layered, nonlinear, and metaphor-rich narrative. How does the patient tell their story, and what are their experiences with symptoms? What details do they choose to include? Or omit? Narrative thinkers like Rita Charon and Gabor Mate argue that our stories, or biography, shape our biology. They are just as important, if not more so, than the classic signs and symptoms that typically characterize a particular diagnostic category.
The doctor’s task is to help patients name their feelings and bear witness to the patient’s experience of dysphoria or dysfunction. They must listen for and begin to untangle the threads that shape the suffering and the individuals’ desire to wear the mantle of “patient” and entrust their body to care.
Begin with humility. The patient is the expert on their own body. While you may have spent hours studying this particular organ or condition, the patient has spent years, even a lifetime, living with it.
Science, while the best methodology we have for encountering the truth, is still just an approximation that we use until something better comes along. Knowledge is always incomplete. According to Babette Rothschild (2021), even the most evidence-based treatment for post-traumatic stress disorder will not help more than 50% of clients.
Even the most thoroughly researched cure will not benefit everyone. Nothing in medicine, psychology, or sociology is a hard fact. Science is a big, unanswered question.
In the words of Rachel Naomi Remen, “The patient is not a problem to be solved, but a mystery to be met.”
Remember why you wanted to be a doctor. If you’re like me, you were captivated by the awe and mystery of not knowing. You’ve studied and practiced medicine for years, and the not-knowing still hangs before you, lighting the way on.
My question to practitioners is this: Can you meet your patient, head down in reverence and awe, with curiosity and compassion, without the need to fix? Can you sit in the discomfort of uncertainty?
Practice systems thinking. From a systems perspective, rather than a reductionist one, each part is integrated and interacts with its layers and within the whole. What layer must be addressed first?
Consider how social forces like poverty, racism, and social categories may affect patients’ symptoms and their ability to heal. Ask how organs, cells, molecules, diagnoses, lab results, and the social and psychological interact. What threads are present, and how might they weave and knot together?
See the person, not the problem. Michael White (2016), the developer of Narrative Therapy, is famous for saying, “The person is not the problem, the problem is the problem.” When we separate people from their problems, we leave room for stories of suffering and strength. We can hold and better listen to their stories, while tackling the problem without erasing the person.
Centre patients as the experts on their own lives and their bodies. Flatten hierarchies and de-centre practitioner power. Educate with curiosity, not to fix or dictate. Leave room for questions and doubt. Learn to roll with resistance rather than fighting against it.
Instead, get curious. Why might these recommendations not be landing for the patient? Ask if the diagnoses and treatment plans make sense to them. And then ask: What matters most? What do you notice? What are you ready for?
Ask patients what threads they would like to tug first. Addressing patient issues and developing plans involves a patient-centred, collaborative approach in which courses of action are suggested, tried, and evaluated for feedback. This way, an intricate dance happens between the patient and the practitioner (Graham et al., 2023).
Self-care. Finally, practitioner burnout is real. Ensure you regulate your nervous system, make space for reflection, and seek support as needed.
For patients:
Trust yourself. Health is not just the absence of symptoms or the relief of pain; it is the sense of wholeness, coherence, and aliveness in your body and your being. Normal lab results don’t cancel out your suffering; a diagnosis cannot fully contain your story. Your instincts and insights are also essential data.
You are not a broken part needing repair, but a whole person, complex, relational, and worthy of care. If something feels wrong, trust that. If you feel unseen, trust it. Your frustration is valid. Your symptoms are messengers.
You deserve understanding, presence, comfort, care, and a path forward.
Empower yourself within the system. Our healthcare system is stretched thin, and sometimes, your suffering may be overlooked. This is not because you don’t matter; it isn’t always because your doctor doesn’t care. Sometimes, even the most well-meaning practitioners work within an overwhelmed structure.
Before your appointment, take a moment to ground yourself. Breathe into your belly. Feel your feet beneath you. Gather your thoughts and write them down. Bring someone who can hold space, ask thoughtful questions, and accurately remember what is said.
Write down your questions before you go. Appointments move quickly, and it’s easy to forget. Describe your top two or three concerns and how they shape your days, energy, and life. Be honest about what you’ve tried, what’s helped, and what hasn’t.
If something feels off, you can gently point it out. “Could we look at this another way?” “This doesn’t quite fit.” “Would you be open to checking this?” If it’s difficult to speak, consider having someone speak on your behalf. You deserve to be witnessed.
Afterward, write down what was said, how it landed, and what you wish you’d asked. Over time, this will build a personal health narrative you can revisit and share with future providers.
Participate in your healing. Responsibility is not about blame. You are not expected to carry everything alone, but you are invited to become a curious, compassionate student of your own body. We can reclaim our agency.
Start by paying attention. Track your symptoms, not obsessively, but as an act of self-witnessing. Look for patterns: what soothes, what aggravates, what precedes the flare or the crash. Learn the basics of your biology and mind: how stress ripples through your system, blood sugar, trauma, hormones, sleep, and your nervous system speak. What are their symptoms, signs, and sensations? You don’t need to diagnose yourself, but knowing your inner landscape helps you recognize when something feels true and when it doesn’t.
Your voice matters, too. Healing is a dialogue. Informed consent is about being an active participant in the conversation. This means learning to describe what you feel, notice, and need.
Pain, for instance, can be more than just “it hurts.” What kind of pain is it? Where does it live? Is it burning, tight, dull, or pulsing? Does it move or stay in place? Is it eased by warmth, made worse by movement, or does it come on with memories or moods? The more we can narrate what we carry, the more we can be seen.
When it comes to tools, focus on what’s within reach. You don’t need a life overhaul or expensive therapies. Sometimes, healing begins with the most minor shift: more rest, a nourishing meal, honouring a boundary, a walk in the sun, or a moment of joy.
The human body requires fresh air, water, sunlight, physical activity, restful sleep, nutritious food, and social connection. While finding a balance of these isn’t always easy, sometimes, the solutions are simpler than we think.
Build yourself a circle of care. No single practitioner can hold everything we carry. If it’s within reach, widen your support: consider consulting a naturopathic doctor to explore root causes, a therapist to help map your inner world, a nutritionist, an acupuncturist, or a massage therapist. Each practitioner can offer a different lens and a different kind of listening. Ask about referrals, covered services, sliding scales, or community programs.
You are allowed to ask for more, to want a second opinion, and to assemble a community of support that sees you more fully. If you have coverage, use it. If you need a referral, ask. If a door closes, it’s ok to knock on another.
Seek information from people you trust. Let wisdom be relational and guided intuitively. Be cautious of algorithms, especially those that induce fear or urgency.
Above all, refuse to give up on yourself. I always believe there is a path toward feeling better. Even when we can’t fully restore the body, healing can still occur through meaning, connection, presence, and peace. Your body is not betraying you. I believe symptoms are cries from the body that deserve to be heard.
Healing begins when we stop reducing people to their symptoms and begin seeing them as whole beings, complex, feeling, and worthy. You deserve care that honours not just your biology, but your personhood, spirit, and life.
You deserve to tell your story and have someone receive it with attention and care.
You deserve a physician who listens.
References:
Charon, R. (2006). Narrative medicine. Oxford University Press.
Dossett, M. L., Fricchione, G. L., & Benson, H. (2020). A new era for mind–body medicine. New England Journal of Medicine, 382(15), 1390–1391. https://doi.org/10.1056/nejmp1917461
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460
Fricchione, G. (2023). Mind body medicine: A modern bio-psycho-social model forty-five years after Engel. BioPsychoSocial Medicine, 17(1). https://doi.org/10.1186/s13030-023-00268-3
Graham, K. D., Steel, A., & Wardle, J. (2023). The converging paradigms of holism and complexity: An exploration of naturopathic clinical case management using complexity science principles. Journal of evaluation in clinical practice, 29(4), 662–681. https://doi.org/10.1111/jep.13721
Kusnanto, H., Agustian, D., & Hilmanto, D. (2018). Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. Journal of Family Medicine and Primary Care, 7(3), 497. https://doi.org/10.4103/jfmpc.jfmpc_145_17
Mankelow, J., Ryan, C., Taylor, P. C., Atkinson, G., & Martin, D. (2022). A systematic review and meta-analysis of the effects of biopsychosocial pain education upon health care professional pain attitudes, knowledge, behavior and patient outcomes. Journal of Pain, 23(1). https://doi.org/10.1016/j.jpain.2021.06.010
Marinker, M. (1975). Why make people patients? Journal of Medical Ethics, 1(2), 81–84. https://doi.org/10.1136/jme.1.2.81
May, R. (1983). Courage to create. Bantam.
Nakao, M., Komaki, G., Yoshiuchi, K., Deter, H.-C., & Fukudo, S. (2020). Biopsychosocial medicine research trends: Connecting clinical medicine, psychology, and public health. BioPsychoSocial Medicine, 14(1). https://doi.org/10.1186/s13030-020-00204-9
Remen, R. (1996). In the service of life. Noetic Sciences Review. https://palousemindfulness.com/docs/remen-service.pdf
Rothschild, B. (2021). Revolutionizing trauma treatment: Stabilization, safety, & nervous system balance. W. W. Norton & Company.
White, M. (2016). Narrative therapy classics. Dulwich Centre Publications.
