Feature: Following Your True Path: An Interview with Timothy McCall, MD, General Internist and Yogi
Tell us about the beginnings of your career and how you became interested in yoga.
I went to medical school at the University of Wisconsin in Madison, and then trained for three years in internal medicine. I practiced office-based primary care for over 10 years in the Boston area.
I noticed there were a lot of changes happening in health care delivery and through my research decided to write my first book "Examining Your Doctor: A Patient's Guide to Avoiding Harmful Medical Care". The book focused primarily on conventional Western medicine and was a consumer guide for patients. From this experience, I realized that I really enjoyed the writing process.
After publishing this book, I decided to investigate alternative medical practices to learn more. It seemed that yoga had a lot to offer in terms of health and medical implications. I would hear stories from fellow yogis about how they had debilitating back pain and it went away or certain poses that helped with sinus pain. I began to read all the research I could find and got deeper into my own yoga practice. This prompted the release of my second book, "Yoga as Medicine: The Yogic Prescription for Health and Healing".
I decided to leave my clinical practice and to teach yoga therapy internationally and to continue to write about my experiences.
How has yoga enhanced your training as an Internist?
Yoga has enhanced my skill-set as a health practitioner by deepening my understanding of causes of and broadening my knowledge of treatments for common physical complaints. For example, chronic back pain was a complaint I encountered daily in my office practice. It's a frustrating complaint for a physician because Western medicine has incredibly few options to offer. However, in yoga, there are literally hundreds of causes of back pain that have been well characterized describing different structural and energetic parameters of all the facet joints and ligaments. Refinements of posture and specific yoga poses can be very effective treatments.
When I write as a journalist, I write for a medical audience. My goal is to use medical terminology to explain the mechanism of action of a variety of poses and remedies so that medical practitioners will better understand their therapeutic value and be more open minded about integrating them into their treatment plans.
When I am collaborating in the yoga world, I try to encourage yoga practitioners to state their sources and support their claims. Sometimes, traditional yoga practitioners have a way of explaining things that would make physicians cringe. While some yoga practices have been validated in scientific trials and experience, others are not very well supported. I try focus on the mechanism of action and describe it in terms that are understandable to physicians. doing so, I aim to highlight the best of both disciplines and to create awonderful cross-fertilization of philosophies. In addition to yoga practice, I have been studying the principles of "Aryuveda", traditional Indian healing. Initially, it seems overly superstitious and is somewhat similar to the Greek Humors. I don't think Aryuveda is fully appreciated by either the East or the West. Upon deeper study, I realize that the holistic approach to patients in Aryuveda is what is missing in much of western medicine and I hope my writing helps physicians incorporate this approach into their practices.
What do you think of our physiological understanding of the effects of yoga and the challenges of producing an evidence base for its therapeutic properties?
When I start describing how yoga works, clinicians often ask for scientific explanations and evidence. There are so many ancient yoga practices that lack scientific evidence because of the difficulty encountered in measuring outcomes without the use of traditional scientific methods. For example, traditional yoga teaching says that shoulder-stand poses are beneficial for thyroid function. However, this has not been validated by any scientific measure. Some yogis feel obligated to rationalize a mechanism, often by attributing enhanced blood flow to the area as a reason without any scientific evidence. They try to gain legitimacy by using scientific language to describe a yoga tradition. I advise people to simply differentiate their sources of information and not feel like they have to make everything sound scientific to be legitimate.
It is important not to confuse the science with the tradition and not attempt to make something scientific. While some concepts, such as alternate nose breathing are well-validated, we need to appreciate that many aspects of yoga are still not fully understood from a physiological point of view. Tradition and science are valuable and each has a contribution to make.
I think yoga is similar to western medicine in that the only way to truly understand it is to practice. You can read and discuss as much as you want but until you do it you will never understand. Despite the common importance of practice, yoga and Western medicine have opposite approaches to defining what's true. In Western medicine there is a focus on randomized control trials with large samples sizes where you use statistically significant data to inform future clinical practice. This is very different from yoga, where you learn to study the individual in exquisite detail by studying their breath and their patterns of muscle contraction, not just their static anatomy. There is also a focus on study of the balance between the sympathetic and parasympathetic nervous system, something we talk about in Western medicine but don't actually use.
Where can yoga have a role in Western medical practice?
I think that it's going to be slow for yoga to become incorporated into regular medical practice. However, there has been a generational shift. Young people get it - yoga has been mainstream for most of their adult lives. The generation of physicians before did not want to have anything to do with yoga. It is very inspiring to see the enthusiasm and open-mindedness of the next generation of physicians to alternative therapies.
Much of what we see in medicine has a psychological component that we cannot always assess from our objective clinical tools. For someone who suffers from anxiety, apart from anti-depressant medications or costly private counseling, we don't have a lot of options. Yoga is a wonderful solution. I think back to my practice and there were a number of patients who I would have described as "needy," which made them difficult to work with, but now I realize that I did not have a sufficient variety of tools necessary to help them. All I could do was order more tests, prescribe more pills or send more referrals but that may not have been what these patients really needed.
To help patients with yoga the best way is to develop your own practice and make yoga a personal habit. Yoga can be used as a tool and when the philosophy is put to practice and small changes can have lasting effects. Yoga is difficult to prescribefor others without engaging in the philosophy yourself.
As a physician-in-training life can be quite busy, how have you managed to maintain a regular asana practice in your life?
Practicing western medicine is an incredibly stressful and it is very important to have a comprehensive stress-management system in order to avoid burn out. Yoga provides comprehensive stress management for caregivers and may help them to incorporate techniques and philosophies into their practices. As busy as life gets, maintaining a regular practice entails carving out five minutes of your day for yoga practice, which can be in the form of asana, breathing, or meditation. As you continue to commit, allow the practice to convince you to continue or not to continue. A small amount of practice done every day allows you to accept the methodology that yoga offers, essentially training the mind to create a new habit.
For more information see drmccall.com or view the list of selected new and upcoming PubMed publications on yoga and internal medicine topics.
Pamela Verma and Devina Wadhwa
University of British Columbia Faculty of Medicine, Class of
2012