Experts: Interviews

What does the next generation of integrative medicine doctors look like? James Nicolai, M.D., 39, medical director of the Franciscan Center for Integrative Health in Indianapolis, Indiana, is clearly an emerging leader of American medical reform. He is a graduate of the Indiana University School of Medicine, a board-certified family practitioner, and completed fellowship training Integrative Medicine at the University of Arizona in Tucson in 2002. He spoke with Brad Lemley.

How would you describe your practice as an integrative medicine doctor?
I am basically a foot soldier for Dr. Weil and his vision of medical practice. I am one of the guys he personally trained, who is trying to apply that training in a clinical atmosphere. So where some doctors might have a specific natural-medicine niche, whether it be botanicals or mind/body medicine, I'm trying to really apply all the principles of Dr. Weil within a clinical setting.

Can you give more specifics?

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One day out of the week, I'm essentially doing a health coaching practice as an integrative physician. I perform an integrative evaluation of a patient, and then apply integrative medicine techniques: those could be lifestyle measures, vitamins, supplements, botanicals, mind-body interventions, stress management techniques, referrals to CAM (complementary and alternative medicine) practitioners, drugs or some combination.

My Mondays are usually devoted to writing or consulting work to introduce integrative medicine practices into businesses, hospitals, and other medical organizations. I also spend a day a week working in an occupational medicine clinic.

The other two days, I am involved in a medical bariatric practice - in other words, a medically supervised weight-loss program. I consult with people who are obese or overweight, and who are looking to change that dynamic. Instead of using surgery or a pharmaceutical drug, my whole focus is an integrative approach that addresses the mental, emotional, spiritual, social and physical aspects of their weight problem, and the medical conditions they may have because of it.

How does the bariatric program work?
It's a 20-visit program. We have registered dieticians here, and we have relationships with physical trainers as well as clinical social workers and psychologists. It's very important to address the emotional component of obesity as well as the dietary and physical activity components.

Besides looking at the whole picture, my side of it is to first assess clients medically; a lot of them have medical conditions. So if they are on medications, you want to make sure that what they are taking does not promote weight gain, you want to at least optimize that regimen. Then, I offer a regimen of supplements; vitamins that can help give them an internal environment that favors weight loss more that weight gain. What I always say is, let's get people into a fat-burning mode as opposed to them being in a chronic fat-storing mode (which they are more often than not). How the bariatric program works is literally an hour-long conversation in itself.

We'll do that soon, and put it here at drweil.com. How do patients find you?
I give talks around the community: I've done TV and written a newspaper column. Or they will find me through the Web. I have seen people who have traveled all the way from Ohio, Illinois and even Michigan, because they want to see an integrative medicine doctor who is trained by Dr. Weil and I'm the closest one.

Tell me a little bit about your background.
I grew up in Indiana. I always had this sense that I wanted to be a healer and I wanted to make a positive impact on people. So I was torn between becoming a doctor or a psychologist because I was really fascinated with the mind and how the mind affects the body. When I got to medical school, I was very surprised because I found that the health care system we have is really a disease management system. I got a lot of education - good education, I might add - but I got a lot of education on disease, on how you find out what's wrong with the body. I did not get much on healing and health, on how to prevent disease, or how to do what's right for the body. It was really disillusioning. For probably about two years, I was really frustrated, and was seriously thinking about leaving medicine.

What medical school was this?
Indiana University. Don't get me wrong, I got a really great clinical education, but like a lot of med students, I got very little training on health and healing. Case in point: I got a week's worth of nutrition education in my seven years of medical school and residency training.

That's better than what Dr. Weil got, though, right?
Yeah, he got like one hour in the 1960s at Harvard. So that's improvement, I guess (laughs). But, I came from a middle class background: my dad came over from Italy and worked in the steel mills. So after two years, I'm about $75,000 in debt from school, so quitting wasn't an option. Then, luckily, I read Spontaneous Healing in 1996. It changed my entire way of thinking about health, healing and what I wanted to do. And the next year, 8 Weeks to Optimum Health came out, and I went from a doughnut-eating, coffee-drinking medical student to a salmon-eating, green-tea drinking Dr. Weil follower. I literally changed my life because of that book, and I decided I wanted to meet him, train with him, work with him. This was the kind of medicine that I wanted to practice.

So in 2000, you began the two-year fellowship at the Program in Integrative Medicine at the University of Arizona's School of Medicine in Tucson. What was that like?
It was the best choice of my life. I had been working as an emergency room physician, and the fellows' salary meant I had to take an 80 percent drop in pay. But it was unbelievable, and I would do it again in a heartbeat. It made me the physician I am now.

Can you summarize the program?
The idea was simply to train you to be an integrative medicine physician. So we would see people and do an integrative medicine interview, not unlike what Dr. Weil does, assessing people mentally, emotionally, spiritually, socially and physically. As a matter of fact, I tell people that when you see me, it's really like seeing Dr. Weil, the only difference being that he's a little bit smarter than I am. But yes, we were trained in all the different botanicals by Dr. [Tieroana] Low Dog, and on mind/ body medicine by Dr. [Steven] Gurgevich, as well as manual and energy medicine, philosophy of medicine, traditional Chinese medicine and homeopathy, as well as how to implement lifestyle medicine into everyday life. We even cooked with Dr. Weil. I remember learning what kale was from him: getting it from his garden, chopping it up, cooking it, cleaning up, even washing the dishes with him and talking about what it takes to truly be a healer. It was just an all-around unbelievable experience.

And unlike your previous experience, they tell you to take your own health seriously. The idea in a typical medical school is to sort of crush the life out of you. But Dr. Weil says a physician should be a model of how to live in a healthy way.
Right. You've got to walk your talk. You can't talk to people about living healthily and not look the part. So I make green tea in my office. I make matcha, the same green tea Dr. Weil talks about and turned me on to. And you know, for people to see me make a client this green soupy stuff that they've never seen before, but is this amazing, delicious, healthy alternative to coffee, there's power in that. They begin to get a sense that the physician can truly be a role model for health and can guide them in that direction.