Transcription of Dr. Ralph Thieme for the show Patient-Centered Wellness #146
Dr. Lisa: This is Dr. Lisa Belisle, and you are listening to the ‘Dr. Lisa Radio Hour and Podcast’, show #146, ‘Patient-Centered Wellness’, airing for the first time on Sunday, June 29th, 2014. Patient-centered wellness is considered the wave of the future, but it is also deeply rooted in the past and in healing tradition such as acupuncture, osteopathic manipulation and naturopathic medicine.
Today, we speak with two physicians who are integrating these traditions into their practices, and helping patients create their own wellness path. Join our conversations with Dr. Ralph Thieme, Dr. Richard Maurer, and Dr. Maurer’s long-time patient and writer, Patty Hagge, and learn more about their unique approaches to patient-centered care. Thank you for joining us.
As I’ve mentioned on the show before, one of the most important things to physicians and healthcare practitioners really is the relationship with their teachers. One of the most important things to me has been my relationship with my teachers, so I’m always pleased to have people in the studio that I respect greatly as practitioners in the field, but also as my teachers. Today, we have with us Dr. Ralph Thieme who is an osteopathic doctor who practices in Falmouth.
Dr. Thieme has been a part of the Integrative Medicine Program with the Family Medicine Department at Maine Medical Center and has done a lot of teaching in the community, and not the least of which has occurred with his own patients. Thanks for coming in and talking with me today.
Dr. Ralph: Thank you, Lisa.
Dr. Lisa: Dr. Thieme, you are not what I would call ‘A standard doctor’. I’m trained in Family Medicine, you’re trained in osteopathic medicine, but you also have acupuncture in your background … You’re truly an integrative doctor. Can you tell me a little bit about what you do and how you got there?
Dr. Ralph: I think I’ll start by trying to go into how I got there.
Dr. Lisa: Great.
Dr. Ralph: Actually, I’d have to look at that retrospectively rather than I didn’t make choices to get there. It’s as I arrived, I got to look back and see maybe how I had been formed to fulfill this position. One of the things that … The osteopathic profession I think began in a more rural area than in urban area. I find for myself that that’s a part of my history.
I grew up in a farm in Wisconsin. It was a dairy farm. My father worked very hard. He didn’t have the opportunity to have much education, but he was a very smart, brilliant, respected man. One of the things that happened with his work was is he ended up having a bad back, and it happen to occur when I was the right size.
One of the things that he had me do was walk his back. In retrospect, I found out that I was doing one of the oldest forms of treatment that has been recorded oftentimes by children or women. I did that.
He was very respected by his neighbors, and because most farmers would rather not spend money, if they had a problem with their cows, they would call my dad first. If he couldn’t advise them, then they would call the vet. There were times where I would help him deliver calves. When I did that, he would have me take a hold of the ropes that he attached on the calf, and he would vert the calf within the uterus and position it so it could come out, but by then, the cows were usually exhausted. He would help me put a little bit attention on the ropes to actually help pull the calf.
In the process, I had to develop a very gentle, mindful touch, which again made me in retrospect think he was training me to be a good osteopath, and of course, he didn’t know that but life just happened. I went through a period where I thought I might be a teacher, and then I thought I might be a doctor, and then I decided that I didn’t want to be a doctor because what I saw didn’t inspire me, so I withdrew from premed and had all of these credits. I thought, “I’ll get a degree in pharmacy”, and I did.
In the process, I happen to do an externship at a VA hospital that had a visiting physician from the UK. This was back in the ’70s, right around the time that Nixon went to China, so there wasn’t really acupuncture at all around yet. I had the opportunity to see a physician do acupuncture in the VA hospital because he came from Great Britain. It really intrigued me.
Then, I continued my training and got my degree in pharmacy. Didn’t practice it even though I have great respect for pharmacists. I still do. Then, I think because of my own inner search, I ended up getting some graduate work both in counseling and in psychology. In the process, I really felt like I needed to be able to also touch people.
By a set of odd circumstances, I ended up having someone recommend to me that I ought to train to become an acupuncturist. As soon as they said it, I felt like a jolt of lightning or a light bulb go on inside of my mind, and I knew I was supposed to do that. That happened. That piece of information came to me on a Sunday in Hawaii.
On Monday, I searched the three schools in Hawaii for acupuncture and the first two didn’t fit. That afternoon at four o’clock roughly, I walked into the third school, and there was this older, kind of frumpy Chinese lady siting there who I thought might be the secretary for the school. I approached her with a question about acupuncture and schooling to her.
She started asking me questions and we started going back and forth for a few minutes. I was curious why she asked me so many questions. Finally, she said, “You very lucky.” That was roughly the phrase she used. She said, “We have a class that starts tonight at six o’clock. Your paperwork can catch up. You come tonight.”
I began that night, and I had really been in Hawaii just a short period of time. One of the members in the class was a Vietnamese monk. He introduced himself to me at a break and asked where I was staying. I told him I had just arrived in the past week and I was staying in a hotel. He said, “That was no good.” He invited me to come and live at the temple.
I’ve always had that part of my personality was important to me also, and so, although I was not a … I am a Buddhist or I’m not a Buddhist, I mean, there are like all the religions or none of them. I spent almost two years there as the live-in carpenter who also had to sit in meditation every day. That took me through acupuncture.
Then, the year after I graduated, I was doing a house call. In Hawaii, if you’ve ever been there, there are many rainbows. I was in this one little valley and I gave a treatment. Inside, they had the shades [drawn 00:11:20]. It was dimly lit.
When I arrived, it was sunny, and when I was inside, it rained. I didn’t know that. When I came out, it was brilliantly sunny again. I proceeded to carry off with my table and my supplies and didn’t realize it had rained and it was slippery and I fell down a flight of stairs. I jokingly acknowledged my guardian angel for standing there with their foot out, because I needed that fall to injure myself because it helped me with the help of a friend who gave me advice. I went to see my first osteopath.
After doing that, I headed off to osteopathic medical school. It was mostly things happened almost to me more than I chose anything. I just followed my curiosity and my passion.
Dr. Lisa: It’s a big plane ride between Hawaii and Maine.
Dr. Ralph: Yes.
Dr. Lisa: How did you end up here?
Dr. Ralph: This osteopath who treated me, as I was getting treated, I asked him if there were still osteopathic schools because I was unfamiliar with them. He informed me that there were. In our discussion, he said that, “If you want a recommendation, I’ll write you one.” He happened to be a very well-known, a national figure in my profession, and he was a great family of manipulative osteopaths, the ones that do the traditional things with their hands to their patients even though he is a general practitioner.
After he said that, I queried the American Osteopathic Association and applied. I applied only to the osteopathic schools. I went around the country and interviewed at everyone that had asked me for an interview. I had all these acceptances and I didn’t know where to go. I was back in Hawaii trying to decide when I got one last invitation for an interview. I questioned about going or not.
With the help of friends, they convinced me I should be thorough, so I flew to Maine. When I drove down the road that leads you to the University of New England College of Osteopathic Medicine, when I drove down that road, I knew that that was where I supposed to go to school. It was a beautiful late April, early May day, sun was shining, I could see the river and I could see the ocean, and it just felt like the spot, so I ended up going to school there. That’s what brought me to Maine.
Dr. Lisa: It seems as though what you’re telling me is you really came to trust yourself and trust the information that you were being given. This seems to fit in very nicely with how you work with patients and how you help them heal.
Dr. Ralph: I think you give me credit for more awareness than I have, but yes. I think I really do trust something. I think it’s an internal thing that I trust much more than I trust the external world. If I feel called to go and do something, I will do it even if it doesn’t make very good sense to some other people.
Dr. Lisa: I think it’s fair to say that when you were first doing acupuncture and osteopathic medicine within the traditional medical community, it wasn’t as widely accepted as it is now.
Dr. Ralph: That’s true. I was challenged a lot at that time, partly because I think it was something other people were unfamiliar with and it was threating to them. I was also internally challenged because I didn’t know another osteopath and another acupuncturist because I was trained in acupuncture first, and most physicians go about it the other way.
I think our training is literally almost like layers within the temple of our brain, and so my base layer was acupuncture and osteopathy got layered on top of that, and it took me a while. Then, the other part that I think was really, really helpful to me, it interestingly came from a medical doctor, Janet Travell who wrote the book on trigger Points and myofascial pain, because her book is so beautifully written from a muscular point of view and a myofascial point of view, that it gave me the anatomical detail that my mind needed to justify the meridians that I had been taught in acupuncture, and all of a sudden, it all clicked, and then it became …
I’m like a kid in the candy store. I’m still having a great deal of fun because I’m trying to put it together. It’s this huge, wonderful internal process in my patients and in me, as well as within our culture because they think their culture is trying to put it together too.
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Dr. Lisa: For people who listen to the radio show, we’ve had some conversations about acupuncture, and in some part, it’s because I’ve practiced acupuncture myself, prodded along by you. I’ll give you credit because when I came back …
Dr. Ralph: Thank you.
Dr. Lisa: … from my acupuncture training, I said, “Dr. Thieme, I don’t think I know enough to practice acupuncture. I feel really worried about this. Can I follow you around? Can you teach me some more?” You said, “You know everything you need to know. What you need to do is practice now.”
Dr. Ralph: Yes.
Dr. Lisa: People who are listening I think have some idea about acupuncture. Maybe you could explain it a little bit more for others who haven’t been long-time listeners.
Dr. Ralph: First of all, acupuncture is part of a medical system oriental medicine. I know for instance that when I was a student and I was doing rotations, I happen to train for one month in Tempe, Arizona and I was doing pediatrics. Of course, by the end of the month, I had quite a few viral illnesses because I was exposed to all these sick kids, and I would go to this nearby Vietnamese restaurant, and when I went there, I would order something to eat.
One day, the lady who is the wife of the couple that owned the restaurant shook her head and said, “That wasn’t a good choice.” I understood what she was saying and I let her order my meal. That really struck me because I thought, “How did she know more than I knew?” It was because she had all the cultural training that took her to that. It led me to really try to review in my mind all this data that I was taught in school, but to make it to come in place, something that my pap who was a farmer or the neighbor down the street already knew, like people know rhubarb is important in spring time because it’s like the spring cleansing thing that tastes so good.
My grandmother knew that, so that’s like integrative medicine, making it simple and something that’s very accessible for every single patient because we all know it already. Oriental medicine thousands of years ago, it’s lost in time. We don’t know when it began. They mapped out emotions and how they affect our body. It’s visible. You can see the way people sit and how they look in their face, and you can tell what their emotions are. We all know that already. They mapped it out so you could actually use that systematically, and they showed the rivers or channels on your body, how that emotion flows, and how you could start regulating it individually.
For most of us, we need someone who might be able to point it out to us so we can do it. We need teachers, and a doctor is first and foremost a teacher, not a prescriber, not a diagnostician. They’re a teacher. I am so struck with my patients that they might come to me and I’ll say to them, “So, you’ve had x-rays. What did the x-ray revealed to you?” They’ll say, “I’m not sure.” I’ll be confused by that because how did they not get that information?
They’ll say, “I have arthritis,” and I’ll say, “Where?” They won’t know the exact level, and they wouldn’t know the implications of that level. I think that that’s … I think as doctors or as acupuncturists, we don’t always realize how lucky we are with our education, so we don’t actually take the time to bring them up to speed so to speak.
We do that with our medical students but we need to do that with our patients. It is so delightful to see in a person’s face understanding and now, they can deal with this painful issue because they know what it means and they feel reassured and acknowledged, and then we can do something with it to teach people how to manage it and understand it and transform it inside themselves.
Dr. Lisa: Yes.
Dr. Ralph: One of the things they talked about also in acupuncture would be the various herbs that could benefit and the various nutritional components. I’ve wrestled with that because over the years, I’ve read the literature that said some of these formulations are tainted, and so we’ve now have better formulations I hope. I’ve also thought about it from the standpoint of like the local food idea. Should we be doing formulas that come out of China, or should we be doing formulas that came from the American-Indians, and how can we construct for my patient who happens to be living in Maine and might be a lobsterman, how can I help him construct the herbs, the nutrients, the exercise program, the self-awareness that will help him to use the structure that we got from oriental medicine, and the structure we have from our own American medical system to rebuild their life in a way that they’re better able to live with what problems they have and maybe correct them?
I think their system is big. It involved sticking in needles to active these channels. They also involve manipulation or massage to activate the channels. They talk about mindfulness, they talk about exercise programs and the nutrition. I think there are other things that they don’t talk about as clearly, but they would also obviously recommend avoiding things that are destructive to your system. I think all of that is pretty well laid out in oriental medicine, and it becomes a perfect adjunct corollary to American medicine and osteopathy, because osteopathy has that hands-on flavor to being a doctor in this country.
Dr. Lisa: Describe briefly what osteopathy is.
Dr. Ralph: It was created by an MD who was a physician and a surgeon. He just lost his family. His children died, and he felt like he needed to develop a different approach. He studied the structure of the human body and dove into anatomy in a very detailed way.
At a time when bonesetters did exist in Europe, it may influenced him here in the States. He really worked hard to develop a way of using his hands to touch people in a beneficial way. I think the important word rather than manipulation just refers to manos which is the hand, so we use this hands. I like the word ‘Touch’ because I think it carries the layers of my words and my touch you emotionally or thoughtfully or in your body, so when he taught …
He taught how to touch people in a way that could adjust their structure and help them to develop better health. In oriental medicine and in osteopathic medicine, we really understand a little bit about the different points or regions in the body, and how those points or regions can influence our inner organs and how they’re functioning. There are some points in the upper front of your chest that if you mindfully breathe up near your clavicle, it’s very relaxing, but it also helps irate your lungs. Those are lung points in oriental medicine, but they’re also points that we might use to touch or manipulate in osteopathic medicine to help people’s lungs to work better, as well as to release some of the tension that gives us anterior chest pain or a neck pain or headaches.
Osteopathic medicine deals with how our structure and our function works together, and it also recognizes how our mind and our body are interacting, and it also posists the idea that we have a spiritual component, whatever that might be. It brought up the idea that we function in the integrated whole, which I think is significant because I think one of the directions that I’ve had the opportunity by working together with Dr. Craig Schneider at Maine Medical Center in the Integrative Medicine Program the idea that were integrated in many layers, and I think that oriental medicine, osteopathic medicine and integrative medicine are these three well-fitting components that I’ve had the opportunity to study and I continue to try to play with and enjoy and work with.
Dr. Lisa: What you’re describing is something that I believe people are craving. I believe that patients are craving it, I believe that physicians are craving it … I think many people who went into medicine really did go into medicine because they wanted to become teachers, and because the touch was important, and the way that medicine has sort of a pendulum has swung is a way from having the time to do that. In the 15-minute visit, it’s hard to even have enough time to talk to someone. Never mind, help, teach them, help them understand, and then, the physical exam, just the examination without even touching to heal. The examination gets lost as well.
I’m sensing that the pendulum is swinging back and this craving is bringing us back to a place of really practicing us physicians and being I guess involved in our healing as patients in a way that is consistent with what you’ve described.
Dr. Ralph: I think that the patients are driving it. That’s been the last … quite a lengthy period of time, decades I believe where they really have been seeking more and more what … it originally was called ‘Alternative providers’ and then ‘Complimentary providers’, and now, they’re looking for integration of it.
Dr. Lisa: Dr. Thieme, how can people find out about your practice and the work that you’re doing in Falmouth?
Dr. Ralph: I could give you the name of our practice and our telephone number, and they could look it up on the internet even though I’ve not done that, so I have no idea what’s there. I do have patients who come in and say that I’m listed under the wrong address and I have multiple addresses, so I don’t know how the system works.
The name of our practice is ‘Falmouth Osteopathy & Acupuncture’. We’re located in Falmouth, 6 Fundy Road. I am pleased that I have a couple of colleagues that work with me there. One is Dr. Joy Palmer who’s a DO who taught, and Virginia, and graduated from the University of New England, and Dr. Elizabeth Strawbridge who went through the Maine Medical Center. Integrative Medicine Program is their part-time. She also practices in Maine Medical Center’s hospital doing integrative medicine and acupuncture there, so I have some very gifted people that I work with there.
Maybe I should give you our telephone number. It’s 207-781-6560.
Dr. Lisa: We had Dr. Strawbridge on the radio show last year, so listeners may remember Dr. Strawbridge. If not, you can always go to the podcast and learn more about the work that she’s doing. It’s really been a pleasure to catch up with you and to hear what you are doing these days and to hear a little bit more about what got you here. I’m sure the people who are listening enjoyed understanding what makes you the kind of doctor that you are and knowing that there are doctors like you out there who are practicing medicine in a very patient-centered way.
Thank you for coming in and thank you for the work that you do, and thank you for being my teacher.
Dr. Ralph: Thanks for the opportunity to spend this time with you and to see you once again.