Dr. Gelane Gemechisa
When people think of integrative medicine, they often picture supplements, meditation, or food-as-medicine. What they rarely imagine is a doctor with a prescription pad. And yet, some of the most important decisions I make as an integrative medicine physician involve deciding when to lean on conventional medicine—and when to hold back.
This is where the practice becomes more than science. It becomes art.
The False Divide
We’ve been conditioned to believe that “conventional” and “integrative” medicine exist on opposite ends of a spectrum: pharmaceuticals and procedures on one side, herbs and acupuncture on the other. But the reality is far more layered.
Integrative medicine isn’t about rejecting one world for the other—it’s about asking:
- Which approach solves the problem most effectively right now?
- Which approach addresses the deeper causes so the problem doesn’t return?
- And how can we respect the patient’s biology, psychology, and values while doing both?
That three-part calculus is what makes integrative medicine decision-making so nuanced.
Why I Sometimes Reach for the Prescription Pad First
It may surprise some patients that I sometimes begin with conventional tools. I do this when:
- The body is in crisis. You can’t meditate away appendicitis. You can’t yoga-breathe through diabetic ketoacidosis. Stabilization comes first.
- Evidence is undeniable. Insulin for type 1 diabetes. Antihypertensives in malignant hypertension. To ignore this is not integrative—it’s unsafe.
- Suffering is overwhelming. A patient drowning in depression or disabling reflux may need immediate relief. The medication isn’t the whole plan—it’s the bridge that allows deeper work to take root.
But here’s the difference: I never stop there. Prescriptions are scaffolding, not the final structure.
When Advanced Diagnostics Change the Story
Here’s where integrative and functional medicine take a turn that conventional medicine often doesn’t: asking the second and third questions.
Take reflux. A decade of proton pump inhibitors (PPIs) quiets the burn but doesn’t ask why acid is backing up in the first place. When I ran an advanced stool test for a patient, we uncovered a gut microbiome lacking diversity, low pancreatic enzymes, and subtle inflammatory markers. That single diagnostic pivot reshaped her care: probiotics to rebuild the terrain in the gut, targeted digestive enzymes, and curcumin to calm inflammation. Six months later, she no longer needed PPIs—and her digestion, mood, and energy improved in ways no acid blocker alone could achieve.
This isn’t “alternative medicine.” It’s medicine that doesn’t stop at the surface.
When Hormones Demand More Than Numbers
Another patient came to me in the fog of perimenopause—insomnia, brain fog, relentless fatigue. Conventional labs said her hormones were “normal.” But advanced hormone metabolite testing told a deeper story: her body wasn’t breaking down estrogen efficiently. When the body breaks down estrogen, it can go down different biochemical “pathways,” some of which are healthier than others.
In her case, estrogen was being processed down routes that can increase inflammation and oxidative stress, rather than the healthier pathways that help protect cells and tissues.
That insight changed everything. We used carefully titrated hormone therapy, paired with magnesium for sleep, adaptogens for stress resilience, and phytonutrient-rich foods to support detoxification pathways.
Her transformation wasn’t from a pill alone. It was from the combination of interventions guided by diagnostics that most physicians who are not trained in integrative medicine know to order.
What If Overreliance Is the Disease?
Here’s the tension I see daily: our healthcare system is good at managing crises, but it often treats chronic disease as a fire to be controlled, not a garden to be cultivated.
But what if overreliance on symptom suppression is itself fueling the epidemic of chronic illness? What if the real work is not to ask, “Which drug?” but rather, “Why did the body need a drug in the first place?”
Integrative medicine asks those questions. And sometimes the answer is uncomfortable: we prescribe too quickly, we medicate silence into bodies that are crying out for change.
Why This Matters
When I prescribe, I do it with intention: not as an endpoint, but as a doorway. Sometimes the doorway leads to advanced diagnostics that reveal a root imbalance. Sometimes it leads to lifestyle redesign: sleep that actually restores, food that nourishes, relationships that heal.
Conventional medicine excels at crisis. Integrative medicine excels at context. The future of health is not either/or—it’s discerning when to prescribe, when to pause, and when to listen to what the body is trying to teach us.
That is the art I and other integrative medicine doctors practice.