1996 Annual Report
Laurel Trujillo, M.D.
"It's more important to know what kind of patient has the disease than what kind of disease the patient has."
That comment by 19th Century physician Sir William Osler, the "father of internal medicine," embodies the essence of Laurel Trujillo's approach to health care: "I've never had a mind walk into my exam room--patients bring their whole bodies, and vice versa," says the Los Altos Center internist. "The more we understand about both mind and body, the more we realize how interconnected they are."
Dr. Trujillo has put her beliefs into action: She helped create and oversees the Personal Health Improvement Program (PHIP) at PAMF's Fremont Center and Palo Alto Clinic. The six-week course is designed primarily to help people who have symptoms for which their doctors cannot find a physical cause.
The course helps people look at how they live--and learn to observe and manage their thoughts, moods and body sensations. More than 120 persons have gone through the course since its inception in January, 1996.
Dr. Trujillo didn't plan to be a doctor. She majored in biology and chemistry as an undergraduate at the University of the Pacific in Stockton,California, then worked as a sales representative for a medical-testing laboratory and in a hospital emergency room. She decided to get a masters degree because of her interest in people's relationships, diet and exercise habits--all involving mind and body.
She received her master's from John F. Kennedy University in Orinda, and soon realized her health-education degree would limit her to working with well populations rather than caring for people who really needed help because of illness.
So she enrolled in medical school at the University of California, San Francisco, later doing her residency at the University of California, Los Angeles. "My whole reason for becoming a doctor came out of my early mind-body interest," Dr. Trujillo says.
She was born in upstate New York, and her family moved to Stockton when she and her two sisters and brother were young. She and her husband, Dennis MacBain, a helicopter pilot, now reside in San Jose with their two sons, Ross, 7, and Cameron, 2. In her spare time, she enjoys cooking, reading mysteries--"You can pick them up and put them down easily"--and working out in a health club.
While still in medical school, she heard of a special mind-body program at the Harvard Community Health Plan and went there to learn about it the PHIP.
Later, while exploring the physician-job market in California, she found kindred souls in PAMF psychiatrist Bruce Bienenstock and internist David Hooper, Director of Satellite Operations, who were just beginning to explore PHIP-type programs. She joined the Los Altos Center and soon began implementing the PHIP.
"As a population, we don't have good training in listening to our bodies," Dr. Trujillo says. "But listening to ourselves' is some thing people can learn, whether that involves thought processes or bodily sensations."
Medicine's past reliance on the extremely powerful "biomedical model" has "helped us create new medications and treat ailments in ways that were unimaginable a hundred years ago. On the other hand, there's been too much of atendency to view other aspects of the person, besides their physical biology, as secondary or even unimportant."
That perspective is changing, and fast, Dr. Trujillo emphasizes. Partly due to managed care, health care providers now have a high interest in keeping people well in "managing health" in the broadest sense.
"When people who are suffering come into my office, they come in because their suffering is limiting their lives in some way. It's really frustrating for them to go to doctor after doctor and be told, `Everything is fine,' or `We don't know what's causing your symptoms.' That inability to find the real cause of a person's distress is what's driving up utilization (medical visits) in many respects. My interest is in how we can truly `heal people,'improve patient satisfaction and provide more cost-effective care.
"Much of what's fun about my job is educating patients to be their ownprimary health care providers that's really what they are: people with symptoms who decide what to do next."
How people view themselves is an essential element of health and how theycope with illness, she says. A recent seven-year study showed that patients who thought their health was poor despite their doctors' good prognoses had a higher risk of dying than patients who thought their health was good despite their doctors' opinions otherwise. The latter actually outlived their doctors'expectations.
"That's very intriguing to me. If we're interested in promoting health,then part of what we should be trying to impact is `perceived health.' And I don't know of anybody who knows how to do that yet. I think the most effective system of medicine as we head into the 21st Century will be one that answers those kinds of questions." Dr. Osler would agree.