Doctor's Orders, Featured
Leave a comment

Physician Wellness and Integrative Medicine: An Interview with Stephanie Marango, MD, RYT

Photograph by Betty Adler

Stephanie Marango, MD, RYT is a physician-educator, yoga teacher trainer and author of The Wisdom of Your Body. In this interview, she tells us what led her down the path into integrative medicine.

Sasha Yakhkind: Dr. Marango, thank you for speaking with in-Training. Could you please tell me about what you do and how you got to where you are now?

Stephanie Marango, MD: I chose the medical pathway following a large car collision on Highway 101 in California that helped me realize that I wanted to enable people’s physical, mental and spiritual well-being.

I subsequently entered medical school with an integrative and non-traditional background. I was older, had worked at start-ups, was a yoga teacher and had always been interested in healthy lifestyle through nutrition, exercise and low stress. I knew I wanted to bring innovation and integration into the medical world, and so I started on that path in medical school. During my first year at the Mount Sinai School of Medicine, I joined forces with a fellow student who was a Pilates instructor. At the time, we wondered why we were learning about the human body as separate from ourselves, through dissection, reference manuals, atlases, but never in regards to our own form.

She, like me, was interested in medical student wellness and saw the opportunity to create a program. So, we developed an integrated yoga-Pilates-anatomy class as a review for our final exams and we offered it as a gift to our classmates. We had over 60 students attend — along with some professors and deans — and everyone loved it. Long story short, over the next decade, it went from a gift to our students to a formal part of the anatomy curriculum, called Living AnatoMe, which has subsequently been taught as an anatomy adjunct at other schools as well.

Living AnatoMe was one of several wellness ventures I created or engaged in. Moving forward in time, I did a psychiatry internship — as psychiatry seemed to be a field that was ripe for integration — and then transitioned to a private practice wherein I saw patients part time and worked with education the rest of the time. Between patients, talks, workshops, apps, books and the like, I currently have a very textured career, which is what I always wanted.

SY: That’s amazing, it’s great to hear that you can shape your career in whatever way you want and don’t have to fit a particular mold.

SM: It is amazing, and I’m grateful every day. That said, while rewarding, it has not been an easy path and much of it I have forged on my own. And, while it’s easier now than it was a decade ago, it’s still not a well-supported path, which is one of the reasons I feel very strongly about connecting with medical students who are interested in integrative medicine or an otherwise non-traditional route. I’ve mentored many students, I’ve hosted holistic electives for students and I talk to many students on the phone because I recognize that the non-traditional path isn’t supported, but the interest and the need are there.

For instance: When we started teaching living anatome a decade ago, we asked the students to raise their hands if they’d ever taken a yoga class and literally no hands went up. Now I ask that question in the same class and three-quarters of the students raise their hands. The desire is there. Students and physicians are people, too; they’re not immune from the larger cultural healthy lifestyle movement, or the desire to be healthy, themselves.

The patient population increasingly wants physicians who appreciate health outside of just disease. It took me several years to realize that western medicine excels in disease management, but not health optimization. Health involves its own set of questions, like: What is health? What resources are necessary to achieve it? What does it mean for you and how can you optimize your own well-being? In contrast, the medical world asks: What is a disease and how can we detect and cure it? Both sides of the equation are required for a healthy human being.

SY: Do you have an example of how you guide a person through what’s going on in their lives?

SM: Let’s say Fred comes in with lower back pain. Before Fred arrives, I have him complete a five-page intake form that reviews everything like past medical history and family history, but also lifestyle factors from stressors to nutrition to sleep and exercise. The first visit I spend an hour and a half with Fred and we discuss everything that’s going on in his life in addition to the back pain. Many times there’s a sense of a lack of support that accompanies low back pain — like the feeling that the patient is missing a backbone so-to-speak, or that no one’s ‘got his back.’ I then spend the next six months working with him — Fred — on a regular basis using primarily the body and its movements, some supplementation and nutrition, breath, discussion and very basic energy forms like visualization and meditation.

What we end up doing together is not only ameliorating the physical ailment, but also establishing a new perspective of what the ailment means to the patient. For example, what thoughts, emotions and behaviors has Fred patterned that doesn’t serve his purpose anymore? That prevent him from receiving the support he requires? What new, healthy patterns can help Fred move from where he is now to where he needs to be, in order to function healthily and happily? My work is collaborative, with a tremendous amount of responsibility asked of the patient. It’s a custom-tailored approach with a fair amount of time spent on pattern change.

Speaking of pattern change, I have tremendous patient compliance rates because I don’t say something like “eat more vegetables,” and leave it at that. Instead, we talk about the “what,” the “how,” and the “why,” and we work through how each change is going to fit into each patient’s day. We create a plan that starts at an exceptionally doable level.

I love educating in this context because I believe that power and responsibility are already in the hands of the individuals I see — they just need help remembering it. At the end of the day, I’m not doing anything to anyone; I honestly see myself as more of a guide. I’m just helping them elicit the health and healing abilities within themselves.

SY: Are the services that you offer covered by insurance or is it all self-pay?

SM: Unfortunately, it’s all self-pay. My work is too holistic to be able to accept insurance. So I sliding-scale my services and I’ve never turned anyone away for lack of money. Little by little, however, the insurance industry is changing based on the demand for more integrative doctors like myself.

SY: What one message do you have for medical students?

SM: No matter how difficult it seems now, start putting some time aside to take care of your wellness, because it’s only going to get harder to do so. There’s a scary, future-oriented health game that’s being played in the medical world among its own professionals: in medical school the thought is, “Oh, well I don’t have to take care of myself now, I’ll do it fourth year.” Fourth year happens and the thought is, “I don’t have time now, I’ll do it in residency,” and so on and so forth until you wake up one day and you’re 45 or 50, and maybe your body’s aching or you’re overweight or depressed.

There are some really appalling stats on Medscape about the poor health of health professionals, such as the overwhelming percentage of surgeons that are overweight, as well as suicide and addiction rates within the industry. Several talks I have given emphasize the importance of caretakers taking care of themselves.

Just remember that pattern change doesn’t happen overnight. There’s no race and no deadline, so small-and-steady is a highly effective way to succeed. Even if it’s one hour a week, if you let that one hour a week snowball positively, the results will speak for themselves. So put some time and focus aside for self-care now, because it’s only going to become more challenging over time. It’s important to practice what you preach because studies show that taking care of yourself helps you take care of your patients better. And, while it’s not going to be easy, it will be worth it.

Photograph by Betty Adler

Photograph by Betty Adler

Dr. Stephanie Marango, MD, RYT is a New York based physician-educator, author and yoga teacher trainer. She is the founder of The Sacred Body Institute (which offers holistic medicine and education), has written The Wisdom of Your Body and is the co-founder of Living AnatoMe and the Functional Anatomy for Movement & Injuries (FAMI) Workshop and iPad app series, which merge the movement and medicine worlds. For further information, please visit her website.

Sasha Yakhkind Sasha Yakhkind (16 Posts)

Editor Emeritus: Former Medical Student Editor (2013-2015)

Morsani College of Medicine at the University of South Florida

Sasha is thrilled for the opportunity to combine her interests in writing and medicine. She has been writing since she got her first journal in second grade, and editing since she ran her high school newspaper. Her interest in medicine evolved through travel, studying the brain through the lens of social science as undergraduate at Boston University, and together with her interest in yoga and dance. Sasha gets inspired on long runs and looks forward to few things more than hiking with her mom.