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Bringing Hippocrates to the 21st century

Dr Vicki Kotsirilos AM describes how her work on integrated medicine helped her patients, her fellow doctors and herself gain insight on ancient wisdom − and resulted in her getting on the Queen's Birthday 2016 Honours List

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Dr Vicki Kotsirilos with her parents, Irene and Bill, at Government House, Victoria, on 21 October, when she was presented the Australian Medal.

08 November 2016

"Hello, Dr Vicki speaking". The greeting is warm and cheerful, delivered with an almost singing voice, but it seems a little too casual, taking into account the accomplishments of the person speaking. On the other hand, no one answers their phone by stating their AM status, even if it is only recently acquired and they're justifiably proud of it.

Associate Professor (Dr) Vicki Kotsirilos AM certainly is. "Winning this award makes me feel honoured and proud for my long service to many organisations and to the community groups", she says.

"It makes me feel grateful to the people I work with, to the people who supported the nomination and to the community groups I have worked with over the years, for believing in me and working alongside of me to work towards good causes and changes within Australia." The extent of work in question cannot be possibly overstated.

On Friday 21 October 2016, at a ceremony hosted by the Governor of Victoria, Linda Dessau AM, Dr. Vicki received the Australian Medal "for significant service to Integrative Medicine, to Health Practitioner Standards and Regulation, to Medical Education, and to the Environment."

She is the president of the Sandringham Foreshore Association, which she founded in 2007 and which focuses on protecting the Bayside foreshore environment, combating coastal erosion and protecting an urban fossil site in Beaumaris, but her community service goes much further than her active engagement in environmental issues. A dedicated medical educator, she holds two associate professor clinical positions (teaching doctors and health professionals about nutrition) at two universities (one at the Department of Epidemiology and Preventive Medicine, at Monash University's School of Public Health and another at the Department of Rehabilitation, Nutrition and Sport Medicine, at La Trobe University), and is about to get a third one at a university in Sydney.

Dr Vicki also plays an active role in educating GPs through the Royal Australian College of General Practitioners working groups and her regular columns in Medical Observer, a magazine that goes out to every GP in Australia.

The third reason she made the 2016 Queen's Birthday Honours list is her government work regarding health practitioner standards and regulations. As the former general medical practitioner representative on the Federal Department of Health's Australian Adverse Drug Reaction Advisory Committee, and also on the Advisory Committee on Complementary Medicines ("I would fly every three-six weeks, up and down from Melbourne to Canberra, for eight years," she says), but also works for other regulatory bodies, such as the Australian Health Practitioner Regulation Agency as a Performance Assessor and Auditor, something she describes as basically "going out to the GPs and helping them to work in a positive way for their patients", and for the Professional Services Review as a panel committee member.

CHOOSING WHAT'S BEST FOR THE PATIENT
And if all these - alongside her work as a busy GP in Melbourne - were not enough, there is her real claim to fame: her pioneering work in integrative medicine, the healthcare philosophy that focuses on individual patient care, combining conventional western medicine with evidence-based complementary medicine and therapies within current mainstream medical practice. Many medical professionals have made the Queen's Birthday Honour's list, but it is the first time that an award is given in relation to integrative medicine, a field that still is surrounded with controversy. Not that Dr Vicki has experienced the brunt of this.

"I've mostly received praise, as I have always focused on the scientific evidence and any risks associated with these treatments," she laughs off the implication.

"I have been blessed, the medical profession has praised me extremely highly. We know that about 70 per cent of patients use natural medicines, but what is not well known by the community, and also by doctors, is what scientific evidence there is about it. There actually have been randomised control trials and systematic reviews for some complementary therapies, often they've been international so they may have not been published in Australian journals. My role has been to help identify these studies and help educate the medical profession what has science and what doesn’t, and which therapies are safe, and which are harmful."

For the past twenty years, Dr Vicki has been reading the journals every day, keeping the medical profession up to date through lectures, publications, newsletters and articles.

"I have a healthy respect for patients who choose to use some form of natural medicine and I have been very active within the Royal Australian College of GPs, in helping to educate doctors on the scientific evidence and lack of, and risks associated with these treatments, so that, when doctors are confronted with a patient who takes supplements or is looking to try a non-drug approach, they can guide their patients and inform them well," she explains, describing her work.

"What we try to teach GPs and doctors, is that we don't have to abandon western medicine. It's not one or the other. It's choosing what's best for the patient. In other words, I might see a patient with high blood pressure. We know that medication is useful for lowering blood pressure, but we also know that lifestyle, diet, exercise, correcting sleep and reducing stress can also help. There's good research, for example, that garlic can lower blood pressure. What we're doing is we don't say 'stop using medication'. We integrate these therapies and treatments for patients into the consultation and that's why it's called integrative medicine."

LEARNING FROM HIPPOCRATES
Her personal interest in this area started very early, when she was no older than 12. "I grew up in St Albans, in the Western suburbs," she remembers.

"I loved school; I loved science subjects, geography, biology, chemistry, math, all those. I used to walk and look at the clouds, the trees, the environment and I used to wonder, even as a young child, how the environment impacts us as human beings and how us humans impact the environment."

It was a trip to Greece that revived this juvenile quest of hers.

"When I was in my first 'hospital year', working as an intern doctor, it was very stressful; I was doing long hours (those days we used to work 36 hour shifts, something that is not allowed anymore), I lacked sleep, I was eating poorly, I was not happy. So the following year I decided to take the year off and travel overseas, to Europe. I spent a lot of time in Greece, staying with relatives, and it was very healing for me. It enriched me as a person. I felt very nurtured, protected and safe and I was able to recover from that very stressful year. When I got back to Melbourne I decided to go back to the hospital and what I found was that the stress came back, with all those long hours. I could feel my health deteriorating again, not eating the right food, putting more weight, being moody, even smoking in those days. Fortunately, I got involved with yoga and meditation, which helped me deal and cope with my studying and exams, and started reading a lot of self-care books about eating the right foods, I gave up smoking, I started eating better, and all of a sudden, I felt better, happier. My skin cleared up, I was energetic, I coped with the stress better in the hospital, I enjoyed work and I completed a total of five years of working in a hospital. The way I coped with stress was through yoga and meditation and healthy nutrition. That personal experience gave me the foundation for learning about the impact of lifestyle and nutrition on health and from there I think I became a better doctor. I learned it for myself, what was good, so therefore I was able to show with more conviction, when I tell my patients why it is important to change their lifestyle, diet, exercise, stress management. That's how it all started. Of course, my interest in science has helped me remain scientifically focused and evidence based; I read a lot, I learned a lot about nutritional medicine, I also started learning about Hippocrates and how he worked. I had a passion to learn more about the history of herbs also, which is part of our food and our tradition as healers. A lot of the modern-day herbs that have scientific evidence date back to the days of Hippocrates. For example he used a herb called Vitex agnus castus (Chasteberry) for menstrual problems and today there are randomised control trials to show it does help PMS. He was one of the first people to understand how nutrition is important and how it impacts health; he said 'let food be thy medicine'; that was more than 2000 years ago, he was way ahead of the times and now research supports all this and it's wonderful that I've played a role in helping to convey in a very scientific, intellectual way to the doctors about not to dismiss these therapies, but to appreciate that they've been around for a very long time and that there is some scientific evidence. The doctors may not embrace the therapies but at least I have the opportunity to relay the evidence. A few years ago, I was a keynote speaker at a Greek-Australian medico-legal conference on Kos, the birthplace of Hippocrates. So I went to the Hippocrates museum, pulled out relevant books that demonstrated what herbs he used that we now have scientific evidence about, and presented the evidence to the doctors and lawyers in the audience. It is important for us to respect tradition and history, to read about it, to understand it and when it has best evidence and safe to do so, to then start integrating it into our practice without abandoning what we've learned as medical students and as young doctors."

'MY HEART LIES WITH GREECE'
By bringing Hippocrates to the modern times, Dr Vicki undertook an enormous task, bridging two sides which have long been suspicious and weary of each other. One can't help but wonder which side has been more prejudiced: patients who don't trust pharmaceuticals or doctors?

"I always tried to take the middle ground", she says.

"I'm always certain that there is scepticism with the audience I am talking to. That scepticism is healthy, it helps them identify what does and does not have scientific evidence. But I respect the medical profession and the Royal Australian College of GPs, my peer body; at the end of the day, they are good doctors, they all want the best for their patients. As for the patients who don't want to go on drugs, this is another issue I am addressing in my lectures, the doctor-patient relationship. When the patients trust us, it is important to maintain a respectful dialogue, to get them to understand and help them become better informed, so that they can make the right decision".

What has been the greatest challenge she has had to face, during this long, arduous journey?

"The most important was to stay calm, centred and not be swayed by emotional responses and comments by the medical profession. Whenever I give lectures it is often extremely well received because I focus on the evidence, keeping the language clear and scientific. I had very good mentors and of course, the support of my husband and parents, who are very passionate people, and their conviction and perseverance to support me in my vision has been paramount."

Bill and Irene Kotsirilos got to escort their daughter to the Governor's House for the prestigious ceremony, obviously proud of her achievements that reflect their own journey.

"My dad comes from Agios Vasilios, a little village outside of Tripolis; my mum comes from Ano Fanari, at the southside coastal side of the Peloponnese; they both come from a poor background, theirs is the typical migrant story coming here with very little and making a life for themselves. They grow their own veggies, as many Greeks do, they have many theories about many things, my mother uses garlic to lower her blood pressure successfully."

Dr Vicki is very proud herself of her Greek background.

"My heart does lie with Greece from a young age; I've only been there four times in my life, but I feel a deep sense of connection with the land and its people. It's not just about holidays; whenever I'm there, I feel at home". She plans to actually make it her home.

"My husband and I are very lucky to have inherited a house in Kastoria, where he comes from and we intend to go live there for a bit, after a year's time. We're just waiting for our children to grow up till we can start to leave them alone. I've got a daughter who's still at high school and a son who's at university".

Having said that, she admits that she might have a harder time, leaving behind her patients.

"The bulk of my work has to do with my patients. That's what I do, I'm a GP. I'm very passionate and I feel very grateful to my patients, who are very loyal to me. Some I've known from their young age and I've seen them grow. It's been an honour.”

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