Being in Northern California, I think I'm in one of the most receptive places towards integrative medicine. I am not an expert, but my understanding of integrative medicine is that it emphasizes treating the whole person using a wide range of techniques, from Western medicine to complementary and alternative approaches. The approach attends to a patient's biologic, social, psychological, and spiritual sides, and seeks to maintain the patient's wellness in all these areas. An integrative healer may utilize evidence based medicine, acupuncture, meditation, counseling, massage therapy, supplements, etc. Like anything, integrative medicine has its proponents and critics, but after listening to a number of medical students and physicians talk about it, I wanted to write a post about it.
I think integrative medicine will become important and catch on in the future. One aspect is the patient side - this is what patients want. They want to be seen and treated as whole people. They (at least in California) want to talk about hypnotherapy and traditional Chinese medicine and Ayurveda. They expect their doctors to know about these alternative schools of thought. In addition, I think in the next few decades, more data will come out on what works outside of mainstay Western medicine. We will gain more tools for combating chronic disease. We will have more ways of maintaining health. We ought to use all the modalities that work, even if it doesn't come from a pharmaceutical company or cost an exorbitant amount. Especially with diseases like fibromyalgia, chronic fatigue syndrome, and mood disorders, we need everything we can get.
It makes me a little uncomfortable, like I imagine it makes most physicians. But, deep down, it also makes me excited. Who is to say that the scientific method, the multi-million dollar clinical trials, and the ridiculous lobbying power of the pharmaceutical industry is any better or less biased than centuries of wisdom passed through traditional Chinese medicine? How can we be so closed-minded as to dismiss everything else as "snake oil" simply because it's not what we learned in school? Of course, we all know these patients aren't the easiest to deal with. But these issues aren't going away. We should embrace anything that makes our patients healthier, better.
Ultimately, I remind myself of one immutable principle: no matter all the hype or excitement around integrative medicine, we must do no harm. If a patient wants neck manipulation for his cervical spine stenosis or mega-doses of St. John's wort while being on antiretrovirals, I will say no. If he believes cognitive-behavioral therapy will trump surgery and antibiotics in appendicitis, I will say I disagree. There are complementary and alternative treatments that harm patients, and all physicians have seen this. But aside from that, it is time to open our minds to other ideas that could potentially benefit our patients with little harm.
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3 comments:
I was just talking about this yesterday--how more doctors (esp. in anesthesiology/pain medicine) are taking a holistic approach. But the problem I thought of is that while insurance companies will cover the (sometimes dangerous) pain meds, they often won't cover the safer holistic treatments like acupuncture. So it's easy for patients to choose just taking meds. Maybe if more MDs were trained in holistic treatments, that would alleviate the problem?
Great post. Thanks a lot for keeping your blog going. Very interesting and helpful as a student to scroll through and read/learn.
Great comment - sorry it took me a few days to get back to you. I agree with you completely, but I think things may change dramatically in the coming years. Last month, the CDC put out a guideline for management of chronic pain for primary care physicians (note it's not for pain specialists) that strongly discourages opiates for chronic pain (outside of cancer, palliative care, and end-of-life management). While I am not sure I completely agree with this, there is no doubt it will have a huge impact on chronic pain management, especially given that we don't have enough pain specialists. As we start trying to wean the nation off opiates, we will need to develop better holistic pain management. Not only will we need better non-opiate medications, but we will also need to turn to "complementary and alternative medication." This will have to start with the next generation of medical students, residents, and young physicians. I think you hit the nail on the head that we need more people trained in holistic treatments. It will take time, but it will alleviate the problem.
As for insurance, I don't have as much knowledge about that, but I hope that as the needs of chronic pain (and other) patients become apparent, and as we have better studies and research on the effectiveness of alternative modalities, especially if they have low risk or downside and are relatively cheap, then hopefully insurers will follow suit and cover these therapies.
Thanks for your comment!
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