Peril and Promise: Emerging Models of Comprehensive Healthcare by Jane Lister Reis I asked five different health practitioners to talk about their individual practices, share their thoughts about the future of integrative medicine, and respond to what they think are the challenges that we face as different health and healing traditions begin to relate to each other. Several of the practitioners will be speaking at the Health Expo and/or The International Conference on Integrative Medicine, which happen simultaneously on April 30-May 2 at the Washington State Convention Center in Seattle. For more information about this event, check their Web site at <integrativemed.com> or call (206) 622-2812. Pamela Snider, N.D. is a licensed naturopathic physician and the current associate dean of the Naturopathic Medicine Program at Bastyr University, where she teaches naturopathic clinical theory. She will be part of a panel discussing Beyond Data: Integration Models, Standards and Accountability at the Conference. At a young age, I was searching for a field that held the human spirit in its work. I started out as a religion major, moved to psychology, became a science major, and finally got closer to what I was looking for when I was involved in the Eugene Birth Cooperative. It was here that I really became aware that patient care included a blend of science, spirit, and the practical things of everyday life. It was during this time that I became ill and went to a naturopathic clinic in Portland, where I was seen by two students and their supervising doctor. The experience changed my life. I walked around feeling like I had a light bulb over my head, saying, "I've found it." I was literally stunned by the difference in how receiving naturopathic care felt and how much more effective it was for me for my healthcare concerns. My life changed from that moment. I decided within five minutes what I was going to do with my life: I was going to become a naturopathic physician. The model that I see for the integration of different health disciplines or systems and modalities is from the patient's perspective, which I think is most important. We are all really patients; we are all consumers. I see a system of comprehensive healthcare that brings the best of all fields, in the most successful and accountable way possible, to patients. This information includes emerging bodies of knowledge, practices that might be very common in other countries but less common here. Patients need a system that will give them the safest, most comprehensive access to solutions as well as help them solve problems and increase their quality of life, not just their life span but also their health span. Our challenge in the healthcare field is that we have an enormous system transformation ahead of us. Thankfully, I think we are at a leverage point for changing the system. Cooperation and a team-care approach between conventional and well trained complementary and alternative medicine caregivers is what the public wants and needs for the best result. Most people, I believe, agree that comprehensive healthcare is a good model for our future, but details of this model will vary as doctors and other players in the system listen and respond to their patients' statements about the kind of healthcare they want. Our greatest challenge and responsibility as professionals is to be innovative without loss of standards. The complementary and alternative medicine disciplines have developed many important standards, which are integrating into mainstream healthcare. These standards will help patients have the best access to what works while new approaches are being developed. Ralph Golan, M.D. has been a general practitioner in Seattle since 1979, specializing in preventive and wellness medicine. He is the author of Optimal Wellness: Where Mainstream and Alternative Medicine Meet, a comprehensive health resource and self-care guidebook. Dr. Golan will be speaking on "Optimal Wellness: Tap into Your Body's Natural Ability to Heal Itself" at both the Conference and the Expo. In medical school, I never knew how I was going to be happy being a doctor. I never learned anything there about what makes — or keeps — people healthy. I was trained to be a disease detector and treater with the limited tools of drugs and surgery. I learned nothing about nutrition other than the usual rules such as if a patient has high blood pressure take away their salt and if they have anemia give them iron. We learned nothing about nutritional supplementation, food sensitivity, individualized diets, acquired amino acid imbalances, or any clinical nutrition. We learned nothing about acupuncture, herbs, or how feeling in touch with oneself or feeling loved plays an integral part in one's health process. Doctors are not trained enough to look beyond conventional causes of high blood pressure, arthritis, depression, and other chronic conditions. Rather, they are trained to feel they are doing their job quite competently by suppressing symptoms with medications, many of them potentially toxic. Doctors are not motivated enough to get people off medications, nor are they trained enough to find alternatives to medications. In today's managed-care and corporate-driven medicine, the quicker the visit and the fewer tests ordered, the better things run. Unfortunately, the quicker visits usually mean more prescriptions and less pursuit of deeper levels of health. This is why many people today feel that our healthcare industry is basically a pathology management industry. The ideal model I see for 21st-century medicine would be where doctors of any specialty, but especially primary care physicians, will come out of their training with the definition and recognition that health means far more than the lack of disease. Rather, health relates to the conscious pursuit of the highest level of physical, emotional, structural, and spiritual well-being. Doctors should be trained how to intervene on all these levels, either directly or through a multidisciplinary team, so that the least toxic and most effective care can be given. This type of integrative care would necessitate that doctors find out from their patients not only what disease they have, but who the person is who has the disease. Integrated care also includes education. In an ideal model, all patients would be able to attend self-care classes to learn how to maintain and preserve their health. There would be classes in nutrition, herbal self-care, exercise, and how to manage stress in one's life. The Greek meaning of "physician" is "teacher." Doctors need to be not only diagnosticians and treaters of disease, but also teachers of health. Billions of dollars could be saved if some of the money spent on disease care today went toward health education. Prevention is the key to so many chronic diseases, and it will be because of consumer demand that doctors will become more health- and prevention-oriented and learn more about complementary medicine. Laura Lewis Frank, R.D., Ph.D. is on the faculty at Bastyr University, where she teaches undergraduate, graduate, and medical school nutrition courses. She is also a nutritional counselor and registered dietitian at Bastyr's Natural Health Clinic. Nutrition is a key component to health and wellness, whether you're looking at it through allopathic or alternative eyes, and it needs to be part of a new model of complementary care. I believe there are three basics components of health: nutrition, exercise, and stress management. These issues can be best addressed through triage or complementary care. It is a viable model for the future of medicine, a future that is becoming more patient-driven. Times are changing as patients become much more aware through media education and new products offered. Patients are becoming much more curious and demanding to know what is available to help them feel better. They are no longer willing to sit in a doctor's office for five minutes and be told to take a drug and go home. They want to know what they can do for their health care. I think we can face the challenge of integration if everyone, and I mean practitioners here, can learn to set their egos aside and respect each other's expertise. I feel frustrated sometimes, because coming from a dietetic direction, I have had the experience, both from allopathic and naturopathic physicians, that they are oftentimes ignorant about nutritional counseling. All of us who work as professionals in the healthcare field need to work together. We need to ask what is best for the patient, not what's best for our egos. That's why I embrace the term "integration," because I see it as our ideal: each person seeking other opinions about their patients' care and then picking and choosing the best treatment for their patients. Carl Dahlgren, L.Ac. is a Classical Five Element practitioner who studied with Dr. J. R. Worsley in England from 1989-1991. He is a current board member of the Acupuncture Association of Washington. From 1992-1997 he was the acupuncturist at Bailey-Boushay House, a facility for people with AIDS. He has taught courses in the Five Elements at both Bastyr University and Northwest Institute of Oriental Medicine. He maintains a private practice in Seattle, and can be reached at (206) 322-1013. I believe we need time and more understanding about what acupuncture can do. This is not a process that can be rushed. Doctors need to see and learn on their own the benefits of acupuncture. This process is already happening. Many doctors are having patients who have had acupuncture say to them, "Oh, by the way, I went to an acupuncturist and this is what is happening to me." When we consider integrating Eastern and Western medicine, I think we need also to bear in mind the Eastern virtues of patience, nourishment, and self-restraint. I know there's a push to get integrated, but I am not actually in favor of it. I think we have to be careful not to "Westernize" Eastern medicine. If we do, we will lose its mystery. Anything we push, if it doesn't grow on its own or naturally, will be artificial. I believe this conference [The International Conference on Integrative Medicine] could be part of the organic process of change in medicine. I think people get excited about some kind of integration, yet we have to be careful because the only model we know is what Western medicine has put together, for instance, bringing a physical therapist and a chiropractor into the same office. We have the idea that if we bring together these different practitioners we'll all be happy. Maybe that will work for some. I, however, trust the process of how people discover things on their own. I guess I try to take the long-term view of things. As a student and practitioner of Classical Five Element [fire, water, earth, metal, wood], the oldest form of acupuncture, I have learned to trust its focus on the spiritual process involved in healing. I am encouraged that people are beginning to regard healing and wellness as a spiritual model. I don't think this was the case twenty to thirty years ago. This is a new phenomenon. Helen Vandeman, M.Ed. is a consultant to the medical field on the integration of mind and spirit into medicine, and is currently teaching Spirituality in Medicine at the University of Washington School of Medicine to first- and second-year medical students, nursing, social work students, and psychiatry residents. Ms. Vandeman has also been a presenter or facilitator at many regional and international conferences on issues related to spirituality, cross-cultural issues and medicine, and consciousness, intuition, and healing. I was a psychotherapist for 25 years, with a specialty in hospice bereavement and death and dying. I addressed issues of mind, body, spirit, and the person's spiritual and religious beliefs in the context of psychotherapy. After 25 years, I felt I needed to move on, but I had no idea where I would go next. I left the country and wandered for about five years, gathering pieces of information. When I got back to the Pacific Northwest, I found that what I had been gathering was multi-faith and multicultural understanding. I realized that we live in a multi-faith, multicultural community and that Western medicine is the only medicine that believes in the germ theory. Other cultures and religious traditions are much more holistic in their understanding of illness and health. They incorporate spirituality and meaning in the illness and in the health of all people. It was during this time that I developed a course called Integration of Mind and Spirit into Medicine. With all the changes in medicine, I noticed many physicians, nurses, and staff members were suffering. People were quitting medicine and setting up taco franchises, anything to get out of what they are doing, because they were no longer feeling satisfied with what they were doing or how they were serving patients. I found few people interested in addressing the needs of health practitioners. Some medical schools were teaching spirituality and medicine (back then it was only a handful and now it is over forty medical schools), but most of them addressed patients' need to harness their own spirituality to help them heal. What I teach is the reverse: physicians, nurses, and psychiatrists need to understand how their patients are interpreting what is happening to them in the context of their culture and within the meaning that they attribute to their lives and their experience. Regarding our challenge as a healthcare community, I believe the natural medicine community can be just as judgmental of the allopathic community as the allopathic community is of the natural community. We need to let go of our judgments in order to create relationships, dialogue, and collaboration. Our challenge is to recognize that we don't need to learn more but that we need to be open to learning from other people who do know more or do know something different and be willing to talk to them. I think this is happening.