- Email: [email protected]
The Integrative Medical Practitioner
The Integrative Medical Practitioner Lee Lipsenthal, MD, ABHM
T
he practice of Integrative and Holistic Medicine (IHM) differs in many ways from the practice of allopathic medicine (AM). Some differences are obvious, for example, the use of modalities of treatment not found in allopathic medical practice or training. This might include but is not limited to such therapies as homeopathic remedies, botanical medicines, or acupuncture. To some, learning to use these “alternative” modalities in an allopathic practice is justification to call oneself an integrative medicine practitioner. The role of an IHM practitioner has already been well defined. For the purposes of this commentary, I will use the definitions of two of the leading organizations in the field, The University of Arizona Program of Integrative Medicine (PIM), one of the leading educational programs in this arena, and the The American Board of Holistic Medicine (ABHM), the national certifying body for Holistic Practitioners. Their definitions of IHM are as follows: Integrative Medicine is defined as healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative. (PIM) Holistic Medicine is the art and science of healing that addresses care of the whole person– body, mind, and spirit. The practice of holistic medicine integrates conventional and complementary therapies to promote optimal health and to prevent and treat disease by addressing contributing factors. (ABHM) These definitions lay the groundwork for the role of the IHM practitioner. On reviewing the above definitions it becomes apparent that IHM is not about what you “do to the patient” but is about how you approach the patient and work in partnership to enhance the individual’s health. In essence, a system-based approach in which you and the patient are active participants in the system. This gives both the practitioner and the patient greater responsibility in relationship. Ideally, AM also uses “relationship-centered care,” but there are further differences. To review these differences, let’s look
President, American Board of Holistic Medicine (http://holisticboard.org). Address reprint requests to Lee Lipsenthal, MD, ABHM, 106 Spring Grove Ave, San Anselmo, CA 94960. E-mail: [email protected]
1543-1150/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.sigm.2005.01.001
at the principles of IHM practice as used by the The University of Arizona PIM and the ABHM.
Optimal Health Optimal health is the primary goal of holistic medical practice. It is the conscious pursuit of the highest level of functioning and balance of the physical, environmental, mental, emotional, social and spiritual aspects of human experience, resulting in a dynamic state of being fully alive. This creates a condition of well-being regardless of the presence or absence of disease. (ABHM) Integrative medicine involves the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease. (PIM) Optimal health is clearly a goal of IHM practice. The key point is that prevention is a primary goal of the medical interaction. Allopathic medicine is, in many ways, a disease treatment model. This has grown due to the therapeutic goal of finding a “magic bullet,” a treatment that be given to “fix” the disease as well as the limited time constraints of most practitioners. It becomes expedient to find a problem for which one can write a prescription rather than spend more time discussing lifestyle or behavioral change. This approach is supported by the pharmaceutical and medical equipment manufacturers, as well as the insurance industry, which pays for prescriptions and procedures, thus making this behavior profitable. Lastly, it has become an expectation of many patients who feel that a visit to the doctor isn’t complete without a prescription or intervention. The optimal health model means a greater commitment of time and energy to evaluate, teach, and enlighten the patient. It also gives the practitioner the responsibility of learning how to teach optimal health and the need to accept the inevitability of disease. Holistic health care practitioners promote health, prevent illness and help raise awareness of disease in our lives rather than merely managing symptoms. A holistic approach relieves symptoms, modifies contributing factors, and enhances the patient’s life system to optimize future well-being. (ABHM) Integrative Medicine involves the consideration of all factors that influence health, wellness and disease, in1
L. Lipsenthal
2 cluding mind, spirit and community as well as body. (PIM) These principles emphasize the search for all possible contributing factors. Such factors may include, but are not limited to, the psychospiritual and emotional issues for the patient, lifestyle issues, environmental exposures, early life exposures, and familial function or dysfunction. Learning to manage these issues is a large responsibility of the practice of IHM.
The Body Heals Itself Both the ABHM and PIM state that the body has an innate power to heal and enhancing this capacity is a primary goal of IHM. All people have innate powers of healing in their bodies, minds and spirits. Holistic health care practitioners evoke and help patients utilize these powers to affect the healing process. (ABHM) Integrative medicine supports the appropriate use of conventional and alternative methods to facilitate the body’s innate healing response. (PIM) This changes the emphasis of treating the patient from the “magic bullet” mentality of an external agent fixing the health issue, to one which looks for ways to bolster the body’s natural mechanisms of healing. For example, a child with multiple ear infections may be treated with multiple courses of antibiotics (allopathic) or with lifestyle change that decreases risk of infection, such as decreased use of dairy products, or those that enhance immune function (IHM). This does not necessarily exclude the use of pharmaceuticals as a temporizing modality, but shifts the emphasis to long-term treatment and prevention. The goal and challenge is to create an action plan that includes a multimodality approach to most health concerns. This requires a greater depth of understanding of the root causes of disease, a deep knowledge of the body’s healing physiology, and the patience to wait for results over time. Instant gratification is often not part of the picture.
Each Patient, at Any Time, Is an Individual Holistic health care practitioners view people as the unity of body, mind, spirit and the systems in which they live. (ABHM) Holistic health care practitioners focus patient care on the unique needs and nature of the person who has an illness rather than the illness that has the person. (ABHM) To the IHM practitioner the patient and their concerns are not just the person sitting before you as a collection of body parts. They are part of a life system. The impact of this approach is the need to do a thorough evaluation to be able to understand the person’s life system. This includes such
things as nutrition, exercise, marital relationships, sleep patterns, work life issues, family relationships, potential toxic exposures, use of supplements, personal health practices, and other issues in addition to the usual medical H&P. The initial evaluation recommended to be a 60- to 90-minute session. While this is not necessarily a cost effective way of evaluating patients initially, it will help you to fully understand the person and their life system, thus allowing you to enhance their health within that system. This will save you time later in future visits as you now will have the full picture of the patient’s life. As the individual’s life changes over time, so will this life system. Changes in relationships, health habits, work life and family will all potentially impact the health of the individual, thus this is a living and changing health record. This must be considered in all future evaluations.
The Integration of Multiple Treatment Modalities Holistic health care practitioners embrace a lifetime of learning about all safe and effective options in diagnosis and treatment. These options come from a variety of traditions, and are selected in order to best meet the unique needs of the patient. The realm of choices may include lifestyle modification and complementary approaches as well as conventional drugs and surgery. (ABHM) Integrative medicine institutes a philosophy that neither rejects conventional medicine nor accepts alternative medicine uncritically. (PIM) This integration is what people first think of when they hear about CAM, integrative medicine, or alternative medicine. Most importantly it is the blending of styles of medical therapy to maximize the patient’s health, not the exclusion of therapies just to be “alternative.” For many years, alternative medicine practitioners were rejected by allopathic practitioners. This led to an animosity that still exists today. Many “mainstream” physicians reject anything that seems “alternative” and many alternative practitioners reject anything “mainstream.” Fortunately this gap is narrowing as new generations of physicians are being exposed to both styles of practice and are beginning to incorporate and experiment with multiple modalities. Recognition that good medicine should be based in good science, inquiry driven and open to new paradigms. (PIM) This truly defines the new generation of IHM practitioners, open minded, interested in science, and willing to provide the best of service to their patients.
Above All Do No Harm Integrative medicine promotes the use of natural, less invasive interventions whenever possible. (PIM)
The integrative medicine practitioner As in allopathic medicine, IHM practice support the idea of using the least invasive approach available. With the mind set of alternative therapies, this means something more natural, less toxic, and with the lowest side effect profile.
Life Is a Learning Experience All life experiences including birth, joy, suffering and the dying process are profound learning opportunities for both patients and health care practitioners. (ABHM) The IHM practitioner sees life events as learning experiences. Death is not the enemy, it is an inevitable part of life that can lead to healing, family unity, and growth for those around it. Illness is the same, it is an opportunity for self evaluation, healing of relationships, and a new beginning. Many of us hear this from our patients who describe their cancer or heart disease as “the best thing that ever happened to them.” For many patients disease serves as a valuable wake up call. Living through these moments with our patients can also be healing for us. We bond with others in these times, we evaluate our own health and we learn from the patients we admire. An elderly patient of my wife was recently diagnosed with a breast cancer recurrence. It was metastatic on diagnosis. She was emotionally fine with the diagnosis and even smiled. At first my wife was surprised at this. The patient went on to tell my wife that twenty years earlier, she had had breast cancer and made a deal with God. If she could see the birth of her first grandchild, thus surviving her breast cancer, she would accept anything God gave back to her. Twenty years later, by her beliefs, God had called her back. She was delighted to have seen the first 19 years of her grandchild’s life. God had given her a great gift and she was ready to go. This woman is a great teacher to us all that death is a learning opportunity.
“It Is No Use Walking to Preach Unless Your Walking Is Preaching” — St. Francis of Assissi Integrative medicine practitioners serve as models of health and healing, committed to the process of selfexploration and self-development. (PIM)
3 Holistic health care practitioners continually work toward the personal incorporation of the principles of holistic health, which then profoundly influence the quality of the healing relationship. (ABHM) One of the largest responsibilities of the IHM practitioner is to be self aware, to learn and grow, and to practice what they preach. This is similar in some ways to traditional psychotherapy, where the practitioner must also be in therapy for themselves. By better understanding ourselves we become better teachers to our patients. By struggling with our own health issues we gain empathy and respect for our patients’ health issues and struggles. This puts us on equal ground with our patients as partners in our healing and theirs. If we can meet our patient with empathy, compassion, and respect, we will enjoy the relationship and so will they.
Love Heals Holistic health care practitioners strive to meet the patient with grace, kindness, acceptance, and spirit without condition as love is life’s most powerful healer. (ABHM) Relationships are critical to our success as practitioners. If we can learn to love ourselves as well as those around us we are truly doing work of service. The IHM practitioner serves themselves so that they can have the energy to be a loving member of their family. When they come from a loving home environment, they can serve the patient with compassion and grace in a true sense of partnership.
Summary The role of the IHM practitioner is not an easy one. It takes time, patience, self awareness and analysis, emotional connection, and an open inquisitive mind. This role is not for everyone. It takes a mind set of service and a lifetime of learning. As a scientist, it is a very exciting path. There are unending questions in the realm of medicine, psychology, and human spirit. There is so much to be learned in the field of IHM that it can be overwhelming. I wish you well on your path in IHM wherever it takes you.
T
he practice of Integrative and Holistic Medicine (IHM) differs in many ways from the practice of allopathic medicine (AM). Some differences are obvious, for example, the use of modalities of treatment not found in allopathic medical practice or training. This might include but is not limited to such therapies as homeopathic remedies, botanical medicines, or acupuncture. To some, learning to use these “alternative” modalities in an allopathic practice is justification to call oneself an integrative medicine practitioner. The role of an IHM practitioner has already been well defined. For the purposes of this commentary, I will use the definitions of two of the leading organizations in the field, The University of Arizona Program of Integrative Medicine (PIM), one of the leading educational programs in this arena, and the The American Board of Holistic Medicine (ABHM), the national certifying body for Holistic Practitioners. Their definitions of IHM are as follows: Integrative Medicine is defined as healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative. (PIM) Holistic Medicine is the art and science of healing that addresses care of the whole person– body, mind, and spirit. The practice of holistic medicine integrates conventional and complementary therapies to promote optimal health and to prevent and treat disease by addressing contributing factors. (ABHM) These definitions lay the groundwork for the role of the IHM practitioner. On reviewing the above definitions it becomes apparent that IHM is not about what you “do to the patient” but is about how you approach the patient and work in partnership to enhance the individual’s health. In essence, a system-based approach in which you and the patient are active participants in the system. This gives both the practitioner and the patient greater responsibility in relationship. Ideally, AM also uses “relationship-centered care,” but there are further differences. To review these differences, let’s look
President, American Board of Holistic Medicine (http://holisticboard.org). Address reprint requests to Lee Lipsenthal, MD, ABHM, 106 Spring Grove Ave, San Anselmo, CA 94960. E-mail: [email protected]
1543-1150/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.sigm.2005.01.001
at the principles of IHM practice as used by the The University of Arizona PIM and the ABHM.
Optimal Health Optimal health is the primary goal of holistic medical practice. It is the conscious pursuit of the highest level of functioning and balance of the physical, environmental, mental, emotional, social and spiritual aspects of human experience, resulting in a dynamic state of being fully alive. This creates a condition of well-being regardless of the presence or absence of disease. (ABHM) Integrative medicine involves the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease. (PIM) Optimal health is clearly a goal of IHM practice. The key point is that prevention is a primary goal of the medical interaction. Allopathic medicine is, in many ways, a disease treatment model. This has grown due to the therapeutic goal of finding a “magic bullet,” a treatment that be given to “fix” the disease as well as the limited time constraints of most practitioners. It becomes expedient to find a problem for which one can write a prescription rather than spend more time discussing lifestyle or behavioral change. This approach is supported by the pharmaceutical and medical equipment manufacturers, as well as the insurance industry, which pays for prescriptions and procedures, thus making this behavior profitable. Lastly, it has become an expectation of many patients who feel that a visit to the doctor isn’t complete without a prescription or intervention. The optimal health model means a greater commitment of time and energy to evaluate, teach, and enlighten the patient. It also gives the practitioner the responsibility of learning how to teach optimal health and the need to accept the inevitability of disease. Holistic health care practitioners promote health, prevent illness and help raise awareness of disease in our lives rather than merely managing symptoms. A holistic approach relieves symptoms, modifies contributing factors, and enhances the patient’s life system to optimize future well-being. (ABHM) Integrative Medicine involves the consideration of all factors that influence health, wellness and disease, in1
L. Lipsenthal
2 cluding mind, spirit and community as well as body. (PIM) These principles emphasize the search for all possible contributing factors. Such factors may include, but are not limited to, the psychospiritual and emotional issues for the patient, lifestyle issues, environmental exposures, early life exposures, and familial function or dysfunction. Learning to manage these issues is a large responsibility of the practice of IHM.
The Body Heals Itself Both the ABHM and PIM state that the body has an innate power to heal and enhancing this capacity is a primary goal of IHM. All people have innate powers of healing in their bodies, minds and spirits. Holistic health care practitioners evoke and help patients utilize these powers to affect the healing process. (ABHM) Integrative medicine supports the appropriate use of conventional and alternative methods to facilitate the body’s innate healing response. (PIM) This changes the emphasis of treating the patient from the “magic bullet” mentality of an external agent fixing the health issue, to one which looks for ways to bolster the body’s natural mechanisms of healing. For example, a child with multiple ear infections may be treated with multiple courses of antibiotics (allopathic) or with lifestyle change that decreases risk of infection, such as decreased use of dairy products, or those that enhance immune function (IHM). This does not necessarily exclude the use of pharmaceuticals as a temporizing modality, but shifts the emphasis to long-term treatment and prevention. The goal and challenge is to create an action plan that includes a multimodality approach to most health concerns. This requires a greater depth of understanding of the root causes of disease, a deep knowledge of the body’s healing physiology, and the patience to wait for results over time. Instant gratification is often not part of the picture.
Each Patient, at Any Time, Is an Individual Holistic health care practitioners view people as the unity of body, mind, spirit and the systems in which they live. (ABHM) Holistic health care practitioners focus patient care on the unique needs and nature of the person who has an illness rather than the illness that has the person. (ABHM) To the IHM practitioner the patient and their concerns are not just the person sitting before you as a collection of body parts. They are part of a life system. The impact of this approach is the need to do a thorough evaluation to be able to understand the person’s life system. This includes such
things as nutrition, exercise, marital relationships, sleep patterns, work life issues, family relationships, potential toxic exposures, use of supplements, personal health practices, and other issues in addition to the usual medical H&P. The initial evaluation recommended to be a 60- to 90-minute session. While this is not necessarily a cost effective way of evaluating patients initially, it will help you to fully understand the person and their life system, thus allowing you to enhance their health within that system. This will save you time later in future visits as you now will have the full picture of the patient’s life. As the individual’s life changes over time, so will this life system. Changes in relationships, health habits, work life and family will all potentially impact the health of the individual, thus this is a living and changing health record. This must be considered in all future evaluations.
The Integration of Multiple Treatment Modalities Holistic health care practitioners embrace a lifetime of learning about all safe and effective options in diagnosis and treatment. These options come from a variety of traditions, and are selected in order to best meet the unique needs of the patient. The realm of choices may include lifestyle modification and complementary approaches as well as conventional drugs and surgery. (ABHM) Integrative medicine institutes a philosophy that neither rejects conventional medicine nor accepts alternative medicine uncritically. (PIM) This integration is what people first think of when they hear about CAM, integrative medicine, or alternative medicine. Most importantly it is the blending of styles of medical therapy to maximize the patient’s health, not the exclusion of therapies just to be “alternative.” For many years, alternative medicine practitioners were rejected by allopathic practitioners. This led to an animosity that still exists today. Many “mainstream” physicians reject anything that seems “alternative” and many alternative practitioners reject anything “mainstream.” Fortunately this gap is narrowing as new generations of physicians are being exposed to both styles of practice and are beginning to incorporate and experiment with multiple modalities. Recognition that good medicine should be based in good science, inquiry driven and open to new paradigms. (PIM) This truly defines the new generation of IHM practitioners, open minded, interested in science, and willing to provide the best of service to their patients.
Above All Do No Harm Integrative medicine promotes the use of natural, less invasive interventions whenever possible. (PIM)
The integrative medicine practitioner As in allopathic medicine, IHM practice support the idea of using the least invasive approach available. With the mind set of alternative therapies, this means something more natural, less toxic, and with the lowest side effect profile.
Life Is a Learning Experience All life experiences including birth, joy, suffering and the dying process are profound learning opportunities for both patients and health care practitioners. (ABHM) The IHM practitioner sees life events as learning experiences. Death is not the enemy, it is an inevitable part of life that can lead to healing, family unity, and growth for those around it. Illness is the same, it is an opportunity for self evaluation, healing of relationships, and a new beginning. Many of us hear this from our patients who describe their cancer or heart disease as “the best thing that ever happened to them.” For many patients disease serves as a valuable wake up call. Living through these moments with our patients can also be healing for us. We bond with others in these times, we evaluate our own health and we learn from the patients we admire. An elderly patient of my wife was recently diagnosed with a breast cancer recurrence. It was metastatic on diagnosis. She was emotionally fine with the diagnosis and even smiled. At first my wife was surprised at this. The patient went on to tell my wife that twenty years earlier, she had had breast cancer and made a deal with God. If she could see the birth of her first grandchild, thus surviving her breast cancer, she would accept anything God gave back to her. Twenty years later, by her beliefs, God had called her back. She was delighted to have seen the first 19 years of her grandchild’s life. God had given her a great gift and she was ready to go. This woman is a great teacher to us all that death is a learning opportunity.
“It Is No Use Walking to Preach Unless Your Walking Is Preaching” — St. Francis of Assissi Integrative medicine practitioners serve as models of health and healing, committed to the process of selfexploration and self-development. (PIM)
3 Holistic health care practitioners continually work toward the personal incorporation of the principles of holistic health, which then profoundly influence the quality of the healing relationship. (ABHM) One of the largest responsibilities of the IHM practitioner is to be self aware, to learn and grow, and to practice what they preach. This is similar in some ways to traditional psychotherapy, where the practitioner must also be in therapy for themselves. By better understanding ourselves we become better teachers to our patients. By struggling with our own health issues we gain empathy and respect for our patients’ health issues and struggles. This puts us on equal ground with our patients as partners in our healing and theirs. If we can meet our patient with empathy, compassion, and respect, we will enjoy the relationship and so will they.
Love Heals Holistic health care practitioners strive to meet the patient with grace, kindness, acceptance, and spirit without condition as love is life’s most powerful healer. (ABHM) Relationships are critical to our success as practitioners. If we can learn to love ourselves as well as those around us we are truly doing work of service. The IHM practitioner serves themselves so that they can have the energy to be a loving member of their family. When they come from a loving home environment, they can serve the patient with compassion and grace in a true sense of partnership.
Summary The role of the IHM practitioner is not an easy one. It takes time, patience, self awareness and analysis, emotional connection, and an open inquisitive mind. This role is not for everyone. It takes a mind set of service and a lifetime of learning. As a scientist, it is a very exciting path. There are unending questions in the realm of medicine, psychology, and human spirit. There is so much to be learned in the field of IHM that it can be overwhelming. I wish you well on your path in IHM wherever it takes you.