Coordinating Care
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One of the principles that guides integrative medicine is the use of all appropriate therapeutic approaches, health care professionals and disciplines to achieve optimal health and healing.
In practical terms, this means that a primary care physician, a surgeon, a nurse practitioner, an herbalist, a nutritionist, a massage therapist, and an acupuncturist may all contribute to the care of a single patient. Communication, proper record keeping, and cooperation are key to the coordination.
In the article, "Shared Borders: Achieving the Goals of Interdisciplinary Patient Care," author M. D. Ray states that, "In multidisciplinary practice, each member of a clinical group practices with an awareness and tolerance of other disciplines. In interdisciplinary practice, members of a team actively coordinate care across disciplines....Such a practice model [leads] to an increased level of trust among professions and a deeper level of understanding about what each profession can contribute." (1)
As a first step in patient care, the Osher Center at the University of California, San Francisco, offers an "Integrative Medicine Consultation." This comprehensive consultation, directed by an experienced integrative medicine practitioner, creates a personalized plan that is designed to help an individual achieve his or her health goals by drawing on the therapies most appropriate for that person. The plan is then put into action, supervised by center medical staff who coordinate with, and oversee, the various practitioners.
Another example of how integrative care is coordinated comes from The Scripps Center for Integrative Medicine, which offers a leading program in heart disease. Physicians at the integrative clinic work with the Scripps Departments of Cardiology and Interventional Cardiology to offer patients a wide range of treatment options, from lifestyle change programs to high-tech invasive surgery. "Our Healing Hearts program is designed to tackle all cardiovascular risk factors," says Erminia Guarneri, MD, founder and medical director of the Center. "Our goal is to establish a treatment plan unique to the individual. Cutting-edge technology is balanced with nutrition, exercise, stress mastery and emotional support." Again, the treatment plan is created with input from a variety of practitioners and supervised by the Center's medical staff.
But coordination of care needs to reach beyond the practitioners of any one clinic. Studies show that people now see a variety of health care practitioners and engage in numerous self-care practices. Therefore, when treating any individual, it is important for health care providers to be aware of the individual's entire care and self-care routines. What vitamins or supplements is he or she taking? Does he or she belong to a health club or take a yoga class? Is he or she using homeopathic remedies or aromatherapy at home? Is he or she under the care of another health care professional, such as a specialist, or, especially in the case of many ethnic groups, seeing a traditional practitioner as well? Understanding the patient and all of his or her health-related activities is vital for the safety of the individual as well as for ensuring that a coordinated treatment plan is effective.
Most integrative medicine centers use an expanded patient interview as the first step to gathering this information and coordinating care. For instance, the patient intake form used by the Program in Integrative Medicine (PIM) at the University of Arizona asks not only about medical history and current conditions, but also about diet, hobbies, religious affiliations, relationships, major life stresses, relaxation practices and whether the person in under the care of any other practitioners. Patients are also asked to bring in their medical records as well as samples of all the vitamins, supplements, and prescription drugs they use. Interestingly, the interview can be healing in and of itself.
"We are often struck by how often change happens after an integrative interview, many times without advice or overt intervention," notes Victoria Maizes, MD, who developed the integrative health history approach at PIM. "This may be due to the power of disclosure. Hearing oneself articulate powerful aspects of one's life can lead to change. Empathic listening alone may be sufficient to create change." (2)
References
1. Ray MD: Shared borders: Achieving the goals of interdisciplinary patient care. American Journal of Health System Pharmacy 1998, 55:1369-1374.
2. Maizes V, Koffler, K., Fleishman, S. Revisiting the Health History: An Integrative Approach. Advances in Mind-Body Medicine, Winter 2002;18(2):32-34