September 2000 • Volume 6 • Number 9
Integrative medicine, or 'keeping body and soul together'
BY CINDY McCANSE
Ginkgo biloba shows promise in managing cerebral insufficiency.Family physician Jane Murray, M.D., has for two and a half years shared her Mission, Kan., office space with a veritable smorgasbord of complementary/ alternative medicine providers.
She practices alongside two specialists in Oriental medicine, a massage therapist, a Taoist counselor, and a specialist in craniosacral and other natural therapies, as well as a more traditional cadre of nurses and ancillary health care personnel. Together, she and her colleagues at the Sastun Center of Integrative Health Care help people find ways to tap into their own inner healing power.
"I honestly think that's what family medicine is," Murray explained. "It's integrating whatever helps the patient."
Family physician Donald Novey, M.D., medical director of the Center for Complementary Medicine in Park Ridge, Ill., holds a similar view of CAM.
"It's a set of useful tools to help people," said Novey. "What we've been able to show here is that you can implement complementary medicine in a safe setting and keep everybody happy."
His center boasts a staff of 12 CAM practitioners and provides a wide range of services, including chiro- practic; acupuncture; massage, nutritional and craniosacral therapies; homeopathy; and herbal medicine.
Oriental medicine specialist Joseph Thomas, Ph.D, uses acupuncture for pain relief.Novey and his colleagues are also involved in the educational aspects of CAM. Lutheran General Hospital, which sponsors the integrated center, initiated the nation's first family practice residency rotation in alternative medicine. The result: a class of FPs comfortable with mixing Western medicine with complementary practices.
A logical integration
Murray seems genuinely puzzled by the fact that more physicians don't see the logic of integrating traditional and nontraditional care.
"I've always been interested in nonconventional care, especially the whole issue of the mind-body connection," said Murray. "I don't know why it's looked upon as such an outlier, because the whole psychosocial connection to health is the main thing we do in family medicine."
Dealing with psychosocial issues is an integral part of Murray's practice. She spends an hour or more with each new patient because, she explained, "Patients want to sit here and talk and be heard. I want to see what they want from me."
Herbal remedies play a role in patient care in some integrated practices.Sometimes, what a patient needs is best provided by another member of the clinic's staff. And often, two or more Sastun providers are simultaneously involved in any one patient's care.
Needless to say, Murray doesn't see herself in the role of the traditional physician/authority figure -- far from it. Patients, she said, need to invest in their own well-being.
Making a personal health investment
One way she and her colleagues ensure that patients make that commitment is by eschewing participation in health insurance plans. All patients pay for their care out-of-pocket.
The simple act of pulling the cash out of one's pocketbook, Murray said -- even if the patient later files for insurance reimbursement -- makes that patient more cognizant of what he or she is receiving in return, thus increasing the chance that patients will work hard to protect their health.
There's another reason for handling payment this way: Many insurers refuse to pay for CAM services. It's a problem with which David Frank, M.D., of Middletown, Pa., is all too familiar.
Jane Murray, M.D., and Joseph Thomas, Ph.D., discuss patient care at a weekly staff meeting at the Sastun Center.A board-certified family physician specializing in sports and rehabilitative medicine, Frank is medical director of WellQuest, a collaborative health institute created last June by PinnacleHealth System of central Pennsylvania. The four-hospital health care system owns 22 family medicine practices, six of which now integrate a variety of CAM services.
"We try to make it as easy for our patients as we can," Frank said. "We code everything for them, give them the ICD-9 codes, the CPT codes -- everything. But we tell them it's not necessarily going to be reimbursed."
It's not that managed care is inherently bad, said Murray, but she does believe it has fostered a "huge disconnect" between payer and patient, a breach that the physician is often expected to fill.
"I don't want to be the interpreter of the health plan," Murray said. "I want to love my work; I want to love my practice. I believe you should do medicine for love. Make your money another way."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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