Positive Health Online

Integrated Medicine is a new buzz word. The UK’s first professional training programme for Integrated Medicine has been launched; integrated clinics and centres are opening and books on Integrated Medicine can be found in pretty much every health book store throughout the country.

In America Integrated Medicine, or Integrative Medicine, as they refer to it, is even further developed. The Duke Centre for Integrative Medicine was launched in 2002 as the America’s flagship Integrative Medicine Centre. Located in North Carolina, its 27,000 square foot premises houses therapeutic treatment rooms, conference and workshop spaces, fitness facilities, meditation spaces, and a state-of-the-art kitchen for healthy cooking demonstrations, guest meals and catered events. Their integrative medical team consists of professionals from medicine, health psychology, life coaching, nutrition and the complementary therapies. In that same significant year, 2002, The Bravewell Collaborative was founded by a small group of philanthropists who were dedicated to transforming American healthcare by returning the soul to medicine. They really have been a major driving force behind the advancement of integrated medicine in the USA. For example, and I can’t help but admit that I am envious about this, they have funded a clinical network of eight Integrated Medicine Clinics, raised the funds to produce a Public Broadcasting Service (PBS) programme on Integrated Medicine called The New Medicine, funded scholarships for 28 physicians to receive training in Integrated Medicine, and funded the infrastructure and growth of the Consortium of Academic Health Centres for Integrative Medicine to its current level of participation – 38 of the leading US medical schools.

Thus Integrated Medicine, the medicine of the new millennium is here to stay, but what exactly does Integrated Medicine mean, and how does it differ from integrated healthcare?

Defining Integrated Medicine (Is Not Easy)

There is not a universally accepted definition of Integrated Medicine – it is a definition in evolution. When I ask people at my lectures what they understand Integrated Medicine to be, I either get blank stares (the majority) or a couple will say something along the lines of “it is about combining the best of conventional and complementary medicine.” That’s partly true, but Integrated Medicine is so much more. These are two of the most illuminating definitions that I have come across.

The first is from The Consortium of Academic Health Centres for Integrative Medicine, that I mentioned earlier. Their mission (in their own words), is to help transform medicine and healthcare through rigorous scientific studies, new models of clinical care, and innovative educational programmes that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing and the rich diversity of therapeutic systems. Their definition is:

Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.

Their Wheel of Health (see opposite) provides a wonderful illustration of the depth and breadth of the Integrated Medicine approach that they offer.

Another, longer definition, is from The Bravewell Collaborative:

What has come to be called Integrative Medicine is a rapidly growing and highly credible field that seeks to integrate the best of Western scientific medicine with a broader understanding of the nature of illness, healing and wellness. In seeking to return the soul to medicine, Integrative Medicine is grounded in the healing relationship – practitioners and patients share information as well as compassion as together they seek ways to achieve optimal health. This approach to giving care focuses on healing the whole person and addresses a person’s body (one’s physical self), mind (one’s mental and emotional state), spirit (one’s personal connection to the transcendent), and community (one’s web of relationships and environment). Informed by evidence, Integrative Medicine makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing and strives to achieve wholeness and health as well as cure illness and disease. Because an informed, empowered patient will make better choices about his or her healthcare and lifestyle options, patient education is an essential element of integrative care.

I remember the first time I read these two definitions – my heart lifted – this is what medicine should surely be about? Patient-centred relationships, compassion, addressing mind, body, spirit and environment, focusing on health and healing as well as disease and illness, and empowering patients to make better choices – these principles were bread and butter for my somewhat disillusioned medical self – they were inspirational and uplifting and surely describing the medicine of the future?

As time has passed, and with the experience that comes with practising for more than seven years as an Integrated Medical doctor, I have reflected long and hard on the subject of Integrated Medicine and come to a couple of realizations that have brought me (in a positive way) down to earth. Whereas I used to see a future in which all people would be offered within the NHS, the width and depth of Integrated Medical services, I now see a different future, one that requires me to distinguish Integrated Holistic Healthcare from Integrated Medicine. They are not the same entity.

Integrated Holistic Healthcare

I define Integrated Holistic Healthcare as the provision of the best possible level of whole-person care, using the most effective and cost-effective approaches from conventional and complementary medicine for the purpose of helping individuals achieve optimum health and healing. Put another way, this is providing the best of conventional and complementary medicine within a holistic framework. This exists to a degree already, and I do see a future where this will be offered formally by the National Health Service. However, it is inevitable, in my opinion, that only a handful of complementary therapies that have had their effectiveness and cost-effectiveness fully evaluated will be invited to join the club. Outside of the NHS, I can see more privately-owned Integrated Health clinics opening that offer, for example, a holistically-informed GP (as a gatekeeper) working alongside a team of complementary therapists.

Providing access to a number of different options and therapies, however, is not Integrated Medicine, it’s Integrated Healthcare, Integrated Medicine is much more. If both are to advance; my feeling is that we need to make clear this differentiation.

The following is my own perspective on what Integrated Medicine is. The two definitions that I shared earlier are great, but incomplete.

Integrated Medicine is an approach to health, healing and personal growth that is informed by the most comprehensive and complete model of health, life and reality available. Its focus is on creating personalized programmes that address the barriers to the individual experiencing their fullest potential for a conscious, healthy and fulfilled life. Integrated Medicine makes use of all of the appropriate self-help and therapeutic assessments, tools and approaches available, and wherever possible does so according to the evidence of their effectiveness. Underpinning the Integrated Medicine approach is the unique relationship created between the practitioner and patient, the commitment of the patient to learning new skills, acquiring new knowledge and transforming perceptions, habits and attitudes, and the skills, awareness and presence of the practitioner.

Although Integrated Medicine can be delivered by one person (such as an integrated medical doctor), in reality it requires a team of people (with different areas of expertise and skill) who share the Integrated Medicine vision. The five defining features of Integrated Medicine using this definition are:

1.    Integrated Medicine focuses on identifying and addressing the underlying barriers to health, healing and personal growth within the individual. This recognizes the truth that labelling someone with a disease tells you nothing about what is preventing that individual from recovering. For example, you can have three people with depression (the same disease) with three very different requirements for true healing to take place. The first person’s depression might be linked to a combination of addictions and trauma, the second to a diet high in sugar and other foods to which he/she is sensitive and the third because of the habit of negative thinking. Each of these on the surface has the same problem, but underneath it would require very different approaches. For example, the first individual might require detoxifying, 12-step groups, family-of-origin work and a trauma recovery approach, such as The Rewind Technique. The second person would probably respond well to coming off sugar and processed foods, being taught how to manage their stress, and having a healthy living programme created for them. The third might respond will to CBT. Integrated Medicine, therefore, addresses the underlying barriers to health, healing and personal growth within the individual;

2.    Personal growth is an important aspect of Integrated Medicine because learning from the experience of disease, and a willingness to embrace it as an invitation to explore some aspect of life that is imbalanced, not only tends to bring some awareness around the choices and factors that led to the symptom in the first place, but it also allows for awareness, gifts, realizations and insights to emerge;

3.    Skills Training and providing knowledge and support is part of the Integrated Medical treatment programme. Pretty much all of us have specific strengths and weaknesses, skills and talents that are well-developed and certain skills that are less-well developed. By teaching the individual how to apply their strengths and develop specific skills – for example assertiveness, active listening, stress management, self-care or guided imagery, they are not only able to assist their own healing and recovery, but importantly shift their entire way of being, relating and reacting;

4.    Healing starts with the practitioner. There are a number of reasons for this. First and foremost is my own belief and experience that the primary impulse of the universe is for us to awaken to our true spiritual nature, and that life and events outside of ourselves can be used to show us what needs healing and integrating within. The commitment of the Integrated Medicine practitioner, therefore, is to one of conscious living (as described above). The second considerable value in practitioners living life to the fullest potential is that we become role models and a source of inspiration to our patients/clients. And thirdly, the healing power of the therapeutic relationship is well-documented. The more present, empathic and grounded in our authentic self – the better able we are to facilitate healing and growth;

5.    Everyone has something valid to share. As Ken Wilber, one of the world’s leading philosophers said, “no-one can be wrong 100% of the time.” As I have journeyed through the world of conventional medicine, complementary therapies, self-help and spirituality, I have really come to appreciate the incredibly diverse perspectives that underpin so many of these contrasting and rich approaches. Rather than dismissing a perspective because it doesn’t fit in with a particular belief system, Integrated Medicine attempts to work from a map and level of understanding and appreciation that is inclusive of many different perspectives and dimensions of life. The hard part is, of course, working out what to include and exclude from the map – which is why Integrated Medicine will always be work in progress!

Integrated Medicine, in summary, is not just about helping individuals recover from disease and distress, but about recovering their authentic self and experiencing their fullest potential for a conscious, resilient, healthy and fulfilled life.

Integrated Medicine in Practice

I would like to share with you in broad principles how I managed two patients both of which had been labelled with depression. At the heart of the Integrated Medical approach is working with the patient – not the disease – and wherever possible discovering what combination of factors is preventing that individual from not only recovering from depression, but also thriving and flourishing as human beings.

Case Study One: Mary

Mary, a 45-year old Executive, had experienced a low-grade chronic depression for about 3 years. She had tried Cognitive Behavioural Therapy with some initial success, but relapsed within 2 months. The thing that struck me about Mary was that she looked great and projected a strong confident demeanour that hid, to the untrained eye, her feelings of worthlessness and depression. After speaking with her for some time and after having completed her questionnaires, I was confidently able to diagnose, one of the most important health problems that masquerade as depression – addictive disease. If an individual is an active, untreated addict – whether to alcohol, drugs, sex, caretaking, shopping or working etc, it is my experience that you will not be able to facilitate a lasting recovery from depression. Her treatment programme was divided into stages. Stage one involved complete abstinence from alcohol, regular attendance at Alcoholics Anonymous, a nutritional programme designed to nourish her bodymind and support her recovery, training in mindfulness meditation and stress management training sessions with a NLP practitioner. This lasted for about 18 months, during which time her depression had lifted and stayed lifted completely and her physical health had improved considerably. The second stage of treatment then involved exploring issues of co-dependency and family-of-origin, as well as grief work and learning the skills of living, loving and relating. Although this work was challenging, Mary was thriving on it and to this day is leading a deeply fulfilling life because of the ‘gift’ of her depression.

Case Study Two: Thomas

Thomas was 35 years old, recently unemployed and had been plagued by moderate severity depression for 7 months. After a number of investigations, I was confident that biological and psychological factors were contributing to his experience. I started Thomas on a nutritional programme which included 5-HTP, high dose omega-3s, chromium and a B-complex. There is some evidence that depression is associated with weight gain, heavy arm/legs, cravings for sweets/carbohydrates and a feeling of grogginess responds very well to chromium. He also reduced his intake of sugar considerably, stopped all caffeine and started a healthy eating programme. He started an exercise programme through his local gym and signed up with the free CBT course www.moodgym.anu.edu.au – useful for patients who don’t want to or can’t get to see a CBT therapist. However according to Thomas, the real key to his recovery was the life coaching he received. By working with a life coach he was able to discover his strengths, values and talents and from that place of self-awareness and insight, start building a new career for himself. Within 4 weeks he set up his own business, which has subsequently become very successful.

Thomas’s depression lifted quickly within 2 weeks, however, he started to develop a gratitude for life that he had never had before. He also felt increasingly alive and that he had the resources to deal with ‘what life brings his way’.

Here were two people labelled with the same diagnosis, but with two very pathways to recovery.There are a multitude of approaches that can work, however the key, from my perspective as an integrated medical doctor is to match the person and their health situation, to the treatments (in the correct order) that are right for them.

The Future

Do I see Integrated Holistic Healthcare – conventional and complementary medical practitioners working more closely together to improve therapeutic outcomes and patient’s quality of life as the future? I do. Do I see Integrated Medicine becoming widely practised and widely desired? The honest answer is no, not for the moment. Despite there being a considerable amount of interest in holistic ways of living, spiritual growth and CAM approaches, very few people are actually willing to translate that knowledge or interest into action. It is easy to talk about change, to talk about treating mind, body and spirit, but who is really committed to changing habits, and learning new skills? The truth is, most people want quick fixes, and fortunately most of conventional and complementary medical practices provide that. And as anyone who is committed to personal inner work knows, waking up, getting real and facing reality is hard work – it requires courage and a commitment to healing and personal growth.

Although not everyone is ready to wholeheartedly embrace Integrated Medicine, I do believe its time will come.

Integrated Medicine Clinics

The Integrated Medical Practice, London www.drmarkatkinson.com
The Dove Clinic for Integrated Medicine, Winchester/London www.doveclinic.com
The New Medicine Group, London www.newmedicinegroup.org
University of Westminster Polyclinic www.wmin.ac.uk
The Drummartin Clinic, Ireland, www.integrativemedonline.com
Integrated Medical centre, London www.integratedmed.co.uk
The Diagnostic Clinic www.thediagnosticclinic.com
The Centre for Complementary and Integrated Medicine, Southampton/London www.complemed.co.uk
Eden Medical Centre, London, www.edenmedicalcentre.com
Nutrition Associates, York, Windsor, Harlow, Edinburgh www.naltd.co.uk
Litfield House Medical Centre, Bristol/London www.drhembry.com
The Burghwood Clinic, Banstead, www.burghwoodclinic.co.uk
Breakspear Hospital, Hemel Hempstead, www.breakspearmedical.com
The SKIAN Clinic, Forres, www.sustainablehealth.org.uk
Wholistic Medical Centre, London www.wholisticmedical.co.uk
Health Creation, Bristol, www.healthcreation.co.uk

Further Information

The British College of Integrated Medicine is hosting this years Integrated Medicine Conference on Women’s Health in London on Saturday May 17th 2008. For more information please visit www.integratedmedicine.org.uk