Positive Health Online

We speak of integration and this is usually, in my experience, focused around the issues of how GPs (and sometimes hospitals) can find ways of working with CPs (complementary practitioners). The discussion is largely 'doctor' centred. There are admittedly many issues and problems facing a GP practice, or a medical department, attempting collaboration with CPs, which require consideration, evaluation, negotiation and resolution.

Some such relationships are easily established, if the CP is simply receiving referrals, and then treating in their own way, before reporting back to the GP/doctor.

In other settings however the relationship is less clear cut, for example where GPs are attempting to understand the rationale and underlying principles of the CP's approach. Here the CP has to have a means of explaining methods and ideas which they themselves often cannot clearly articulate. And unless a CP can put into clearly understandable language what they are doing, and why, major communication gaps can occur, and confidence wane. If they can, then the collaborative relationship can be an enlightening and beneficial one for the GP as their vision of health care broadens.

But there is another side to this integrative effort, that of the CP's needs and ambitions.

Why would a CP want to work with GPs/doctors?

What is there to gain from such a relationship?

I can only answer this from a personal point of view, others must find their own explanations, and the single word I would use to express my own experience of over 5 years in an NHS setting, as a CP – is education.

When I joined an inner city NHS GP practice in 1993, as a naturopath/ osteopath, I thought (after over 30 years of private practice) that I knew a thing or two about dealing with health problems. Nothing that had gone before prepared me for the reality of GP practice.

Forget your TV and soap medical image. Forget also the idea that – as in private practice – you have the luxury of time to talk, teach, treat, review, and discuss. Forget the economic freedom of self-selected patients with money to spend on nutrients, other forms of therapy, classes, lessons and equipment.

In the real world of an inner city, GP led, NHS practice, problems are often closely linked to social conditions, and we cannot change these.

Patients' needs may not be so very different, but in many instances the means of offering alternative, complementary, interventions, changes dramatically when there isn't the option of suggesting the purchase of nutrients, or herbs, or even a change in eating patterns, as such changes are often impossible for economic reasons.

I found myself thrown back on basic principles, looking for ways of supporting the patient's homeostatic, self-healing, potentials, which were inexpensive as well as easy to explain and understand (to both the patient and the GP, who requires evidence for whatever is applied therapeutically). Simple measures involving self applied hydrotherapy or breathing techniques, or other stress reducing methods, or modest dietary changes – often offer (at least partial) solutions.

This was, and continues to be, an educational process which I would not have missed for anything, how to simplify interventions by focussing on self-regulating mechanisms, in as low-tech, and inexpensive, a way as possible

What else have I learned from integration?

Well for one thing my 'anti-allopathic' prejudices of a lifetime vanished soon after the experience of sitting in and watching GPs cope with their stream of patients – at under ten minute intervals. The sheer volume, and variety, of health concerns is incredible. On top of this the GP is often struggling with communication difficulties, often with people whose English is minimal, or whose intelligence is limited, or whose belief system is complex and antagonistic. There are also those patients whose background is so painful (refugees, homeless people, victims of torture, etc.) that their health problems represent the mere tip of an iceberg of repressed pain and distress.

The educational process which evolved from the experience of watching GPs cope with this stream of suffering was profound. As I sat there I was constantly seeking answers to the question "What would I advise?", and on many occasions there was no answer forthcoming, based on the reality of the patient's situation. The educational process was one in which reality was superimposed on theoretical ideals.

This does not negate the theories. Yes, the body/mind is a self healing complex. Yes, if you can remove causes, and enhance the functional integrity of the body's systems, health should emerge. Yes, in an ideal world, given adequate nutrition, sunlight, hygiene, rest and recreation, harmonious relationships etc., health can be restored, once it has been lost, far, far more easily than when diet is bad, stress enormous, hygiene poor and future prospects poorer.

The reality in my new world of the NHS GP practice is all too often in the latter situation, and what does naturopathy and osteopathy have to offer then?

Well fortunately still a lot, although focus tends to move from 'fixing' to 'maintaining' or even 'containing' patients, and their multifaceted health problems.

Is my means of delivery of osteopathy and naturopathy limited by being in an NHS setting? Yes, but in many ways it is better for this. This is the educational process which awaits anyone who is lucky enough to find a poorly paid post in an NHS setting. We have a lot to offer I believe, but a great deal more to learn.

Integration is a two way process.