Integrative Medicine to Care for the Whole Patient

Every patient has unique needs, challenges, beliefs, and circumstances, and integrative medicine—which combines alternative, conventional, and complementary medicine—is designed to personalize that care across the entire health spectrum by optimizing patient quality of life and well-being, emphasizing prevention, and promoting healing.

Integrative medicine is becoming an established part of health care in the United States, explains Susan P. Blackford, MD, an integrative medicine physician at the Duke Integrative Medical Center. Indeed, integrative medicine has become a focus in numerous universities, health care systems, and hospitals across the country.

Why Integrative Medicine?
Blackford explains that integrative medicine provides the physician with additional methods to treat illness, promote healthy behaviors, help patients regain and maintain their health, and empower patients to take a more active role in improving their own health. "It offers the time and tools to take a deeper dive into health issues,” she says. “Conventional medicine is great for acute conditions, but integrative medicine is really ideal for handling many chronic issues like fibromyalgia or irritable bowel syndrome, for which conventional medicine may not have all the answers."

Duke Integrative Medicine’s team of board-certified physicians individualize treatment based on the needs of the patient. "As a team, we work with patients to help foster healthy behaviors so that they can use these skills throughout their lives," says Blackford. In that way, she says, she partners with conventional physicians in both the primary care and specialist settings to help patients take charge of their care plans. "Our strategies support and complement conventional medicine," she explains.

Visits with an integrative medicine physician typically last between 30 minutes and 1 hour, explains Ya-Ling J. Liou, DC, a chiropractor based in Seattle, WA, and author of Every Body's Guide to Everyday Pain. That's about 50% more time than the average primary care visit, Blackford says. "Because it takes time to engage patients in their care, that huge difference in time is key."

Reimbursement can still be a challenge. "Nevertheless, a shift has started to occur in the last few years in the acceptance of integrative medicine with regard to the previous limitation of insurance coverage," says Blackford.

Liou agrees. "Reimbursement and clinical trial data have helped legitimize integrative medicine. Attitudes are changing. Insurance coverage is getting better."

Both Blackford and Liou note that rates of reimbursement vary across the country, with some insurance companies in the western United States more likely to cover integrative care than those in the eastern United States. "But we're getting there," says Blackford. "That tide is definitely shifting."

Most of the patients referred to her practice, says Liou, are self-referrals or are referred by other patients, not by conventional physicians. And that's a problem, she explains. "Those who come to me and who aren't referred by their doctors feel like they're going 'rogue.' They feel like they're flailing and are coming to me as a 'last resort.'"

"There's still work to be done on educating conventional professionals on when to refer patients," says Liou, but she explains that communication among physicians is getting better as integrative medicine becomes more accepted and insurance companies recognize its benefits.

Those patients who have been referred to her by other conventional physicians—Liou says that physiatrists, orthopaedists, and neurologists represent the largest group of referral physicians to her practice—want her to communicate directly with their doctor about what's going on, so she is beginning to see change. But, for those "last resort" patients, she says, "they're missing a therapeutic alliance if their doctors aren't talking to each other."

Partnering with patients and conventional medicine colleagues is paramount to the success of integrative medicine, say Liou and Blackford. "At Duke Integrative Medicine," comments Blackford, "we [conventional physicians and integrative medicine physicians] may have mutual patients, so communication with our colleagues is key. Yes, we're partnering with conventional physicians, but we're also looking to partner with patients. That's what integrative medicine is about."

She continues: "If you engage patients in the process, they've got some say in the matter, so that gives them reason to follow the plan." Liou concurs. Engaging with patients helps to develop that therapeutic alliance, she says.

Blackford explains that the team environment is another important aspect to the success of integrative medicine: "As a team, we can collaborate on patient cases with our team of health psychologists, acupuncturists, nutritionists, and massage therapists, among others, to help dig into the heart of a patient's issue. This type of collaboration is what brings back the joy of medicine."