What Can You Expect from an "Integrative Medicine Clinic'?

The more it comes into use, the more uncertainty there seems to be with what integrative medicine means to the person who chooses to schedule an appointment.
by John Weeks

If you go to a clinic that portrays itself as “integrative,” what might you expect to experience?

Ardent backers promote “integrative medicine” as the medicine of the future. They present integrative medicine as the leading edge of a great transformative movement to shift our system from a “disease care” model to one that truly merits the title “health care.”

I like the sentiment and the direction. We need to bring a health focus to our system of care. But what does this term mean where the rubber meets the road—or rather, when a human being walks through the doors of a clinic that claims to offer “integrative medicine”? What sort of practitioner(s) will be there? What services will be provided? Might these services be appropriate for addressing your health and wellness goals or those of your loved ones? Will they be the right services to treat some specific condition?

To ask such questions is on target. Because the more it comes into use, the more uncertainty there seems to be with what integrative medicine means to the person who chooses to schedule an appointment.

The term was originally invented in the mid-1990s by medical school-based or hospital-based medical doctors (MDs). Integrative medicine was meant to capture Western medical practices that also included some alternative therapies. Services may have included referrals to staff alternative practitioners such as massage therapists or acupuncturists. Typically consumers were already using these therapies. Most mainstream medical doctors didn’t yet accept them or denigrated them as quackery.

As integrative medicine caught on, some community-based MDs who may have offered alternative medicine or “functional medicine” for decades began appropriating the term. Now subsets of the naturopathic, chiropractic, nurse practitioner, and even acupuncture and Oriental medicine professions are adding “integrative” to descriptions of their practices.

The truth is that the term “integrative” can presently be tagged onto the clinic of any practitioner—just like that. Go to a seminar on herbs over the weekend. Paint “integrative” on your window on Monday. Add “integrative” to your community newspaper advertisement the next week. The word, now used by so many different practitioners, has reached that meaningless state already associated with terms like “prevention,” “natural,” or “holistic.”

A recent report, “Integrative Medicine in America: How Integrative Medicine is Being Practiced in the United States”, will be a helpful, reader-friendly guide if you are trying to understand what an integrative clinic might mean. This beautifully-crafted document is available to anyone online as a free PDF download thanks to funding by the Bravewell Collaborative, philanthropic backers of integrative medicine.

In the survey, 29 clinic directors were given a list of 20 conditions and asked to select those that they “believed their practitioners treated most successfully with integrative strategies.” The top five selections included chronic pain (75 percent) followed by gastrointestinal disorders (59 percent), depression/anxiety (55 percent), cancer (52 percent) and stress (52 percent).

Most of the clinics seem to be living up to the claim that they represent a health-focused paradigm. Exactly two-thirds (66 percent) subscribe to the value that they “use the least invasive therapies first.” Roughly 62 percent offer lifestyle-change programs. Over a quarter include staff “health coaches” to assist patients with change processes. Unlike in most outpatient treatment, pharmaceuticals are not the main option. Conventional drugs rank seventh in a list of “the interventions prescribed most frequently” across all of the 20 conditions. Supplements rank second, behind food/nutrition.

I was pleased to see increasing openness to staff members from other professions. As compared to a similar report from a decade ago, the percent with chiropractors and naturopathic doctors on staff roughly doubled to 38 percent and 28 percent, respectively. Fear among these medical doctor directors of allowing patient choice also seems to be subsiding. While medical doctors are the top dogs uniformly at the clinics surveyed here, 79 percent allow users to self-refer to whatever provider types are offered.

Yet the report is, itself, evidence that caveat emptor (“let the buyer beware”) remains the order of the day in integrative medicine. The title is misleading. It should read: How Integrative Medicine Is Being Practiced in [Health Systems] in the United States (bracketed section added). The only clinics included among the 29 surveyed were those sponsored by hospitals, academic medical centers, and health systems. To truly reflect “Integrative Medicine in America,” the sponsors would have needed to expand this project to include the scores upon scores of community practices where integrative medicine services are in use.

Still, this snapshot is a great look at the emerging field through the lens of the most conservative “integrative clinic” environments. Go to bravewell.org to download it. Anyone who is both a consumer and an advocate for this movement in medicine will find the document a treasure trove of information that is just plain fun to skim through.

 

John Weeks, the publisher-editor of The Integrator Blog News & Reports (theintegratorblog.com), brings 28 years of involvement in integrative practice politics and business to his writing. Questions? Write to johnweeks@theintegratorblog.com.