What’s the best way to implement alternative care?
What’s the best way to implement alternative care?
Bringing complementary medicine to your facility
Turn on the evening news, and chances are there will be a report about some alternative therapy as a potential cure for some disease or condition. Go to your grocery store, and you find vitamins infused with herbal remedies — even teas that contain purported cures for forgetfulness, depression, or insomnia. Study after study shows that Americans are spending more money on alternative medicine than ever — often without the knowledge or input of their primary care physicians.
With such strong evidence of the power of alternative therapies, some hospitals and health systems figure it’s time to jump on the bandwagon and help their patients make responsible choices. One such organization is St. Barnabas Health Care System, based in Livingston, NJ. Last year, it hired Adam Perlman, MD, MPH, as medical director of the Carol and Morton Siegler Center for Integrative Medicine to run the Center for Health and Wellness at the St. Barnabas Medical Center.
An internist from Boston, Perlman was charged with formulating a complementary medicine program. The Center for Integrative Medicine opened in April, and Perlman’s experience putting together the program could provide some valuable lessons to others who want to follow in his footsteps:
• Understand prevailing attitudes. Although Perlman has had a long interest in alternative therapies, he knows that not all physicians, nurses, and administrators share his enthusiasm. He says his first goal was to meet with as many people as possible and get a sense of their feelings. "From the beginning here, there was an interest in building something that could be integrated into the health care system," he says. "But our sensitivities did have to be adjusted."
For instance, some therapies may offer patients something, but to medical staff seem alienating — either because they feel that the therapy is not valid, or because they feel it will take a patient away from their care. For example, acupuncture may offer something, but will that physician then lose the patient forever to the acupuncturist?
One way he has helped to alleviate those fears is by committing St. Barnabas to doing original and collaborative research on various complementary therapies. "This not only adds credibility, but is something that is sorely lacking in the field," says Perlman.
To further ameliorate these fears, patients must be referred to the complementary medicine program. "I don’t practice primary care medicine," says Perlman. "This center is like any other consultant. The physician gets a letter back from the center telling him or her [that] I have seen the patient, what I have done, and what the plan is. For many doctors, this is a kind of dream: the acupuncturist, the primary care physician, and the oncologist all sitting around the table — figuratively — discussing the patient’s care."
• Educate, educate, educate. Another way that Perlman met the challenge of tepid interest was to educate staff and the community on alternative medicine. He gives half-day symposiums and short lectures to the community and health care professionals about various treatments. "A lot of prejudice against this kind of treatment comes from ignorance," he says. "It’s hard enough to keep up with traditional medicine. This is one more thing, and something they [physicians] haven’t been taught. Let them see this is not voodoo medicine. There is evidence for some of this, for much of this. And there isn’t evidence for a lot of what we do in traditional medicine, too."
• Make your approach evidence-based. This is the hardest part, says Perlman, because it means dissuading many patients from using something they believe in. "I get patients coming in taking a lot of supplements, and I tell them, You don’t need a prescription for this,’" he explains. "But I tell them they shouldn’t make decisions without accurate information." Much of his clinical time is spent explaining what is safe, what may work, and what might be dangerous to patients. "This is the best way to help patients and also to address the concerns of physicians."
• Start slow. Although there are many therapies out there, Perlman believes in starting with what you can do well. "We have massage therapy and acupuncture now, and biofeedback and hypnotherapy." Next up will be hiring a nutritionist to do nutrition and nutraceutical counseling. Currently, patients are referred out for that. Patients also have access to experts at the health and wellness center at the St. Barnabas Hospital. A fitness center for people with medical conditions, it is staffed by people who have experience in creating fitness regimes that may help alleviate symptoms for many conditions.
• Build relationships. "The success of this venture will revolve around our ability to build strong relationships with health care providers in and out of our system," Perlman says. We have tried to be sensitive, to meet them one on one and let me see that I am a credible person."
While that may not be the most efficient use of Perlman’s time, it is the best way to get physicians who might be lukewarm towards alternative medicine to consider the prospect.
Bringing alternative therapies to health systems and hospitals is relatively new, Perlman says. "There is no gold standard out there, but you want to learn from what has been done. You don’t want to totally reinvent the wheel." (For more information on alternative medicine, see "Further reading on alternative medicine," above left.)
Finding good practitioners isn’t the issue, he adds. "There are a lot of great people out there doing acupuncture who know more about their healing arts than I do. The challenge for us in building this is not about where to put the needles. It’s about understanding the process of building this kind of program."
Further reading on alternative medicine
• Physicians’ Desk Reference for Herbal Medicines (1st Ed). 1998, Medical Economics Data. $59.95.
• Alternative Medicine Alert monthly newsletter, American Health Consultants, $219 ($269 for continuing education credit).
• Professional’s Handbook of Complementary and Alternative Medicines. Charles W. Fetrow, PhD, Juan R. Avila, PhD. 1999; Springhouse Publishing Co. $39.95.
• Alternative Medicine: What Works. A Comprehensive, Easy-to-read Review of the Scientific Evidence, Pro and Con. A. Fugh-Berman, MD. 1997; Lippincott, Williams & Wilkins. $14.95.
• Complimentary & Alternative Medicine: Legal Boundaries and Regulatory Perspectives. M. H. Cohen. 1998; Johns Hopkins University Press. $16.95.
• Complementary/Alternative Medicine: An Evidence-Based Approach. John W. Spencer, Ed. 1998; Mosby Year Book. $39.95.
• The Complete German Commission E Monographs. 1998; Integrative Medicine Communications. $189.
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