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Perspectives on integrated health

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perspectives, integrated health, discussion papers

Dr Karine Nohr and Dr Catherine Zollman

treeimagefornewsletterIntegrated health embraces ideas that are fundamental to the delivery of good general practice

We are more than just our physical bodies and there are psychological, spiritual and societal dimensions to our well-being. Our awareness that healing may be hindered by difficulties in ANY of these areas allows us to address the bigger picture.

We are naturally self-healing organisms – having an innate capacity to heal and to mend. Therefore, treatment should seek to enable and support that process. As Hippocrates said, ‘Everyone has a doctor within; we just have to help it work. The natural healing force within each one of us is the greatest force in getting well’. Much of our work as GP’s is about harnessing that force.

It prioritises the importance of lifestyle – increasingly recognised within conventional medicine, well-being must embrace attention to diet, exercise, work, relationships, and so on and so forth.  The WHO definition of health is that ‘health is not only about the absence of infirmity and disease but also a state of physical, mental and social well-being’. GP’s work holistically, recognising the potential of mobilising the patients themselves in their own self-care, both at preventative and interventionist levels.

It recognises the importance of the doctor-patient relationship in the healing process – this is not simply a contractual relationship, but one that is based on care, empathy and trust, in an honest and mutual partnership that upholds the different nature of the expertise of both of its members. We often have longstanding relationships with our patients and are finely attuned to their ideas, beliefs and expectations, in a familiar environmental context that may embrace their family, their work and their culture.

There are many paths to healing – the more we are educated in the diversity of the therapeutic toolbox, the more we can be patient-centred in our approach. In the words of NICE chair Sir Mike Rawlins, as he concluded his 2008 Harveian Oration: ‘hierarchies of evidence should be replaced by accepting – indeed embracing – a diversity of approaches’. So much of the time, we work with patients who have no formally-recognised diagnosis, too much of the time we fail to enable them in their endeavours to improve their well-being, and it is therefore imperative that we need to ‘think outside of the box’.

Recognising that the conventional therapeutic toolbox is limited and too often simply not useful, Integrative Medicine often does embrace ideas that are outside conventional medicine.  Contrary to what some critics may say, the Integrative Health Movement encourages critical evaluation of all interventions. The role of the College, in enabling that analytic process, is of vital importance, as well as having an essential role in terms of education, support and joined-up thinking, for both the lay patient population and the professional healthcare workers themselves.

Where an integrated medicine approach is central to general practice – preventative medicine and risk factor reduction

We increasingly recognise that using medication alone to lower cholesterol, aid weight loss, prevent bone loss or to lower blood pressure without effectively addressing and changing the lifestyle factors which contribute to the risks of developing chronic disease is like continuing to mop the floor when the sink is overflowing, without making sure the tap is turned off. Using IM approaches, which improve motivation, use Nutrition therapeutically, and develop exercise and mind-body practices that reverse some of the chronic inflammatory processes at the root of many chronic diseases, may reduce the need for medication, and/or increase its effectiveness and sustainability.

Chronic diseases where conventional approaches alone may be sub-optimally effective

Migraine Irritable Bowel Syndrome

Fibromyalgia Osteoarthritis

Chronic pain

Chronic anxiety and depression

Pre-menstrual syndrome/ Pre-menstrual dysphoria disease

Type 2 diabetes, and many other conditions.

Broadening the range of approaches that are available and involving patients in using these and actively engaging with integrated self-management programmes improves patient satisfaction, functional outcomes and often encourages other positive lifestyle changes, such as increased exercise, better stress and weight management etc., which reduce the risks of other chronic disease.

Diseases where there are effective conventional treatments but where adverse effects of treatment may cause problems with compliance and/or quality of life

Cancer

Chronic pain

Severe depression

Chronic inflammatory diseases

Parkinsons Disease, and many other conditions.

Using IM approaches such as relaxation, visualisation, acupuncture, tailored exercise programmes including approaches like yoga and Tai Chi, psychosocial support, improved nutrition, can improve tolerability of conventional treatments and help patients regain a sense of control over their symptoms. By improving compliance, disease outcomes are often favourably affected.

Medically unexplained symptoms – patients without a clear diagnosis

Conventional medicine often finds itself at a loss as to how to deal with these patients. Patients continue to suffer, often with severe and life-limiting symptoms. IM approaches with non-biomedical perspectives can often make sense of symptoms in a way which patients find helpful, and can sometimes help to stimulate or harness self-healing, and improve function and quality of life.