Conscious Choice: Hospitals Integrate Alternative Care

November 2001

Hospitals Integrate Alternative Care

by Molly Birk

These days, in the search for an integrative care practitioner, options abound. With the growing popularity of alternative and complementary medicine among Western practitioners, new facilities have opened up across the country, offering a variety of treatment options. Some integrative physicians have chosen to establish their own practices, while others have joined up with one of the newer, hospital-based centers that offer a greater selection of practitioners within a more conventional clinical and academic setting.

Until the early 1990s, alternative medicine was largely an underground industry. Practitioners operated out of storefront clinics and their homes, relying mainly on word of mouth to build their clientele. But over the past decade or so, the American public has grown increasingly aware of alternative therapies, and the demand for qualified, easily accessible providers has risen. Western doctors have seen increasing numbers of patients seek alternative therapies without their consultation. It is currently estimated that more than 40 percent of patients today use some type of complementary medicine — whether it be herbal supplements, acupuncture, massage therapy — and many of these patients do not even tell their primary care physician. Some patients are afraid that the doctor will not approve, others are not aware of potential contraindications of different treatments.

Whatever the reason, more doctors are beginning to recognize the necessity for communication between a patient’s primary care physician and his or her complementary medicine practitioners. In response to this need, hospitals around the country have poured big bucks and big research into the development of integrative care centers that operate within the hospital system in order to better monitor patients’ use of alternative health care methods.

Integrative Care Centers Arise

The Northwestern Memorial Physicians Group’s (NMPG) Center for Integrative Medicine (CIM), opened in 1997 and was created originally to serve the needs of Northwestern’s doctors. "Market research was telling us that patients were seeking alternative services without the knowledge of their doctors," says Drew Palumbo, Vice-President of Business Affairs for NMPG. The initial plan, Palumbo explains, was to provide a center for integrative care within the hospital system which would serve the needs of hospital patients seeking alternative medical care. This way, a doctor who had diagnosed a patient with a particular ailment, say lower back pain, could then offer the patient a wider range of treatment than they would previously have had access to. The patient could then visit the center’s M.D., who would evaluate him or her and recommend a course of treatment involving one or several of the other practitioners at the center. In the case of the patient with lower back pain, a visit to CIM’s massage therapist may be in order, or perhaps the acupuncturist. These days, only about half of CIM’s patients come from within the NMPG system. The other half are referred from other physicians, or come independently after hearing about the center.

Pros and Cons

There are multiple benefits to the hospital-based approach. The practitioners at the center work together to diagnose, treat, and prevent conditions. Patients get the variety of care they seek, while doctors can more closely monitor the treatments given. Patients who had previously only seen an allopathic (Western) physician may not be aware that such treatments are even an option, or don’t know how to go about selecting the provider. A hospital-based integrative care center takes some of the guesswork out of the selection.

Western medicine has for the most part represented itself as a disease-treating, rather than a disease-preventing, system. The hospital based integrative care centers take away some of allopathic care’s hard edge. According to Dr. Karen Koffler, a Board-certified internist practicing at Evanston Northwestern Healthcare’s (ENH) new Park Center in Glenview, integrative care allows Western-trained doctors to ask, "How can we empower the patients to treat themselves?" Many patients who are discouraged by Western medicine’s lack of focus on prevention, but feel they can’t abandon it completely, feel right at home at a place like the Park Center.

While many patients are irritated by Western medicine’s skeptical attitude toward all things alternative, some practitioners enjoy the criticism. Koffler, who was trained at the University of Arizona’s integrative medicine program headed by Dr. Andrew Weil, prefers to practice within an academic setting because she must always ask herself if her treatments are making a difference. "Conventional medicine demands that you evaluate and justify what you do," she says. This self-criticism, however, can also be a drawback to the hospital-based centers, which may be more hesitant to try healing methods that are not backed by academic research. On the other hand, Western medicine is not immune to criticism from alternative practitioners. "I do feel a responsibility to educate the Western medical world," says Polly Liontis, a shiatsu practitioner for ENH.

Practitioners at hospital-based centers agree that the environment lends credibility to an industry that is still trying to find acceptance in mainstream America. While the patient base of small practices is largely educated in alternative medicine and methods, many of the patients at hospital-based centers are there on recommendation from their general practitioner, or because they didn’t know where else to turn for help. Liontis, who also runs her own home-based practice, attests that many of her patients at ENH come to the center because they have not been able to get relief for their condition through Western medicine, and are "doing this as a last resort."

Many of the patients who enter integrative care centers skeptical about the methods find it reassuring to have a Western-trained M.D. on the staff. Patients also seem to like the credibility that academic research can provide. "I think people have problems with practitioners that say,‘Oh, do this, do this,’ and have nothing to back it up with," says Dr. R. Charles Dumont, a pediatrician and acupuncturist at Loyola University. The prevailing belief among staff at hospital-based centers is that having an M.D. present allows patients to be more accepting of unfamiliar methods of treatment.

Despite the appearance that integrative care has become "institutionalized" by its move into the hospital setting, practitioners are still mindful of their roots, maintaining a focus on treating the whole patient, not just the body. Dr. Theri Griego-Raby, director of CIM, says that though she went to school to study Western medicine, alternative medicine is part of her heritage. Born in New Mexico of Mexican ancestry, Raby has always been aware of natural healing methods, and has always had the desire to incorporate them into her own medical practice. "It was something I was raised with culturally," she says. In addition, Raby believes that the holistic approach of the center has been well received by patients at the hospital. "Patients really want this," she says.

Another benefit of seeking treatment from an integrative care center is the possibility for reciprocal referrals. A massage therapist, for example, has the ability within a hospital-based center to refer a chronic pain patient to a rheumatologist or other specialist within the hospital network. Doctors, on the other hand, can send patients to the integrative care center for treatment. At this time, the referral system benefits complementary care providers most. Independent practices lack the built-in patient base afforded by a hospital setting."The referral base is really critical to keeping us afloat," says Raby.

While practitioners for the most part enjoy working in a large practice, some admit that running their own practice has definite benefits. Nicole Hohmann, an acupuncturist at ENH who also operates a private practice one day a week in a rented space, says that the group setting can be noisy at times. She gives the example of trying to treat a patient while there are conversations in progress in the hall outside her treatment room. But in Hohmann’s private practice, "the treatment environment is very much under my control," she says. Despite the sometimes less than ideal setting, Hohmann says she enjoys the camaraderie between the center’s practitioners — something she doesn’t get in her private practice.

Business As Usual

A dilemma particular to large practices, however, is that the practitioners are employees, rather than shareholders, of the business. They are not financially or legally invested in the practice, and they may not stay for long. Patients looking for a more personal relationship with their doctors may be unhappy when there is turnover. On the other hand, the system remains in place so that the practice remains in place, even when practitioners change.

Of course, the main problem facing integrative care practices large and small is a lack of insurance coverage. Patients must pay out of pocket for most "alternative" treatments, which limits the patient supply to those who can afford to pay cash for care. Some hospital administrators worry that, while this system is fine when the economy is good, patients will choose to sacrifice care in the face of a recession. Hospital-based practitioners do, however, seem virtually unanimous in their confidence that insurers will expand their coverage as integrative care becomes more mainstream.

The Future of Integrative Care

Dumont sees prosperity and growth for integrative care centers in the future, as long as academia remains invested. "I think these centers are going to grow as more and more evidence comes out [supporting complementary medicine]," he says. Economics, patient demand, and acceptance from the Western medical community, Dumont believes, will interact in an upward spiral to increase the availability of integrative care. As more people practice in academic-based centers, hospitals will conduct more research, which will create more interest in integrative medicine, increasing the demand for qualified practitioners in, you guessed it, hospital-based centers.

According to Koffler, there are two forces within medicine today: that of the entrenched biomedical model on which Western medicine is based, and the grassroots movement behind the inclusion of complementary medicine. Reconciling these two forces, Koffler believes, is the key to a prosperous future for integrative care. "When you combine systems of thought," she says, "you have the best chance of treating patients successfully."

Resources

Evanston Northwestern Healthcare Park Center, 2400 Chestnut, Glenview, IL 60025. 847-657-3510

Loyola University Health System, 2160 S. First Avenue, Maywood, IL 60153. 708-216-9000. Click here for more information on services offered at both the Maywood location and at Loyola’s Integrative Medicine Program in LaGrange Park, IL.

Northwestern Memorial Physicians Group Center for Integrative Medicine, 680 N. Lake Shore Drive, Suite 815, Chicago, IL 60611. 312-926-2224

Recommend this page to a friend

Top Ten pages recommended to friends: