Dawn Marshall suffers from undifferentiated connective tissue disorder. Symptoms range from chronic pain and swelling to extreme fatigue and sleep problems. The Duke employee is an active member of society but constantly feels ill. Conventional medicine has not provided her an acceptable form of relief—Marshall believes prescribed medicines often have similar side effects to already existing symptoms. As a last resort, she turned to the Duke Center for Integrative Medicine for help.
Currently located within the Duke Center for Living, the Duke Center for Integrative Medicine has offered a patient-centered approach to health care for the past four years. As an emerging field, integrative medicine combines the effectiveness of conventional medicine with the benefits of carefully selected alternative therapies, including acupuncture, herbalism and meditation. Together, clinicians treat the body as a whole rather than focusing on specific symptoms.
“I was seeking alternative means of care for problems that my primary care physicians were really not able to help me with,” Marshall said. “They tried, but have not been able to improve the quality of my life. Integrative medicine seems more natural.” With the care of doctors who have pioneered this form of medicine, Marshall’s pain has subsided.
Duke is a recognized leader in this type of health care, partly through the vision of former Chancellor for Health Affairs Dr. Ralph Snyderman. Always a proponent of prospective and personalized health care, Snyderman believes integrative medicine could be the cure for the depersonalization of health care.
“We currently spend $1.5 trillion a year on health care, but we aren’t getting our money’s worth,” Snyderman said in a statement included with DCIM’s publicity materials. “What has been missing in America is a health system designed to facilitate the ability of individuals to enhance their health by being more involved in their care and helping them focus on preventing those illnesses most likely to cause them great harm.”
And America seems to want a change. A 1998 study reported that 40 to 42 percent of Americans have tried alternative medicines in order to improve their health, and 91 percent of physicians acknowledged that patients have mentioned that they use or have considered using alternative therapies. Linda Smith, director of programs at DCIM, noted that people are also spending more money on alternative approaches than on conventional medicine. “The public is saying that they want to learn from the best of both worlds,” Smith said.
DCIM Director Tracy Gaudet believes alternative medicines are often more effective than conventional medicines—especially in areas like chronic pain, which Gaudet feels are not addressed well by conventional medicine.
“The therapy [of alternative medicines] is less invasive and less costly. The potential benefit is effective treatment without as much risk and as much cost,” Gaudet said.
But even with the demand for alternative approaches, one stigma integrative medicine must first overcome is patient and professional skepticism about its effectiveness.
“I did have a healthy skepticism,” Marshall said. “I was concerned it would be too far out there, or too new age. I thought they would work with all natural methods and not integrate with conventional medicines. I think Duke has done a good job at integrating the normal medicine with the integrative side. I was concerned that that was not going to be the case.”
And clinicians have diligently worked to create a balanced treatment. Gaudet said that doctors often help patients sort through what medicines they currently are taking. She added that “most people leave here taking less self-prescribed medications and supplements.”
Before the patient even arrives for his first appointment, a doctor asks him to fill out a health questionnaire, which includes questions about spirituality and health history and is designed to sort through the needs of the patient. “It is surprising that some patients have never thought about their spiritual side before,” Gaudet said.
The typical first appointment lasts about an hour and involves some diagnostic testing as the doctor begins to understand the patient and his illness. The doctor also introduces the “Wheel of Health”—a wheel with wedges of the different aspects of health, which help patients visualize problem areas.
“If the patient is just interested in maybe one thing, we will respond to that interest,” Smith said. “Other patients want a more comprehensive look at the multiplicity of symptoms and health history and preventing further risk of complications down the road.”
After specialists and a multidisciplinary team review the case, follow-up appointments involve the creation of a customized wellness plan.
“My doctor went over issues and concerns of why I was there that day,” Marshall said. “The doctor made recommendations on my health plan. It was easy to follow and included short-term goals and long-term goals—all of which I had a say on.”
Each patient then chooses a plan that involves one to four follow-up appointments and a personal wellness coach who checks in with the patient via e-mail to verify that the personal plan is working.
Integrative health is only becoming more popular. Some insurance plans now cover alternative medicines, and Duke has even offered a plan to its employees that includes integrative medicine.
With educational classes for health professionals, conferences and a new building specifically designed for integrative medicine, Duke’s Center for Integrative Medicine seems poised for the future.
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