The Future of Medicine - Integrated Medicine

Integrated medicine is the new buzz word. The UK's first professional training programme for integrated medicine is about to be launched; integrated clinics and centres are opening and books on integrated medicine can be found in pretty much every health book store throughout the country.

In America integrated medicine, or integrative medicine, as they refer to it, is even further developed. The Duke Centre for Integrative Medicine was launched in 2002 as the Americas flagship integrative medicine centre. Located in North Carolina, its 27,000 square foot premises houses therapeutic treatment rooms, conference and workshop spaces, fitness facilities, meditation spaces, and a state-of-the-art kitchen for healthy cooking demonstrations, guest meals and catered events. Their integrative medical team consists of professionals from medicine, health psychology, life coaching, nutrition and the complementary therapies. In that same significant year, 2002, The Bravewell Collaborative was founded by a small group of philanthropists who were dedicated to transforming American healthcare by returning "the soul to medicine." They really have been a major driving force behind the advancement of integrated medicine in the USA. For example, and I can't help but admit that I am envious about this, they have funded a clinical network of eight integrated medicine clinics, raised the funds to produce a PBS programme on integrated medicine called The New Medicine, funded scholarships for 28 physicians to receive training in integrated medicine and funded the infrastructure and growth of the Consortium of Academic Health Centres for Integrative Medicine to its current level of participation-38 of the leading US medical schools.

So integrated medicine, the "medicine of the new millennium" is here to stay, but what exactly does integrated medicine mean, and how does it differ from integrated healthcare?

Defining Integrated Medicine (Is Not Easy)

There is not a universally accepted definition of integrated medicine - it's a definition in evolution. When I ask people at my lectures what they understand integrated medicine to be, I either get blank stares (the majority) or a couple will say something along the lines of "it's about combining the best of conventional and complementary medicine". That's partly true, but integrated medicine is so much more. These are two of the most illuminating definitions that I have come across.

The first is from The Consortium of Academic Health Centres for Integrative Medicine, that I mentioned earlier. Their mission (in their own words), is to help transform medicine and healthcare through rigorous scientific studies, new models of clinical care, and innovative educational programs that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing and the rich diversity of therapeutic systems. Their definition is:

Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.

Their Wheel of Health provides a wonderful illustration of the depth and breadth of the integrated medicine approach that they offer.

Another, longer definition, is from The Bravewell Collaborative

What has come to be called integrative medicine is a rapidly growing and highly credible field that seeks to integrate the best of Western scientific medicine with a broader understanding of the nature of illness, healing and wellness. In seeking to return the soul to medicine, integrative medicine is grounded in the healing relationship-practitioners and patients share information as well as compassion as together they seek ways to achieve optimal health. This approach to giving care focuses on healing the whole person and addresses a person's body (one's physical self), mind (one's mental and emotional state), spirit (one's personal connection to the transcendent), and community (one's web of relationships and environment). Informed by evidence, integrative medicine makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing and strives to achieve wholeness and health as well as cure illness and disease. Because an informed, empowered patient will make better choices about his or her healthcare and lifestyle options, patient education is an essential element of integrative care.

I remember the first time I read these two definitions - my heart lifted - this is what medicine should surely be about? Patient-centred relationships, compassion, addressing mind, body, spirit and environment, focusing on health and healing as well as disease and illness, and empowering patients to make better choices - these principles were bread and butter for my somewhat disillusioned medical self - they were inspirational and uplifting and surely describing the medicine of the future?

As time has passed, and with the experience that comes with practising for more than 7 years as an integrated medical doctor, I have reflected long and hard on the subject of integrated medicine and come to a couple of realisations that have brought me (in a positive way) down to earth. Whereas I used to see a future in which all people would be offered within the NHS, the width and depth of integrated medical services, I now see a different future, one that requires me to distinguish integrated holistic healthcare from integrated medicine. They are not the same entity.

INTEGRATED HOLISTIC HEALTHCARE

I define integrated holistic healthcare as the provision of the best possible level of whole-person care, using the most effective and cost-effective approaches from conventional and complementary medicine for the purpose of helping individuals achieve optimum health and healing. Put another way this is providing the best of conventional and complementary medicine within a holistic framework. This exists to a degree already, and I do see a future where this will be offered formally by the National Health Service. However it is inevitable, in my opinion, that only a handful of complementary therapies that have had their effectiveness and cost-effectiveness fully evaluated will be invited to join the club. Outside of the NHS, I can see more privately owned integrated health clinics opening that offer, for example, a holistically-informed GP (as a gatekeeper) working alongside a team of complementary therapists.

Providing access to a number of different options and therapies however is not integrated medicine, its integrated healthcare, integrated medicine is much more. If both are to advance my feeling is that we need to make clear this differentiation.

The following is my own perspective on what integrated medicine is. The two definitions that I shared earlier are great, but incomplete.

I define integrated medicine as a personalised, person-empowering approach to healthcare, one that is committed to helping individuals experience their fullest potential for health, healing and personal growth. Rather than exclusively focusing on recovery from disease and distress, it embraces a wider vision of health, one that seeks to help individuals thrive and flourish - physically, emotionally, mentally and spiritually. To achieve this integrated medicine makes use of all of the appropriate self-help, conventional and complementary therapeutic assessments, tools and approaches available, and wherever possible does so according to the evidence of their effectiveness. Underpinning the integrated medicine approach is the unique relationship created between the practitioner and patient, the commitment of the patient to learning new skills, acquiring new knowledge and transforming perceptions, habits and attitudes, and the skills, awareness and presence of the practitioner.

Integrated medicine is not just about helping individuals recover from disease and distress, but helping them discover how to thrive and flourish as human beings.

The Future

Do I see integrated holistic healthcare - conventional and complementary medical practitioners working more closely together to improve therapeutic outcomes and patient's quality of life as the future? I do. Do I see integrated medicine becoming widely practised and widely desired? The honest answer is no, not for the moment. Despite there being a considerable amount of interest in holistic ways of living, spiritual growth and CAM approaches very few people are actually willing to translate that knowledge or interest into action. It's easy to talk about change, to talk about treating mind, body and spirit, but who is really committed to changing habits, and learning new skills? The truth is, most people want quick fixes, and fortunately many conventional and complementary medical practices is set up to provide that. And as anyone who is committed to personal inner work knows, waking up, getting real and facing reality is hard work - it requires courage and a commitment to healing and personal growth.

Although not everyone is ready to wholeheartedly embrace integrated medicine, I do believe its time will come.

Dr Mark Atkinson is an integrated medical doctor, Founder of The British College of Integrated Medicine www.integratedmedicine.org.uk , Chairman of The British Society of Integrated Medicine and author of The Mind-Body Bible His website is www.drmarkatkinson.com

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