“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.”
—Consortium of Academic Health Centers for Integrative Medicine
The following is a brief summary of some insights from the path I traveled to come to an understanding of the type of medicine described in the Consortium’s definition above. For me the journey is just in its nascency, although I hope the steps I took may shed some light on an approach to patient care that is as yet not fully incorporated into traditional medical education.
A Background
As with many of the medical students I have met with an interest in integrative medicine, I had a series of experiences prior to medical school that brought me to this particular niche within the medical field. For me, the entry point was traditional Chinese culture. Previously I would tell people that it was my father reading Zen stories to me as a child or my Chinese martial arts training or taking summer courses at the New England School of Acupuncture that hooked me. Now I see that it really was a culmination of all of these pieces of traditional culture that spoke to me: values of respect, humility and dedication as well as an understanding of the body not by its individual pieces, but by how our bodies function as a whole and interact with the world around us. Shaped by these philosophies, I began my journey towards integrative medicine.
Whether the insight comes from a life experience, a class, a teacher or a parent, this spark lights the way for an understanding into the philosophy of healing-oriented medicine as well as the curiosity to pursue it further.
Clinical Practice vs. Scientific Research
“The way to change the current medical system is by publishing more and more research on CAM (Complementary and Alternative Medicine) practices.” One of the principal investigators I worked with at Harvard Medical School’s Osher Research Center for Complementary and Integrative Medicine in 2007 said these words to me which, at the time, instilled in me the desire to contribute to the ever-growing evidence base of traditional Chinese medicine. Research studies provide a language for traditionally-trained physicians to communicate with each other about the effects of integrative therapies. It helps in writing treatment protocols such as the NICE criteria (National Institute of Clinical Excellence) for lower back pain, which recommends the use of acupuncture as part of the recovery plan. And perhaps in the future, the strong research base in these various healing modalities may persuade insurance companies to cover their cost.
Despite all of the opportunities that unfold with further research, as I helped coordinate clinical trials on tai chi at Osher, I began to realize the limitations inherent in some of these studies. For example, there have been hundreds of studies indicating that tai chi improves clinical outcomes in patients with rheumatoid arthritis, osteoarthritis, tension headaches, diabetes, congestive heart failure, COPD, insomnia and vestibular disorders, among other conditions. The difficulty comes in parsing out tai chi’s mechanism of action from all the confounding factors inherent to these studies. Possible “active ingredients” include mindful movement, increased physical activity, community activity, teacher-student relationship, consistent practice of an activity or a bio-energetic component. The next question I struggled with in researching certain integrative therapies is that the nature of many of these healing modalities is holistic as opposed to reductionist. Isolating a single herb to test its efficacy may be beneficial; however, many traditional medicines were originally prescribed as a combination of multiple herbs in a formula, much like modern medicine’s combination therapy in cancer treatment. Perhaps it is not a single herb that has the most benefit, but rather the cumulative effect of multiple herbs together.
Finding a Community
On entering medical school, there were only two or three other people in my class who showed a sincere interest in pursuing the study of integrative medicine in their career. The curriculum also did not offer the opportunity to further understand this field of medicine. On looking to the medical community nationally, however, I discovered what was, in my mind, an ever-growing group of medical students and physicians dedicated to bringing complementary therapies and their philosophies to conventional medicine. My first experience with this group was at the American Medical Student Association’s annual “LEAPS into IM” week-long retreat at Kripalu yoga center. This week opened my eyes to learn how physicians are incorporating integrative medicine into their practices and how they are working on a larger scale to educate medical students across the country on this philosophy. In addition to these lessons, my eyes opened up to the passion and interest of other medical students across the country who shared my views on the way medicine can be practiced differently than it is today. The students embraced each other warmly and supportively as we shared our experience with being somewhat on the fringes of Western medicine. Similar bonding happened at the University of Arizona’s Integrative Medicine elective, which brought to mind not only a variety of ways to treat patients, but also the importance of physician self-healing. I then became aware of the Consortium of Academic Health Centers for Integrative Medicine as well as the American Board of Holistic and Integrative Medicine–two national organizations that coordinate dialogue throughout the medical community about integrative medicine research, education and clinical practice. With a caring community of physicians and students united together, not only is the practice and philosophy of integrative medicine more alive on a grand scale, but the fire within me burned more brightly as I knew I had found my place in medicine–the place where I could make the biggest difference in others’ lives and my own life.
Delving Deeper
After understanding the structure of integrative medicine in the medical system, I began to explore the various modalities that fall under this umbrella term “integrative medicine.” At the University of Arizona Integrative Medicine elective, I began to delve into energy medicine–the chakra system, Reiki and shamanic practices. Learning briefly about osteopathic manual therapy during this elective, I had the opportunity to practice more hands-on medicine during a month-long rotation at the Maine Dartmouth Family Medicine Residency program. As an MD, I was able to tap into the importance of touch in patient encounters–something that we glossed over during our physical diagnosis lectures in school. Combined with my background in traditional Chinese medicine, I felt more complete in my knowledge of medicine and how best to approach patient care. Rather than looking at our conventional training as the main road, with complementary therapies as minor side streets, I understood medicine more as a large pie with many slices–Western medicine being only a small piece that I can choose to use in my practice, while not ignoring the benefits that other slices may have for my future patients.
Giving Back and Moving Forward
With great respect and appreciation, I bow to all of the teachers I have had along this journey so far. I was fortunate enough to share many of my experiences with students and physicians in my home institution through a complementary and integrative therapies health fair, a complementary and integrative medicine elective, and an integrative oncology initiative, all of which blossomed from the collaborative efforts of several students equally as passionate and knowledgeable about these practices and how they may allow for a health and healing oriented care system now and in the future.
As residency at the University of Wisconsin Family Medicine program in Madison fast approaches, I take these few moments to empty my cup into this essay, allowing room and humility for new experiences, knowledge and wisdom that may continue to shape how I live both as a physician and as a human being.
Columnist Emeritus
University of Massachusetts Medical School
Vinny is a Class of 2013 student at the University of Massachusetts Medical School, applying to family medicine residency programs. Passionate about strengthening the body's own healing mechanism, he is invested in learning more about integrative medicine and hopes to practice family medicine in combination with Chinese medicine and osteopathic manipulation therapy in the future. He loves his fiancée dearly and is looking forward to their marriage in May 2013!
