James S. Lin, MD, and Folashade Omole, MD, Department of Family Medicine, Morehouse School of Medicine
An integrative medicine curriculum should be instituted in every family medicine training program to meet the demands of our patient population. The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), whose members include 42 medical schools in the United States, defines integrative medicine as a healing-oriented medicine that takes account of the whole person, including body, mind, spirit, community, and all aspects of lifestyle.1
Complementary and alternative medicine (CAM) is widely used in the United States. Approximately one out of three Americans use some form of CAM modality, according to a Harvard study.2 Popular CAM modalities include acupuncture, herbal medicine, nutritional supplements, massage therapy, chiropractic manipulation, imagery, biofeedback, and spiritual healing. Patients choose CAM because it fits their personal values. They believe that many CAM modalities are less invasive than conventional treatments and that natural products are safer than prescription drugs.3 Whether or not natural products are safer than pharmaceutical drugs is debatable, but in general, they are.
So why should we incorporate integrative medicine into family medicine training? First, primary care physicians simply cannot overlook the fact that consumer demands are too large to ignore. Therefore, we must train family physicians to become knowledgeable in discussing different CAM modalities and their safety, even if they are not comfortable or willing to incorporate CAM into their practice. Secondly, growing evidence is showing that many CAM modalities are effective and safe. This implies that we would not be practicing best medicine if we do not integrate CAM into conventional medical training. Thirdly, integrative medicine emphasizes positive lifestyle change and prevention, which could potentially rescue our national economy by decreasing unnecessary health care spending. Finally, the Arizona Center for Integrative Medicine at the University of Arizona has defined the goals of integrative medicine to include (1) establishing a therapeutic partnership between client and practitioner, (2) facilitating the body’s innate healing ability, (3) neither rejecting conventional medicine nor embracing CAM practices uncritically, (4) realizing that good medicine is grounded in good science and open to new paradigms, and (5) focusing on health promotion, disease prevention, and treatment of diseases. These goals are congruent with the principles of family medicine and therefore family medicine is the natural vehicle for the incorporation of integrative medicine.
The two main barriers to starting a successful and sustainable integrative medicine curriculum in our program were unavailable funding and not having expert faculty in the field. Once extramural funding was secured, we then had to overcome the obstacles of implementing and integrating CAM. We started off with having a nonphysician acupuncturist on staff. His presence and service stimulated further interest in the holistic approach to health care among providers in our department and patients we serve. For our residents to get a better understanding of what our patients’ needs were from an integrative physician’s perspective, two of our faculty members pursued and completed acupuncture training. Another faculty member has also completed an integrative medicine fellowship and is finishing acupuncture training. We changed our gynecology block rotation into a longitudinal experience and replaced it with a 1-month block rotation in CAM. Currently, we are in the process of replacing our CAM experience with an integrative medicine curriculum. We have also started to recruit other community CAM providers such as chiropractors, massage therapists, herbalists, and homeopathic and naturopathic physicians to help train our residents. We still have a long way to go to accomplish our goals, but we have started the ball rolling.
1. http://www.imconsortium.org/about/home.html. Accessed May 12, 2011.
2. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N. Engl J Med 1993;328(4):246–52.
3. Astin JA. Why patients use alternative medicine: results of a national study. JAMA1998;279 (19):1548-53.