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Informații din acest site au fost preluate din cartea Integrative Medicine de David Rakel
Reducing Suffering
The secret of patient care is patient care.
Good care and weak medicine can give a better result than poor care and strong medicine.
At the heart of ensuring health and healing is our ability to alleviate suffering. This is not something we learn in a book but requires exploring our own suffering before understanding how to help others with theirs.
We are our first patients, and part of our continuing education requires a recurring exploration of our inner self so that we can understand what it means to be truly present without judgment. By learning this, it is helpful to understand how suffering influences the severity of pain and the quality of our lives.
Pain and suffering are closely related, but not the same. Pain is as normal as night and day; suffering is not. Pain helps protect us from further harm; suffering is an opportunity to learn.
Suffering influences how our body perceives pain — "the more I suffer, the more pain I experience."
Our job is to reduce suffering so that we can reduce pain to its most physiological cause. In treating someone's suffering, we can often make the pain more tolerable. In reducing the severity of the suffering, we can often avoid the long-term medications that are used to suppress the symptom.
It is often through our listening and presence that we are most able to heal suffering. When there is no "correct" or "medicated" answer, we must not stop: we continue with energy therapies; we move on to cleaning the energetic aura; we continue with energy meridian therapy; we also address Holotropy; we will also use Hypnosis.
Our human compassion, connection and unconditional positive regard always work, even when our tools don't. Compassion is one of the most important parts of our work and is why we heal in the process of helping others do the same.
5.Does the therapy fit the patient's culture and belief system?
In our conventional medical system, we have traditionally drawn the patient into our thinking paradigm by telling them what they need. This method is often necessary for acute illnesses, but for chronic conditions where there is no "right" answer, we will be more effective if we provide treatment plans that best match patients' belief systems. In this way, we can activate the internal healing response, a process we know as the "placebo effect". Rather than dismissing this as a nuisance, the skilled clinician will use it to enhance healing. Becoming able to integrate healing methods from various cultures will further enable the clinician to better match therapy to the individual. The art of medicine may lie in the clinician's ability to activate this response without deception. We should give patients what they need before we give them what we know. It's nice when we have knowledge about what our patients need, but this often requires collaborative treatments with an integrative team of providers working toward a common health goal for the patient.
4. What is the cost?
One of the first duties of health care personnel is to educate the masses not to take drugs. The cost of healthcare is different from country to country. America has the most expensive health care system in the world, spending $5,440 per American each year. The second most expensive healthcare system is in Switzerland, which is 47% cheaper. A large influence on this cost is our over-reliance on technology and pharmaceutical agents for the treatment of disease. Focusing on disease before health further fragments care and drives up medical costs. Creating a better balance in health care delivery where the primary care provider is able to use their knowledge through relationship-centered care to help the body heal itself will improve care and reduce costs. Despite spending more on providing health care than any nation in the world, the United States ranks 15th in quality compared to the top 25 industrialized countries, according to the World Health Organization's 2000 report. The success of the higher ranked countries stems from a strong primary care infrastructure. Those primary care providers who offered a range of alternative therapies were found to have reduced hospital referrals and treatment costs. Unfortunately, not all Integrative Medicine practitioners are primary care providers, and the use of alternative medicine without the direction and continuity of these clinicians will further fragment care and increase costs. The key is to incorporate this integrative philosophy into medical education so that primary care is improved and alternative therapies can be used to better enable the provider to facilitate health. Alternative therapies are generally low-tech and low-cost and reduce the need for more expensive interventions. Integrative Medicine users report that their use of prescription drugs and conventional therapies is decreasing. When CAM was combined with biomedicine, one study (Sarnat RL, Winterstein J: Clinical and cost outcomes of an integrative medicine IPA. J Manipul Physiol Ther 2004; 27:336-347) showed a reduction in pharmaceutical use by 51, 8%, the use of surgery and outpatient procedures by 43.2%, and a reduction in hospital admissions by 43%. There are many economic incentives for America's doctors to do interventions and little for them to do the lifestyle education that would reduce the need for expensive pills and procedures. The philosophy of integrative medicine has the potential to lead to huge cost savings, improved efficiency and quality of care.
3. What is the harm potential?
It can be dangerous if we look at the evidence only for the potential benefit of a therapy, without looking at the evidence of potential harm or impermissibility. The integrative medicine practitioner uses the least harmful and least invasive therapy before more invasive therapies. It is important that we continue to research not only the potential benefits but also the potential harms of the therapies we prescribe. Because of the potential risk of external health influences, we should encourage lifestyle habits with the least potential risk (whole food nutrition, stress reduction, moderate exercise, spiritual connection) so that fewer high-risk interventions are needed, resulting in the least potential risk of harm.
2. What is the evidence?
The scientific model allows us to understand which therapies have the greatest intrinsic value. Once we have analyzed the evidence, we can combine it with the "art of medicine" to further stack the deck in favour of a positive response. Unfortunately, the amount of evidence we have to rely on is limited. Of the 2014 treatments reviewed in healthcare, 15% were found to be beneficial and 47% were not adequately tested.
It is quite expensive to do good research, and the therapies that achieve the highest quality of evidence are often those therapies that have the greatest potential for economic gain.
Unfortunately, there is little economic incentive to promote therapies that result in cures in our current health care model.
The onus is on academic institutions and governments to provide funding for research into all potential therapies, despite their lack of economic rewards.
Key questions to ask before prescribing therapy
1. Does the therapy result in symptom resolution or symptom suppression?
Our initial goal should always be to resolve the symptom, so we need to use fewer external influences to maintain health. This often requires exploring with the mind both the energetic and spiritual aspects of a symptom (see Knowledge Base Web page).
A symptom is our body asking for some kind of change. If we simply suppress the symptom without understanding what might need to go away, the symptom is likely to recur or appear in another part of the body.
In order to favour the emergence of symptoms, we must explore both external and internal reasons for their expression. An external therapy (medication, acupuncture, surgery, bodywork, energy therapy) will not have lasting benefits unless coupled with an internal exploration of why the symptom exists (emotions, stress, meaning and purpose, energy abnormalities, past lives etc).
The physical and the non-physical are inseparable, and unless we address both, it is difficult to resolve the symptom. If we have explored both and found no underlying internal source, then it is appropriate to suppress the symptom with our tools to reduce suffering and improve quality of life;
The term integrative medicine has emphasized the importance of using evidence to understand how best to integrate alternative therapies into the health care model in many countries and has allowed for a better understanding of how these therapies can be used to facilitate health and healing. This evolving understanding has helped influence positive changes in the healthcare system of many countries.
The goal of the Integrative Medicine practitioner is to Reduce Patient Suffering
Circular diagram for Integrative Medicine
The public interest influences change
The deterioration of the patient-provider relationship, the overuse of technology, and the inability of the medical system to adequately treat chronic diseases have contributed to the increased interest in complementary and alternative medicine, especially Integrative Medicine.
The public sent their message by going to the Alternative Medicine Clinics and by investing from their pocket for treatments other than allopathic ones. In fact, there were more visits to Alternative Medicine Office providers in the early 1990s than to all primary care physicians, and patients were paying for these visits out of pocket at an estimated cost of $13 billion.
This trend continued through the 1990s, with 42% of the public using alternative therapies, increasing spending to $27 billion from 1990 to 1997.
Patients are also demanding less aggressive forms of therapy and increasingly suspect the toxicity of pharmaceutical drugs. Adverse drug reactions became the sixth leading cause of death in hospitalized patients, and in 1994, herbal products were the largest growth area in retail pharmacies.
Research shows that people find complementary approaches more aligned with their "own values, beliefs, and philosophical orientations toward health and life." The public, before the Medical Institutions, realized that health and healing involved more than pills and surgery. Less invasive, more traditional treatments such as nutrition, natural products, meditation, massage, acupuncture and others that were neglected during the explosion of medical science and technology are now being rediscovered with great enthusiasm:
A Brief History of Integrative Medicine
More technology, less communication
The system encourages patients to believe that tools are the answer to their physical woes and discourages them from paying attention to the interplay of mind, community, and spirit. Technology is the golden calf in this scenario. We have become dependent on it, and overuse has widened the communication barrier between patient and provider. The old tools of the trade – ratio, intuition and laying on of hands etc. – were used less and less as powerful drugs and high-tech interventions became available. Doctors are dissatisfied in part because of the loss of autonomy in the practice of medicine. Patients are dissatisfied in part because they feel they are not getting the attention they need. The most upset are those with chronic medical conditions whose illnesses do not respond well to the treatments of specialist medicine. This comes at a time when the incidence of chronic and degenerative diseases is at an all-time high. Diseases such as heart disease, diabetes, irritable bowel syndrome, chronic fatigue and chronic pain syndromes are quite common. They require evaluation and treatment of much more than just one organ. Patients have begun to realize the limitations of Western medicine and want more attention to be paid to the health and healing of the whole person, especially when there is no "part-organ" to fix.
From Aristotle to Fresner
Long before there were magnetic resonance imaging and CT scans, Aristotle (384-322 BC) could simply experience, observe and reflect on the human condition. He was one of the first holistic physicians who believed that each person is a combination of physical and spiritual properties, with no separation between mind and body. It wasn't until the 1600s that a spiritual mathematician became concerned that prevailing scientific materialist thinking would reduce the conscious mind to something that could be manipulated and controlled. René Descartes (1596-1650), respecting the great unknown, did his best to separate mind and body to protect spirit from science. He believed that the mind and spirit should be the focus of the church, leaving science to dissect the physical body. This philosophy led to the "Cartesian split" of the mind-body duality. Soon after, John Locke (1632-1704) and David Hume (1711-1776) influenced the reductionist movement that shaped science and our medical system. The idea was that if we could reduce natural phenomena to greater simplicity, we could understand the greater whole. So, to learn about a watch, all we have to do is study its parts.
Reductionism facilitated great discoveries that helped people gain control over their environment. Despite this progress, doctors had few tools to effectively treat the disease. In the early 20th century, applied science began to transform medicine. In 1910, Flexner had a significant impact on the development of allopathic academic institutions. These institutions have come to emphasize the triad that predominates today: research, education, and clinical practice. Reductionism and the scientific method produced the knowledge that encouraged the growth of these institutions.
The scientific model has led to a better understanding of the pathophysiological basis of the disease and the development of tools to help combat its influence. The subspecialization of nursing made it easier to apply all the new information. We now have practitioners who focus on "parts (organs)" and a society that values their problem-solving skills. Unfortunately, this approach does not work well for chronic diseases involving more than one part (part-organ). In fact, all of the body's organs are interconnected, so just fixing one part without addressing the underlying causes of its failure provides only temporary relief and a false sense of security.
Integrative Medicine
Key questions to ask before prescribing therapy
A Brief History of Integrative Medicine