Integrate Or Disintegrate

Back in 2007 when I named my practice "Sound Integrative Health" I was choosing the name on a conceptual basis rather than a functional basis. Now, after 10 years of existence I have a clearer idea of what it actually means to be an integrative practice. And, guess what? It has less to do with the fact that I give natural treatments and sometimes western treatments, and more to do with what it means to integrate my patients care between multiple providers. 

Chronic disease often leads to many cul de sacs; not necessarily dead ends. A cul de sac, being a node where we land on some answers but not necessarily the complete answer. Example: If one has Rheumatoid Arthritis and finds an excellent Rheumatologist with a warm bedside manner and therapeutic drug regimens. However this Rheumatologist falls short on knowing about other ways to manage the disease through diet, lifestyle, herbal treatments, cam therapies, and so on.

So what happens? The patient finds another provider that might provide answers and schedules a consult. This additional provider provides advice and another node is created. Now if the knowledge and needs of the patient requires more assistance and another node will be created.

Sounds great? Right?  Not so fast.

The problem is the nodes (aka) providers don't speak and often provide data and ideas that contradicts one another.  Patients (and Providers) end up feeling confused or overwhelmed and being put in the middle. For example if provider A says “Oh your taking Drug X, did you know that it depletes Folate?" Or...on the flip side provider B says “I have never heard of Boswellia serrata so I would be careful as it might cause more harm than good".

The providers end up "Disintegrating" compared to integrating.

The solution. It starts with a note.

The medical note is a passport toward integration. All providers have medical notes. If the patient provides a fax number for each provider on the team then the thought process, rationale, data, and treatment suggestions can be shared across-the-team. Mutual collegiality can be developed and everybody wins.  The patient must insist that each provider gets copied on the notes. If one provider is not playing along that should be a big red flag. Is it extra work? Not really as the note is already going to be created and putting something in a fax machine takes less than a couple minutes.

Other solutions exist that create integration. I signed up for Klara  (I have no affiliation) which ultimately allows me to securely text message any provider that is part of the Klara network if I need to discuss a mutual patients concerns.  If their network grows large enough I would hopefully be able to find most of my patients other providers. 

I also signed up for a system that is HIPAA secure video conferencing that allows me to text or email invite any provider for a secure video consult about patient matters. Of course I can also do this with a patient while they are in another providers office so we can have a "team meeting".

In addition, I also signed up for Sookasa  (I have no affiliation) which allows medical records to be securely uploaded to my desktop within a few clicks and allows me to send encrypted records to any email address within a few clicks.

Do you see where I am going? Integrative Medicine is now more about what providers do to make the treatment team more integrated and less about giving a combination of drugs and natural supplements to see if they work better together. Now also know that integrative medicine is also about being able to navigate and help patients choose whether a natural treatment or conventional treatment would be more appropriate for a given situation.

So in 2007 I was thinking the concept of Integrative Medicine is what I wanted to nourish and represent. And today 10 years later, the name represents more of the action I want to take with my chronic disease patients.

The obstacles to fulfilling this are unwilling players and/or providers. Also patients need to be open to allowing their providers to cross-communicate. More, low compensation of physicians makes going the extra mile even more difficult. In addition, consults with other providers are often uncompensated time.   These are valid concerns and shed light to changes that would need to be made to make integrative care more possible. 

It is extremely fulfilling for patients and providers when we feel like we are part of a functional care team. Let's work toward this integration. I like cul de sacs...they are peaceful in a way. But what I like more are networked systems where everybody is focused on doing what they do best.

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Adam Rinde, ND is a licensed Naturopathic Physician in Kirkland, Washington  at Sound Integrative Health and also the founder of Blankets For Cancer a non-profit focusing on pediatric cancer. He has  general practice sees primarily adults with chronic disease with an emphasis Gastrointestinal Disorders and Stress-related Illness. www.soundintegrative.com .