Perspective
Alternate Route
Seven physicians tell how they became interested in integrative medicine.
Every physician’s career is a journey. It begins during medical training when they’re introduced to different specialties, care settings, and ways of thinking about patients and patient care. Those experiences nudge them toward a particular career path.
That path is paved with encounters. For some, it’s with a colleague or patient who exposes them to therapies that don’t fit with their ideas about conventional medicine. For others, it’s with a health issue of their own that doesn’t respond to standard treatments. As they open up to different ways of thinking about health and medicine, some find themselves taking a more holistic approach to patient care and viewing health as an intersection of the mind, body, and spirit.
We asked physicians whose path has taken them in such a direction to tell us about their journey and describe how they’re working to blend the best of conventional and complementary medicine. Here are their stories.
Mark L. Hoch, M.D.
My journey toward holistic integrative medicine began during my first year of medical school in 1985. Even though I was grounded in science and neurobiology, I had a sense that something important was missing. I found it strange, for example, that something as basic as nutrition was not part of what I was taught.
I was fortunate to meet members of the American Holistic Medical Association (AHMA) at an American Medical Student Association meeting. One was Gary Kaplan, D.O., an osteopath who is also trained in acupuncture. I was impressed with how enthusiastic he was about medicine, and I wanted to learn more about what he was doing. So the next summer, I did a preceptorship at his office in Arlington, Virginia. Many times, he was able to help patients whom other doctors had been unable to help. And he did this using a combination of conventional medicine, nutrition, acupuncture, and osteopathic manual treatments. His approach often involved helping his patients make the connection between the state of their health and what was going on in their lives.
I was inspired to learn more, and that summer I joined the AHMA. Since then, I’ve attended 18 of its conferences and served on its board of trustees, including as president of the association. I’ve worked at the Arizona Center for Health and Medicine, which provides primary care as well as acupuncture, osteopathic and naturopathic medicine, and wellness, tai chi, and yoga classes, and at the Atkins Center for Complementary Medicine in New York. I now practice in Minneapolis in a group that includes experts in psychology and family therapy, traditional Chinese medicine and acupuncture, and body-based therapies.
I take a holistic approach with my patients at every visit. To me, this means being interested in every aspect of their health including its physical, emotional, mental, social, environmental, and spiritual dimensions. I focus on treating the whole person rather than their symptoms or disease, and I help people utilize their inborn capacity for healing. To make a diagnosis, I take a comprehensive health history that also explores how the person views their situation, do a comprehensive medical and osteopathic physical examination, and do standard and specialized laboratory testing as needed. I take all of this information and, in partnership with each patient, devise a personalized treatment plan.
Over the years, I have studied nutritional medicine, osteopathic medicine, Chinese medicine, and Western herbal medicine. I am currently in the middle of a Bush Medical Fellowship and am studying Sufi and other healing practices. I offer several “complementary and alternative” therapies in my office as well as “conventional M.D.” treatments. To me, the issue is not whether a treatment is conventional or alternative but whether I have applied the best of science in a way that is effective and safe and meets the unique needs of each patient.
I use nutrition as part of a comprehensive approach to general good health as well as for treatment of osteoporosis, diabetes, heart disease, irritable bowel syndrome, and other diseases. I use osteopathic medicine for musculoskeletal problems and even for some organ-related maladies such as pneumonia, gall bladder problems, and intestinal adhesions. I find it is effective for infants who have colic, feeding problems, and plagiocephaly. I use herbal medicine for a number of conditions and turn to spiritual approaches when a patient has a psychospiritual issue that relates to their health problem. I use qigong exercises and Trager therapy for patients who have pain, restricted movement, or neurological problems such as Parkinson’s disease.
Scientific research shows that many treatments that have been considered alternative are effective and safe. I’ve been looking at this evidence for a long time, and I’ve been particularly impressed with the studies on nutritional medicine. I hope that the growing body of evidence will prompt medical schools to incorporate nutrition education into general medical training so that every physician and patient can benefit from it.
I’m often asked why I practice holistic medicine. The answer is because it works. I find this way of practice to be effective, cost effective, and safe for many people. It may require me to spend more time with my patients than I once might have spent, but this helps me better understand their needs and the root causes of their problems. We are able to work together to figure out effective, lasting, and safe therapies that help restore them to health and enable them to lead more comfortable, happy, and functional lives.
Bonnie Warhol, M.D.
Rehabilitation medicine, my specialty, has always been very holistic. In addition to addressing what brings a patient to us, say they’re having difficulty standing and moving after a stroke, we ask about where they live, the design of their house, who’s around to support them, their nutrition, their sleep habits, and their mental health.
Often by the time I see patients, they’ve tried all the standard treatments, so we end up using therapies that many consider alternative and complementary such as craniosacral therapy and myofascial release. These have been around for decades but aren’t usually done on the first pass through physical therapy. I frequently refer patients for acupuncture or sometimes to a physical therapy group that does muscle energy technique, energy medicine, visceral medicine, myofascial release, and craniosacral therapy. I pay attention to their nutritional status and use supplements such as cranberry extract to decrease the frequency of bladder infections and magnesium for back and neck pain or fibromyalgia.
I became interested in some of these therapies during my residency at the University of Minnesota. Two of my colleagues were osteopaths who practiced manual medicine. I didn’t know anything about that until I had back pain and one of them used it on me, and it worked.
One of those colleagues who now practices in Des Moines, Jackie Stoken, D.O., is involved in holistic medicine. She treats patients who have headaches and neck and back problems with manual medicine and uses acupuncture and herbs in her practice. I work with patients with spinal cord injuries, musculoskeletal problems, and long-term disabilities such as cerebral palsy and postpolio syndrome. We have very different practices, but I learn so much when I talk to her.
She’s involved in the American Holistic Medical Association and invited me to a conference years go. I’ve since gotten to know people in the local chapter. Through the group, I’ve learned of different providers to whom I can refer patients, including a holistic family physician who offers chelation, manual therapy, and nutritional medicine.
Many of my patients have success with alternative therapies. But the challenge is getting them treated. For example, there’s a group in Edina that does fabulous manual therapy, but it may not be covered by a patient’s health plan. If a patient lives in Stillwater, getting to Edina may be a real barrier.
Some holistic practices are strictly fee for service. I’ve never worked with a population that has a lot of money, so that limits what I can do. Frankly, it’s hard getting people to take multivitamins if they’re not covered by insurance and they don’t have the funds to buy them.
But many patients are already trying these things, so I try to guide them. I let them know the evidence regarding alternative therapies, and frequently it’s sparse. If they’re taking supplements, I can have our pharmacy make sure they aren’t getting oversupplemented. I can also make sure the supplements aren’t interfering with other medications they might be taking.
My goal is to make sure my patients are safe while keeping an open mind. People frequently come in and say that no one listened to their problem before or gave them a thorough exam or prescribed something other than the usual treatment. They’re grateful to have someone who listens to them and is willing to look at the treatments they want to try.
Linda A. Marden, M.D.
I consider myself a very traditional medical practitioner. But I’ve always had a fairly positive view of alternative therapies. I was treated by a chiropractor for headaches and back pain prior to going to medical school in 1987. I think chiropractors have done a great job of documenting how effective their treatment is for low-back pain.
I see my role as being a partner with my patients. I respect their wishes about the way they want to be treated. Sometimes that means helping them sort through treatment options that I don’t endorse. However, I believe that my role is to provide information on complementary and alternative medicine (CAM) options (if they are available) and continue to suggest and offer “traditional” options.
I keep up on CAM therapies for headache, multiple sclerosis, Parkinson’s disease, and other conditions. I don’t suggest them (although I do recommend yoga for back pain that is chronic and radicular); but if patients ask, I give them the data I have and let them make as informed a decision as possible. For example, there are small studies that demonstrate the effectiveness of magnesium supplementation and riboflavin for preventing migraine headaches. I provide them with information about the doses utilized, the numbers of patients in those studies (usually very small), the side effects, etc. I do this because I believe that people will use these treatments with or without my input.
People are not always willing to accept my ideas about what will work, but they appreciate being given the opportunity to do things “their way.” They are the ones having the headaches or the movement disorders (not me!), so they are the ones who have to decide what they are going to do. If they don’t feel empowered to manage their disease, they won’t do very well. If they are empowered, they will know when to call me and follow-up.
Physicians should know about CAM therapies that are being used in their area of practice. If we are informed about these modalities and open to discussing them with our patients, we can better help them. This makes us more credible in their eyes. I keep a large compendium of natural supplements in my exam room. When people list the nutritional supplements they are taking, I look them up. I then ask them if they realize that the herb or supplement can block their anticoagulation therapy or make their birth control pills less effective. When they realize that “natural” doesn’t always mean “safe,” they are more open to coordinating their CAM therapies with their traditional medical treatments.
As long as television infomercials and websites continue to tout the benefits of questionable treatments, patients will be uneasy about traditional medical practices. Thus, all physicians need to be able to address the issues that patients raise about different approaches to care and treatments that may not fit with conventional medicine.
Gregory Plotnikoff, M.D., M.T.S.
My interest in integrative medicine comes from the question many patients have asked me throughout my years of primary care practice: “What else can I do?” The reason for this question varies. Some have tried everything conventional medicine can offer but have not achieved their health goals. Some see Western medicine as being “alternative” and want a treatment plan that fits their cultural beliefs. And some want low-cost, low-toxicity options to expensive pharmaceuticals.
Being able to answer this question has challenged me to better understand the evidence base for both pharmaceutical and nonpharmaceutical interventions. Being able to answer it well has led me to new discoveries such as the power of vitamin D for treating chronic pain and the efficacy of traditional Japanese herbal medicine for multiple functional symptoms.
As an internist and pediatrician interested in cross-cultural and integrative medicine, I believe my mission is the same as that of all physicians: to listen deeply, to know the medical literature incredibly well, to partner with the patient, and to counsel from an evidence-based perspective. Where I may add value is in blending different healing traditions, applying interventional nutrition, and addressing spiritual concerns. (I am also a graduate of Harvard Divinity School.) With every patient, I seek to incorporate the best of my med-peds training with that of my training in hospital chaplaincy, interventional nutrition, mind-body medicine, and traditional East Asian medicine. What does this mean? I may, for example, work with a person recovering from cancer to develop nutritional, physical, cognitive, mind-body, and spiritual fitness. In these “survivorship” visits, I take a holistic approach to meeting the patient’s needs during and after chemotherapy. I may involve members of our integrative health team—physicians, an Ayurvedic nurse practitioner, nurses, acupuncturists, massage therapists, a reflexologist, a music therapist, nutritionists, exercise physiologists, health-wellness coaches, a healing coach, and a spiritual coach—as well as staff from the oncology, genetics, physiatry, and primary care services. Success for patients includes discovery and development of their innate healing capacities, their ability to prevent relapses, as well as a significant reduction in anxiety, nausea, fatigue, pain, and fear of recurrence.
I believe that in the future all physicians will need to support people’s capacity to act on information and access their innate healing abilities using mind-body techniques in order to promote wellness, prevent illnesses, and better manage chronic illness.
Selma Sroka, M.D.
My interest in holistic patient care goes back to the time before I even thought about going to medical school. In the 1960s, I used meditation, yoga, nutrition, and herbs as a grassroots approach to well-being and health. In fact, my undergraduate thesis focused on the history of childbirth and midwives and looked at how childbirth could be made more personal and humane and still benefit from contemporary knowledge and technology.
During medical school, I found a home in family medicine because it is innately the most holistic of specialties. After completing my residency training at Hennepin County Medical Center, I joined the faculty there and sought to build on this foundation. I studied indigenous healing and bodywork as well as nutrition and botanicals. At that time, our program director, Pat Cole, M.D., was my primary supporter. We learned about the American Holistic Medical Association (AHMA), and I attended their conference and took the first board exam offered in 2000 by the American Board of Holistic Medicine. The AHMA conferences and the local chapter, the Minnesota Holistic Medical Association, provided a support network for me. In 2001, I began to work with family medicine residents on self-care and wellness; this gave me new passion for my work, and it has become a component of our residency curriculum. Our faculty has become increasingly supportive, and a number of them now teach aspects of the self-care curriculum.
My clinical practice also has become more holistic, as I’ve learned about the evidence for a variety of conventional and complementary approaches. My goal is to partner with each patient and try to learn enough of their personal story to gain a sense of who they are as human beings. I choose what I consider to be the best of conventional allopathic medicine and integrate that with a person-centered approach and complementary therapies.
To become more person-centered and holistic, I’ve had to go beyond my medical training. For example, in medical school, I learned little about nutrition, except for a few details about the biochemical structures of vitamins, extreme vitamin deficiency states (scurvy and rickets), and the biochemical pathways (lipid metabolism). Nutrition was rarely considered. Yet more and more information is showing how a poor diet (that is, the standard American diet) contributes to the development of the chronic diseases that overwhelm our medical system. An increasing body of research shows how nutrition can be used to prevent and treat many of the chronic problems we see every day in primary care such as hormonal imbalances, chronic fatigue and pain syndromes, diabetes, and heart disease. Food really is medicine, and doctors need more of a working knowledge of clinical nutrition so they can counsel patients effectively.
I am currently in the University of Arizona Center of Integrative Medicine’s fellowship program, which emphasizes evidence-based use of nutrition, botanical medicines, manual medicine, mind-body therapies, and other therapies. I have studied visceral manipulation and craniosacral therapy through the Upledger Institute (an osteopathic organization) as well as indigenous healing approaches. I have meditated and practiced the relaxation response and yoga for many years and am comfortable introducing these things to patients and residents. On the other hand, I have studied acupuncture and traditional Chinese medicine only to a level where I can appreciate their therapeutic value and know when to refer patients for treatment.
Practicing holistic integrative medicine is much more than learning about a few complementary modalities. It really is the art and soul of good practice. It requires personal transformation and growth on the part of the practitioner; this doesn’t happen overnight. But holistic integrative person-centered health care is what people want. It is perhaps the best hope for family medicine and primary care.
Laura Praeger, M.D.
I have a strong interest in the mind-body connection. How we think can affect our health on so many levels. If I am consistently angry or stressed, my immune system will decline and my endocrine system will be strained. This will make me more susceptible to getting sick, feeling tired, and being generally dissatisfied with life. A patient with diabetes who is not aware of this connection is less likely be in control of their disease and potentially will have more complications.
Exploring the connection between the body and mind involves asking patients questions that lead them to a deeper understanding of themselves. If they can understand what drives their emotions and the decisions they make, they can change behaviors that may negatively affect their health.
I try to take a holistic approach to patient care. This entails listening to patients and gathering information about what affects their health. I’ve learned over the years that how I relate to patients generally determines how much information they share. Together, we can then decide which modalities might be most beneficial for them, drawing from both Western and alternative medicine. The possibilities range from acupuncture and bodywork to learning mind-body skills to receiving psychological care. Once we decide on a direction, I can refer them to practitioners who offer these services.
I have adopted this approach as a result of my own health journey. I have used acupuncture, massage, chiropractic, and nutritional therapy in complement with conventional therapies to ease neck and back pain as well as menstrual irregularities. My own experience as a patient has intensified my commitment to working in partnership with my patients and to fostering self-exploration.
We are in an exciting time. Alternative therapies are becoming more widely available and more commonly accepted by the medical establishment and patients alike. I am encouraged that there is a growing body of evidence that supports some of these therapies and a holistic approach to care. I believe that healing most often occurs when we strike the right balance between alternative and Western medicine.
Michael Mesick, M.D.
I have always been interested in providing care that considers the whole person—all the elements that affect one’s well-being. My decision to specialize in family medicine arose out of this and I consider integrative medicine to be an extension of the core values of family medicine.
I was first introduced to the concept of holistic medicine in 1985, when Bill Manahan, M.D., spoke to our second-year class at the University of Minnesota Medical School. I remember him having a unique approach for interviewing patients, as he considered how stress and lifestyle interacted with their complaints. During residency, I focused on the traditional curriculum. It wasn’t until I began to practice that I realized I had a particular interest in the physical effects of stress and mental health. Later, I learned that the term for what I was interested in was mind-body medicine.
I joined the American Holistic Medical Association and began attending the Minnesota chapter’s quarterly meetings. I learned that holistic medicine was the discipline that best embraced the importance of the mind-body connection.
Many of my patients suffered from chronic pain. For many of them, standard treatments had limited efficacy. So after 14 years of practicing family medicine, I decided to study integrative medicine, with a special focus on pain management. In 2007, I was awarded a Bush Medical Fellowship, which allowed me to pursue medical acupuncture training at the Helms Medical Institute in Berkeley, California, and mindfulness-based stress reduction training through the Omega Institute for Holistic Studies in Rhinebeck, New York.
I have completed my fellowship and now offer integrative pain consultations and acupuncture services. When I meet with patients, I encourage them to share any interest they might have in complementary and alternative treatments, and we explore what course of treatment may be the most helpful for them.
There is more and more evidence about the potential benefits and known risks of certain therapies. I refer to this research as I help my patients make decisions. I am far more comfortable than I used to be discussing both conventional and alternative options. But I realize there is so much more to learn about integrative medicine, and I will continue to take advantage of opportunities to further my education. MM