Conscious Choice: Sampling the Future of Health Care

July 2000

Sampling the Future of Health Care

A Visit to the Center for Integrative Medicine

by Jonn Salovaara

Consider this scenario: You’re visiting your M.D. She thinks she knows what’s causing your headaches but wants to ask another practitioner a question before continuing her diagnosis. She asks you to wait a minute while she confers with her colleague, a doctor of Traditional Chinese Medicine (TCM), who shares the same suite of offices and examining rooms. They agree that it might be best for you to receive treatment from the certified massage therapist who is also a member of their group. Or they agree that you should try a TCM course of acupuncture, or see the clinical psychologist, the nutritionist, or the chiropractor, all of whom practice with them. Does this combination of professionals sound too sensible, too conscious, to be in a facility run by an affiliate of a major university medical center? Are we years away from an organization like Northwestern Memorial Physicians Group (NMPG) operating such a facility? You guessed it; the answer is no. It’s not too early; the future is here, at the NMPG Center for Integrative Medicine.

I recently had an occasion to experience the services offered by this center first-hand. For several months I’ve been bothered by a build up of fluid behind one of my eardrums. It isn’t particularly painful; it just feels like I’ve got a wad of cotton in my left ear even though I don’t. My own M.D. recommended decongestants which I tried for a while and which seemed to help a little. But I disliked the side effects of the decongestants, the problem seemed to persist anyway, so I stopped taking them. My doctor told me she would next recommend my seeing an ear nose and throat specialist who is also a surgeon, who would be likely to recommend my having tiny tubes surgically inserted in the eardrum to help drain the fluid. Even with insurance, this kind of treatment runs into money. Besides that, in my less courageous moments I have a premonition that I would be one of those rare individuals who does not come out of the anesthesia. In any case, I am very interested in trying some alternative approaches first.

I arranged a visit both to see how a place like the Center for Integrative Medicine might treat my problem with something other than surgery and to learn more about the center for this article. Arriving for my appointment, I was immediately struck by one thing. The decor of this suite — where the center moved in January after two years in another part of the same building — isn’t like any doctor’s office I’ve ever been in. The serpentine walls of the exam rooms and offices curve and flow in a warm deep shade of yellow and are covered with a charcoal-colored misty wave-like mural. In the waiting room, before a curving wall of glass bricks, a thin film of water flows down an oblong slab and trickles into a pool at its base, where a smooth stone says, "Dream."

A Feng Shui consultant helped design this space and it feels like a meeting between medical office and Transitions Bookplace or Healing Earth Resources. In addition to the sound of the waiting room fountain, soothing cello music played on the stereo and I later noticed several miniature fountains on desk tops and counter tops, all playing their own restorative sounds. The scent of rosemary essential oil rose from an aromatherapy burner on the reception desk. These touches are refreshing for anyone habituated to the druggist’s counter-feel of many doctors’ offices. What’s even more refreshing, I discovered, is the center’s variety of modalities, the quality of the practitioners, and the level of communication taking place between them.

My first stop — I learned later that this is a fairly common first stop — was with an M.D. Both the doctor and the nurse I saw first were dressed in civilian clothes. It surprised me how much this small detail of costume might matter in creating a feeling of equality between patient and care provider, especially if you’re used to doctors and nurses affecting a lab technician look. The nurse asked me to fill out a medical history. It included a number of questions about my diet, as well as the question, "Do you meditate?"

Theri Griego-Raby, M.D., is a doctor of internal medicine who has a strong connection to the practice of alternative modalities. She explains this as stemming from her Mexican heritage and a lifelong personal interest in herbal remedies. After looking at my ears and throat, Dr. Raby said that if I were her regular patient, she would probably recommend a lab screening for food allergies which might be a source of my congestion problem. When the report came back, it would include a recommended diet which I would review with the certified clinical nutritionist who is part of the center’s group of practitoners. Dr. Raby recommended that I begin by cutting out dairy products and citrus, since these often contribute to congestion, and, she recommended that I try decongestants again. She also recommended that I consult with James Moore, the TCM practitioner in the group.

In response to my more general questions about the center, Dr. Raby, the center’s medical director, commented that patients there feel safe and comfortable because "It offers the best of both worlds. They are confident that the big things won’t be missed, so it’s a safe place to try some other things first." I was beginning to feel I’d come to the right place.

On this same day, I also met with the clinical psychologist and the massage therapist. My meetings with them were for general information about their work at the center; I wasn’t consulting them about my ear. Melanie Aoki, Ph.D., the clinical psychologist, drew me a diagram of her approach to helping people through cognitive behavioral therapy. She depicted unhealthy behaviors as part of a continuum beginning with an event, whether in the past, present, or future. That event provokes thoughts about it that may be more or less habitual. These thoughts lead to feelings and those feelings may result in the unhealthy behaviors which might include social withdrawal, bouts of insomnia, muscle tension, etc. Dr. Aoki said she would try to help a person by intervening somewhere on this continuum. She sees herself as something like a coach, giving clients practical advice about how to better manage their thoughts, feelings, and behaviors and providing them with "homework" — ideas about things to try.

Her approach on the whole seemed very practical, very sensible, and quite unlike some other kinds of talk therapy. There is also an obvious difference between seeing a psychotherapist in this context — a center devoted to overall physical and mental health — and seeing one on your own, perhaps even without the knowledge of your medical doctor. It’s common to hear people say that mental illness should not have a stigma attached to it; but this setting, where the clinical psychologist shares the suite with your other primary care providers, actually does something to remove that stigma.

The greatest pleasure of this, my first day visiting the center was my meeting with Charles Cornyn, a certified massage therapist, one of a group of massage therapists who work at the center and who have a special focus in neuromuscular massage. As he worked on the area of my back that I identified as most in need, Cornyn explained to me a theory about why muscles can remain tense after a traumatic physical experience and how the work of the massage therapist can help put an end to that chronic tension. I liked the notion of getting the brain to shift out of a "tense" gear where it’s been stuck by mistake for years since some event. But the pleasure of this session went beyond learning about this appealing notion. Cornyn seemed to locate the real source of the tension in my right shoulder blade. The pain in this area has been with me off and on for so long that I no longer think of it as something that might be "cured." It’s just the place where I experience stress. But after the pressure the massage therapist applied to this sore spot, I felt like someone, namely Cornyn, had lifted a weight from my shoulders that I’d been carrying around for years. I went around the rest of the day trying to be very careful not to do anything to put that weight back on.

After the massage, I learned that there was a chance for a meeting with one of the center’s two oriental medicine practitioners. We decided to talk generally about what he does and meet again in a few days to talk about my ear problem. During our talk, James Moore explained that oriental medicine is "a whole other way to go," a very different way of thinking about illness and health. For instance, the Chinese concept of liver and what the liver affects would be very different from Western ideas about liver function. Moore also commented that in the western United States, acceptance of traditional Chinese medicine is more widespread than in the Midwest, that in California and New Mexico he might have to work to get a patient to visit his Western-medicine practitioner. From something a friend who was seeing a TCM practitioner once said, I had the impression that TCM frequently required the taking of herbal remedies over a long period of time to gain results. I asked James Moore about this and he responded that people were generally very accepting of the TCM treatment and the results and that complaints about treatment taking too long were not much of an issue. His approach to helping people is "holistic and pre-emptive." The people who consult with him already understand this and don’t expect a magic bullet kind of medicine.

Just what James Moore meant by holistic and pre-emptive became clear to me when I consulted with him about my ear problem after an intervening weekend. He made full use of the medical history form that I had filled out and talked about a couple of other past and chronic conditions of mine, not because they are necessarily directly linked to the ear problem, but because an overall healthier body will be able to deal more effectively with that problem. We discussed my current level of exercise (the doctor recommended an increase) and went into detail about how I might go about resuming the practice of yoga which I’ve let slide since I took a class several years ago. It seems that yoga is a personal favorite of James Moore; he believes that such a practice (it might also be Tai Chi or something else) can help improve sleep, appetite, and more. For the ear problem itself, he provided me with a mixture of powdered herbs — remarkably bitter tasting — to be taken stirred in hot water twice a day for five days, and he gave me some Chinese dietary recommendations, some of which overlapped with the advice of Dr. Raby. He also said that if I were to continue treatment with him he would recommend acupuncture needling at four different points. He recommended that I try ear candling, a process by which a specially designed "candle" — a roll of paraffin — is inserted in the ear of a reclining patient and then lit to create a vacuum in the ear which might prompt the fluid behind the eardrum to be drained. He would want to see the records of my previous treatments and tests and would also have me keep a diet journal.

All of this had a different feeling from a meeting with an M.D. It was a little more like having a personal medical trainer, one who knows his Traditional Chinese Medicine. James Moore struck me as a very astute practitioner, maybe especially qualified through his commitment to his field and his own Western origins to bring Chinese medicine to Western patients. He not only prescribes the herbal remedies; he mixes them himself in what amounts to his own apothecary. Moore said he is noticing increasing respect from Western doctors on those occasions when he is asked to speak to them about what illnesses might best be referred to a TCM practitioner. I felt like my consultation with him very much lived up to the name of holistic care: not just focusing on the illness I was presenting, though it did that too, but going into detail about habits of mine related to my general health, as well as my overall health history.

You may have gathered from this account so far that I was very favorably impressed by the care I received and the openness of the practitioners at the Center for Integrative Medicine. I never considered falling in love with a medical center before, but if any center could persuade me to be interested, this center could. What impressed me most was the idea of all these different practitioners, also including a chiropractor, Dr. Kimberly Egly, working together, talking informally or formally about cases, and creating a new kind of primary health care.

That new kind of health care is the real news at the center, according to Andrew C. Palumbo, Vice-President for Business Affairs of the NMPG. The center is helping to set a standard that may ultimately leave everyone feeling that integrative medicine, the combination of a variety of standard and alternative modalities, is of course the best kind of primary care. The day may be here when any top-flight primary care facility must make this kind of care accessible to its patients.

What prompted the establishment of the center, according to Palumbo, was the reportedly large number of people seeking non-traditional practitioners in addition to their primary care M.D.s. Those people, so the thinking went, should be able to find reliable practitioners who were in direct communication with their regular doctors.

The Center for Integrative Medicine is part of the Northwestern Memorial Physicians Group and the physicans who practice in other offices of that group are very aware of the center. They may refer patients to the center or their patients may refer themselves after becoming aware of the center through posters, postcards, newsletters, and advertisements. (Of course, anyone looking for this kind of care may call for an appointment.) Even if they never come to the center, the patients who see NMPG physicians benefit. Through the center’s outreach, they and their physicians become more educated about alternative modalities. In furthering this, the center also offers a variety of classes — in yoga and aromatherapy for example — as another way of welcoming people into its midst.

Because of its connection to the university, comments Palumbo, there’s an academic bias at the center: the alternative modalities offered might not be as experimental as those at an independent holistic medical center. By the same token, there are many patients who feel more comfortable having a university seal of approval on whatever treatment they receive. Furthermore, because of the university connection, the financing dynamic is different. The center is not a company backed by venture capital and this may mean it feels less pressure from the marketplace, allowing it to grow and develop more calmly.

Unfortunately, though the future may be here, the insurance industry is still lagging behind. According to Palumbo, there are still major gaps in the kinds of alternative modalities most insurance plans will cover. This doesn’t make a lot of sense. If the cost of a course of treatments by an internist alone is roughly the same as the cost of treatments by an internist working with a TCM doctor, why shouldn’t they both be covered? And, if it’s a case where integrative treatment means the avoidance of expensive surgery, why is the insurance industry willing to pay for the more costly treatment but not the less expensive? Improvements in some insurance plans have been made and maybe, with more people seeking this kind of care and demanding coverage, more improvements will follow.

Meanwhile, many people are already spending their own money for this kind of treatment because it works for them. You may be one of those people. Or you may be someone who hesitates to branch out into trying alternative modalities, not so much because of the expense but because of the "disconnect" between those modalities and the rest of your medical care.

Whatever your situtation, if your idea of a real primary care facility is one where M.D.s and alternative practitioners work in close communication and refer patients to each other, the Center for Integrative Medicine may be the place for you. For my part, I’m grateful for the treatment I received there and I’ll continue to make good use of the holistic advice.

Resources

The Center for Integrative Medicine, 680 N. Lake Shore Drive, Suite 815, Chicago, IL 60611; 312-926-3627. Discounted parking is available at the 441 E. Erie garage and at the Superior/St. Clair/Huron garage.

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