Judul : Lake Superior Community Health Center
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Lake Superior Community Health Center
nancy sudak, md, abihm: hi. i'm dr.nancy sudak. i'm the executive director at the american board of integrative holisticmedicine. we're here with dr. dave rakel. thank you, dr. rakel, for taking the timeto meet with us. dr. rakel is on the board of directors of the american board of integrativeholistic medicine. he's a founder and director of the university of wisconsin in madisonprogram in integrative medicine, and also
Lake Superior Community Health Center, an associate professor in the department offamily medicine. so, dave, is it possible to teach how to facilitate healing? dave rakel, md, abihm: i believeso. it is a controversial subject. some people would say, "no, we can't." others would say,"yes, we can." some people believe that we
just have this innate personality that's hardto change. in fact, in europe in medical education, they will often bring in acting coaches totry and teach empathy and compassion. that actually works pretty well. what bothers meis it's inauthentic. if we are trying to act a certain way without being a certain way,another human being can pick up on that. if we are going to really be authentic, in orderto teach how to facilitate health and healing in another person through our presence, thatwe have to first do this for ourselves. dr. nancy sudak: what are some ofthe ways that we can learn how to do that for ourselves?dr. david rakel: â in creating this curriculum of how to really create a... i don't wantto sound trite, but a healer. it sounds a
little trite. really, what we are trying todo is, in the future we're going to have this big mega computers that will tell us the differentialfor everything we want to know. but that computer will never be able to really be present andunderstand through our intuition in understanding of a complex story and be able to attach alot of various bits of information into a conclusion that will lead towards a path towardshealth. there are our opportunities to helpunderstand. in order to do this well, we have to do it for ourselves. that's the main key.that's why the american board of integrative holistic medicine focuses on this so much.we need to first start with ourselves in order to be best prepared and train ourselves tobest help someone else, because it's really
hard to sit with another suffering human beingif we are suffering more than they are. dr. nancy sudak: [2:35] yes. well, can youtalk about how integrative medicine has changed or will change the shape of research in thefuture? dr. dave rakel: â yes. it's been really exciting.this whole field we always hear, "ok, where is the evidence for that?" now we are startingthrough nih support and other funders to realize that we can't do research the way we did inthe past, that the randomized double‑blind, placebo‑controlled trial is really goodfor a supplement or a medication. it really doesn't work well to understand how complexsystems heal. if we are going to really look at theendpoint of what we want to achieve, which
is health for a complex human being or evena community, we have to say, "ok, what does health look like at the end products? whatdo i want to achieve? if i want to achieve better health in my community, so i have moreresilient, healthy human beings who are kind to one another, what type of interventionwould i need in order to facilitate that outcome?" we are starting to realize the importanceof more of a pragmatic or practical randomized controlled trial where we decide what we wantto achieve, which hopefully is health for our community. then we're not so concernedabout the drug or the pathophysiological process, but we might include a number of differentvariables into that, maybe through the patient‑centered medical home and primary care.may be by incorporating a team approach to
say what does this community need to be healthyand how can i achieve that? that's really encouraging us to do research in a new andexciting way that is really expanding our awareness into how to study complexity.dr. nancy sudak: â well, would you be willing to give an example of a research project thatyou did? dr. dave rakel: well, one that comesto mind that we did not do, but is a really good example of a pragmatic controlled trialis one of neck pain. we might just look at acupuncture or we might just look at a musclerelaxant for a neck pain, but they did a pragmatic trial where they had different groups of therapy.one was just education for the neck pain. one was a physical therapist who was ableto not just follow a protocol based on the
research direction, but they've really matchedthe therapy to the unique individual and what they needed.then there is also yoga therapy for that. it wasn't just the yoga therapy that was combinedalso with an emotional awareness process of how stress can be held in the neck. then youlook at those three different arms and you say, "which one works best?" then we triedand reproduce that. we're not so concerned about what chemical it is that we are influencing.now that research is important too. well, we're more concerned about the outcome inhelping that person with neck pain. how can we improve their quality of life, so theyneed us less? it's not that we don't want them tocome see us, but we meet them in a different
way. this is what we are trying to do in theamerican board of integrative holistic medicine. educate people to feel more prepared to reallyappreciate and shift their complexities, so we can move in a new direction and we needresearch as our guide. this whole evidence‑based medicine processis transforming to evidence‑informed medicine. if all we did was practice evidence‑basedmedicine we wouldn't be able to prescribe much, because we just don't have enough evidencefor that. evidence informed medicine says, "hey, this is really important. it's goinghelp guide us towards not harming and really helping that individual".dr. nancy sudak: â what are some of the resources that you would recommend for individuals wishingto learn more about this kind of research
approach?dr. dave rakel: the research approach is evolving as we speak. the national institutesof health, the national center for complementary and alternative medicine is probably the bestresource for us to understand how we are using more of this practical outcomes research toreally understand how we can add value to healthcare delivery.dr. nancy sudak: â in addition, what about resources for teaching integrative medicinein academic setting? what would you recommend for that?dr. dave rakel: sure, yeah. lots of different resources were biased right?we really believe strongly in the american board of integrative holistic medicine andwe have our syllabus that is quite expansive
in regards to what it offers. after startingmy fellowship in 1999, i felt that there was a tremendous need to create a resource forprimary care docs specifically to understand how to use the evidence that we have to helpguide us towards really integrating books both traditional and non‑traditional methods.we just published a third edition of "integrative medicine," which i edit but a lot of my friendsincluding you have contributed to and it's really a work of love - i'm going to say it!dr. dave rakel: â [07:38] we hope it really acts as a guide. it is divided into threesections. first is the art of what we do. it's the healing encounter. it's the philosophyof this field and that's just three chapters. but the majority of it is a reference text.what if you want to use an integrative approach
for neck pain? what's the evidence for yogafor neck pain? what's the evidence for acupuncture? we also have a little icon that rates theevidence, the weight of the evidence but also the weight of harm. that is something youdon't always see in traditional medical text. what we have going for us in integrative holisticmedicine is we are using therapies that may be matched to the patient's belief and culturebetter. they have less harm in regards to some of the other therapies that we are moreused to prescribing in conventional medicine. after each chapter, there is a therapeuticreview and there is an evidence versus harm icon which is an arrow.the more up it is, the better evidence with the least harm. the more down it is,the worst evidence with the more harm. it's
a really quick icon that helps guide the reader.if they are seeing someone with hypertension, they can just turn right to it and just skimthe summary. it is meant to really be a guide in their practice.the last section is tools for your practice. these are educational quick chaptersto help us learn how to do an elimination diet. or, "how do i do self hypnosis for abdominalpain or headaches? what can i learn about reducing the toxins in my environment?" theseare really practical how to chapters that we just wan to really give guidance basedon research. lots of these authors have years ofclinical experience. we want to share that with other physicians, healthcare practitionersand clinicians to really help us move towards
creating more of an excellence in salutogenesis.this excellence in how complex systems heal and that's what we are doing together. thiswhole organization is creating an excellence for health, which we already have a prettygood excellence for disease in acute and catastrophic care, but we need a better balance and ifwe are going to add value to healthcare where we have improved outcomes with reduced cost.this is what we have to explore. dr. nancy sudak: dave, what are someof the factors that you think will have an impact on our current disease focused modelof healthcare? dr. dave rakel: you have to focus too muchon payment, but it really doesn't drive what we do. we need a currency for health. rightnow, we have a currency for disease. once
we can figure out how to pay healthcare teamsto really reach out and create help for our community, we're going to create a focus forus to do this together. the team of the future will be physician led, but not physician dominant.we're going to have other professionals in here. we're going to choose that professionto best serve the needs of that specific community. if i have a community that has a lot of obesity,i'm going to maybe choose a psychologist and a nutritionist, maybe an exercise sociologist,and we're going to work together to create these programs. but how do you pay for themis the key. if we can figure out how to rewardhealth or the outcomes that we want to achieve, that's ideal. now, some businesses are startingto do that. they're saying, "hey, my healthcare
premiums are too high. i can't make my businesswork out, because i'm spending all this money on healthcare."they're saying, "hey, i'm not going to pay these high premiums. i'm going to give moneydirectly to a patient centered medical home or a health clinic to manage my populationand my business. not just to treat their disease, you can do that, obviously that's needed,but to also facilitate their resiliency and their present‑ism at work and their creativity.give me what i want for my employees if i'm spending all this money."if we do that, if we continue to pay for acute and catastrophic care through the third partypayer, through the insurance, but directly allow money to flow into the community clinic.we have a resource to bring in these teams
of professionals to reduce the cost, becausethey don't need to go in for dialysis, they don't to go into the hospital or urgent careas much because we're really focusing on what that unique individual needs to be well.we're just exploring how to do that but through businesses, is a really low hanging fruitthere. that's if businesses want this for their employees, we'll give it to them. butgive us the money to do it because we need that support to create these teams. that'show we'll create this currency for health. dr. nancy sudak: that's an excellentand hopeful answer. it does suggest that integrative medicine, in many ways, is the solution toour healthcare crisis. dr. dave rakel: â well, you and i are biased,so we would agree with that. but it's just
good medicine right? and drop the adjectives,and this should just be what we do for our friends and our communities and the peoplewe care for. it's not the deal that the model was wrong, it's the best we could do, butnow we're starting to be insightful, and to understand we need to do it a little differently.we need to start to pay for what we want.
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