The polarization between reductive biomedical science and a whole person integrative model obscures deeper differences relative to human nature. The top-down, fix-it mode of the former is grounded in a fundamental belief that people (a.k.a. “patients”) either do not want to change or simply can’t. Meantime, the time-consuming, get-in-there-and-partner focus of lifestyle-oriented integrative practitioners assumes that the presenting human being arrives with seeds of change seeking ground for germination and growth. A recent Harris poll on perceptions of self-care among conventional medical doctors and their patients that was funded by the Samueli Foundation and led by its integrative health director Wayne Jonas, MD describes the chasm that has opened between the two parties. The patient is seeking an integrative model for self care amidst the present predication of medical delivery on the skeptical view of human nature.
The number of acupuncturists employed in federally qualified health centers (FQHC) is no longer negligible yet still far from routine. The number who have that experience and have also served their state as members of technology review panels charged to evaluate the science behind non-pharma approaches to pain may be just one. The person doing both in what is essentially a national pilot program in the state of Oregon is Laura Ocker, LAc. I got in touch with Ocker, the past president of the Oregon Association of Acupuncture and Oriental Medicine (OAAOM, for an acupuncture practitioner’s perspective on practicing in the context of the controversial program that led national pain leader Sean Mackey, MD, PhD` to spark a national campaign to limit its expansion. While not fond of the spotlight, Ocker agreed to share some of her experience as part of this ongoing Integrator series.
On the surface of things, the values of “accountable care” and “patient-centered medical homes (PCMH)” and those of integrative medicine suggest a convergence. A survey found alignment in integrative medicine leaders. Maryland integrative doctors David Fogel, MD, and his spouse Ilana Bar-Levav, MD, presented with a substantial philanthropic gift, jumped into the apparently convergent rivers with both feet, creating the interprofessionally rich environment that is now CHI Health Care. The goal was and remains to prove the value proposition of integrative medicine in the medical industry’s move from volume to value. The center gained recognition as a PCMH and became part of a Medicare Shared Savings accountable care organization (ACO). Now Fogel makes clear that the convergence of the two paradigms have produced rumblings of boulders at the river bottom. While he remains positive about the model, the systemic obstacles are daunting.
The evolution of the American Congress of Rehabilitation Medicine (ACRM) began in the 1930s with a founding focus on a single emerging modality and now boasts a position as the largest multidisciplinary-centered rehabilitation organization in the country. ACRM was first a medical academy for x-ray therapy, broadened to more physical therapies, then focused in on physical medicine, and finally extended outward again to address both physical and psychological issues. Core disciplines are medicine, physical therapy, occupational therapy, and psychology. The door is not shut. Anyone can join.