Integrated medicine - the thoughts and insights of a final year medical student

During the past six years of my medical training I have noticed that I have always been looked at disapprovingly by doctors when I express my interest in integrated medicine or complementary therapies. However, interestingly, the reverse seems to be true when discussing this with patients!

As part of one of my 'special study modules' this year I chose to do a one month placement in complementary medicine. I was able to join a course in Integrated Healthcare which was being held for GPs and nurses who are interested in integrating complementary medicine in their conventional practice. During the course, we learnt some basic acupuncture, homeopathy, nutrition, autogenic training, herbal medicine, and musculoskeletal treatment methods, as well as the research base and evidence for each of these.

We had a very inspirational talk by Dr Dixon who works as a GP at an integrated practice (College surgery) in Devon. During his talk, I remembered that I, like many other medical students, went in to medicine with the vision of helping people. Somehow, during the medical training, this initial vision seems to get lost among the endless lists of things to learn. So much so, that once qualifying as doctors, we’re so wrapped up in following guidelines and meeting targets, that sometimes we can forget the most important aspect of medical care - the patient. Dr Dixon explained how, at his practice, there are a wide range of alternative therapies offered to complement the conventional treatment options, to the great satisfaction of the patient. This reminded me of another of my placements that I had spent at the Bromley by Bow practice in East London as part of one of my Special Study Modules when I was in my 2^nd year of medical school. Here, I was fascinated to see various art therapies being used to complement conventional treatments to the positive benefit of the patients.

During my recent placement in complementary medicine, I was also able to sit in and observe the patient consultations in various integrated clinics (acupuncture, herbal, homeopathy, musculoskeletal, women’s health and oncology) held at the Royal London Homeopathic hospital. I noticed that many of the patients had come here as a last resort, having been through endless drug regimes, procedures and investigations. By coming here, patients have the double advantage of being safely diagnosed and treated by doctors who have both conventional medical training as well as  training in complementary therapies.

Many of the doctors who worked there were once GPs  who noted that there are many illnesses and diseases for which using a solely conventional approach is very unsatisfactory, for example in the treatment of patients repeatedly presenting with chronic back pain, eczema etc. They had found that by using an integrative approach they were able to complement their conventional treatment methods with other healthcare approaches leading to a more satisfied patient.

Sitting in on one of the clinics I noted a particularly interesting incident. The doctor was in the process of saying that he was going to write a letter back to the patient’s GP explaining the complementary therapies that he had integrated into the patient’s conventional care. To my surprise, the patient pleaded to the doctor not to make any correspondence with their GP, saying ‘My GP won’t understand. He’ll really tell me off for coming to this place.’ If doctors do not allow their patients to feel that they are able to openly talk to them about using an integrative approach to their health, then I fear that this could jeopardise the safety of these patients as once the patient is discharged back into the community, the GP may be unaware that they are, for example, using certain herbal remedies which could potentially interact with some of the conventional drugs that the patient is also taking.

In contrast to the attitudes towards complementary medicine that I have observed in the UK, during my elective in India, I noticed that doctors there are generally much more open to an integrative approach. Doctors accept that their patients are using a large variety of non-conventional remedies such as nutritional, herbal (Ayurvedic) and homeopathic medicine, as adjuncts to mainstream care. They are open to discussing the risks and benefits of these with their patients in an accepting non-judgemental manner.

My experiences in medicine so far have made me realise that any one mode of healthcare does not have all the answers to all health problems all of the time. Therefore, I believe that it's good to have knowledge of different types of healthcare and therapies and then use the most appropriate of them according to the specific needs of the particular patient. I think that there will be significant advances and improvements in patient care if the alternative and orthodox medical approaches are not considered as separate entities of healthcare. We should use the knowledge of both orthodox and complementary medicine to fulfil our initial vision that we came into healthcare with: providing the best care for our patients.