Dr Karine Nohr
Bravewell have kindly agreed to fund a second integrated health fellow, to take part in the University of Arizona's groundbreaking integrated medicine course. Dr Karine Nohr has accepted the Fellowship. Here she tells us what interests her about integrated medicine and some of the barriers to practice.
To properly assess Chinese Medicine, an alternative, but consistent and reasoned system of evaluation must be employed
My interest in integrative medicine started when I was a gynaecology registrar, around 1985. At that time, a frequent reason for planned admission would be for laparoscopy: an investigation for unexplained pelvic pain. Invariably, no abnormality would be found. The patient would be told that 'there's nothing wrong with you, you're discharged'.
The whole experience seemed not only potentially dangerous (such as the patient who got a perforated bowel and ended up in Intensive Care, with a colostomy) but futile. I asked myself whether there might be another way of looking at the problem and it was this question that lead me to train in pyschotherapy.
As a part of this training, I had to undergo a certain number of hours of personal therapy. I found this so useful for developing my own self-awareness that I extended my own therapy far beyond the minimum requirements; it ultimately lasted for 7 years. Only then could the old adage 'physician heal thyself' have any real meaning for me. I became so much more aware of the greater potential of life within, an education that has informed my relationships, including those with patients, ever since. Personal experience of Yoga, Chi Kung and Alexander Technique has also enabled me to understand the remedial potential of physical therapies.
Being on the receiving end of Medicine, as a patient or as a relative of a patient, has been a painful lesson in the inadequacies of the traditional model. Healing has often had to be sought using other methods.
I have trained in both Westernised Acupuncture and Traditional Chinese Medicine. Although the use of Westernised Acupuncture is becoming more widespread in the English medical world, the Chinese model is almost unknown. Providing 'evidence' of effectiveness is not easy; the studies that meet acceptable Western standards according to evidence-based medicine are growing but still few and far between.
A Health Needs Assessment in the area found that 82% of people would value access to complementary medicine
This means I have not fully worked out how to offer the therapeutic choice to patients regarding Western and Chinese treatment. Time restraints are a perennial problem. Neither have I worked out how best to describe to patients, in the limited consultation time, what Chinese Medicine has to offer.
Our General Practice is in an urban deprived area of North Sheffield. Nearly half of all households have no earner. It has one of the worst health records in the city, with a high mortality rate, a high rate of overall illness, high rates of hospital admission for coronary heart disease, strokes and accidents, high depression rate, high rate of drug misuse, high rate of unemployment and low educational attainment. There are problems with overcrowding, crime incidence, convictions for criminal activity, high rates of single parent families, pensioners and people living alone.
I am really looking forward to being part of a forum with my peers where we can discuss and appraise complementary therapies - how they can be evaluated and how they might be integrated into the Western model.
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