The #1 problem my patients bring to my office is that they are rushed through when they go see their insurance-covered doctors. Most of my patients like their doctors, but resent the little time their doctors spend with them, forced by bean counters to complete cumbersome digital notes to document the patient’s visit. A significant portion of said notes are to minimize the risk of getting sued, and fulfilling obfuscating insurance requirements to get reimbursed.
Doctors who dare spend more time with their patients often end up doing all their charting at home, on their own time. They are not compensated, nor valued, for the attempts to engage the patient in meaningful conversation about their lives, and the factors that cause disease: nutrition, environment, and relationships. Worse, some of them are dismissed from corporate care because they “didn’t see enough patients” to maximize profits.
I tell my patients it is not their doctors’ fault. In fact, half of them would like to quit the system, and half of medical students regret going into medicine. They don’t want to be/become “hamsters on a treadmill.” The problem is that our Health Care system is broken.
Truly caring for patients cannot be rushed, nor reduced solely to a profits’ equation. Yes, doctors need to make money to keep the doors open. But how much money does it take? Who else is benefitting from the rushed visits doctors are obligated to offer? Follow the money.
Consequently, the main thing I offer my patients is unlimited time visits. They happily reimburse me “out of pocket,” a sign they desperately want someone to take the time to listen to them. I left the health care system because I wanted to practice “whole person integrative care,” and put Humpty-Dumpty back together again.
Reference
Surveys show providers and patients increasingly endorse ‘whole-person’ integrative care
Healio Minute, November 20, 2023
“It has taken decades, but with each passing year, integrative health care is marching more squarely into the mainstream of American medicine.
Countless millions of patients have long embraced the benefits of complementary, nonpharmacological approaches to relieve chronic pain and prevent disease, and the good news is that practitioners are increasingly seeing the benefits and incorporating them.
The latest key indicator is a new survey from The New England Journal of Medicine Catalyst Insights Council, which found growing momentum among providers around the world to offer an increasing range of “whole-person,” evidence-based integrative approaches.
NEJM Catalyst tracks trends in medicine by periodically surveying more than 900 clinicians, clinical leaders and executives, and its September report showed that 51% of health care organizations were now offering integrative care and 16% were planning to do so within the next 2 years. Only one-third said their organizations had no plans to adopt it. Nearly three-quarters of respondents (72%) said it was personally very important or extremely important to them that their facilities offer integrative care.
This trend is particularly gratifying for me, as someone who has practiced integrative medicine for more than 30 years, starting in an era when skeptics labeled it snake oil. (They scoffed at the possible effectiveness of “quack-upuncture,” for example.) Now, the continuous evolution in nomenclature reflects its growing acceptance. In its earlier forms, this kind of care was labeled “unconventional” medicine. By the 1980s, I oversaw integrative research when I ran the NIH’s Office of “Alternative” Medicine. Later, NIH rebranded the department as “Complementary and Alternative” Medicine, and then it became “Complementary and Integrative.” Other brands include “functional medicine” and “lifestyle medicine.”
Regardless of what we call it, a rapidly growing body of evidence clearly shows that this blend of conventional, complementary and self-care methods that we now call “whole-person care” yields improved outcomes and reduced costs that could help bring about the desperately needed transformation of our ailing health care system and our nation’s health.
We know that pills and procedures remain the mainstays of health care and probably always will as long as money is to be made and patients seek simple fixes to complex problems. But many patients have also long recognized the value of care that accounts for their whole being — not just an illness or condition, spending well over $30 billion annually, according to NIH, on natural therapeutics such as supplements, vitamins and herbs, along with lifestyle behaviors such as diet and nutrition, exercise, massage, meditation, acupuncture, yoga and chiropractic.
At my organization, the Healing Works Foundation, we recently completed a survey of more than 1,000 patients with cancer and found that more than 60% strongly believe in complementary therapies and 71% want their health systems to offer them. In fact, 55% of patients said they would have chosen a different health system with more complementary therapies if they could go back in time, up substantially from 40% just a year earlier.
As with patient support, we are seeing provider endorsement increase, too. The NEJM Catalyst survey showed enthusiastic support among practitioners: 93% of respondents said they believe integrative care improved or greatly improved the patient experience; 83% said it improved patient health; and 74% saw improvement in the provider experience. And 81% said they believe that health outcomes for patients receiving integrative care are better or significantly better than those for the general population.
A primary roadblock to more widespread acceptance of integrative care has been a lingering skepticism among practitioners about the evidence base to support it. Among NEJM respondents, 39% believe there is strong or very strong evidence. But 19% said there is weak or no evidence, and the largest response was the 41% who believe there is only moderate evidence.
Yet, we’re seeing changing tides on many fronts. For one, medical associations are beginning to put out guidelines that support integrative approaches to pain and addiction management and also for improving pain and mental health issues associated with cancer and cancer treatments. In addition, HHS has just released a major brief on its actions to strengthen primary care that places whole-person, integrated care and well-being at the heart of its efforts.
In addition, the Veteran’s Administration (VA) has demonstrated tremendous success with a whole-person model called “Whole Health” that has improved patient outcomes and saved nearly $5,000 annually per patient. The VA and others are still in the process of developing “wellness metrics” to better define systemwide measures to see if shifting to whole-person care is really worth it.
Finally, CMS, private insurers and other payors are increasingly embracing whole-person health and continuing to experiment with value-based payment systems that go beyond fee for service. Some are moving toward a “bundled” payment system; for example, instead of paying a fee for knee replacement surgery, they would pay for a bundled amount for alleviating the patient’s pain and improving and sustaining enhanced function. That kind of payment model emphasizes the ultimate health outcome, not the means of getting there.
Money alone, however, is not actually the issue. We don’t really need CMS to give us more money. What we really need is for CMS to tell us that we have permission to take the money they are already paying us and redirect that money into things that actually create health and prevent disease, what I call “salutogenesis” rather than just “pathogenesis.” That means tracking and paying for risk reduction and disease reversal, not just its treatment in late stages.
Health care leaders and clinicians want to do the right thing, but they are often heard saying they don’t have the money, the staffing, the tools and the training. All that is true. But they actually do have sufficient resources if they redesign and reorganize how they do things. Within our current workforce, we can begin to create teams of primary care and other specialists with skills to take enhanced, smarter approaches to preventive and health promotive care.
We have the capability to transform the way we deliver care. I encourage you to learn more about the innovations that are happening every day. We can keep our patients healthier and, in the process, enable ourselves to spend more time doing what we wanted to do when we first became doctors: practicing healing. To learn more, check out the free CME course on whole-person care created by Tufts University as a place to start.”
