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An Introduction to Integrative, East-West, and Well-being Oriented Primary Care Medicine

Published July 1, 2015

Written by Justin Laube MD

This article aims to help the public better understand the basic constructs underpinning the integrative, East-West, and academic primary care clinic at UCLA Center for East-West Medicine. The Center’s model continues to evolve as the Center grows, each provider bringing their own unique perspective to our practice.

WebIn This Article:

I. Introduction
II. What is Integrative Medicine (IM)?
III. Integrative East-West Medicine at the CEWM
IV. Defining “Well-Being”
V. Applications of IM to the Primary Care Setting
VI. Conclusion
VII. References

 

 

I. Introduction

The UCLA Center for East-West Medicine (CEWM) offers primary care services at our clinic in Santa Monica under the leadership of Edward Hui, MD. Dr. Edward Hui is son of the Center’s Founder and Director Ka-Kit Hui, MD, FACP, and has been trained in both internal and geriatric medicine. CEWM’s Primary Care East-West Program consists of two other internal medicine providers, Justin Laube, MD, and Felicia Yu, MD, and in July 2015 will welcome family medicine physician Katie Hu, MD. The goal of this article is to help patients better understand the basic constructs underpinning our integrative, East-West, and academic primary care clinic. The Center’s model continues to evolve as the Center grows, each provider bringing their own unique perspective to our practice.

 

II. What is Integrative Medicine?

Integrative Medicine (IM) is the term that best reflects our type of practice and perspective at the CEWM. There are a variety of definitions for IM. One that captures the deeper aspects of this medical movement is from Andrew Weil, MD, Founder and Director of the University of Arizona Center for Integrative Medicine. Dr. Weil defines IM as:

“a healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” [1]

Within this definition are five major themes. First, a “healing-oriented medicine,” references the self-regenerative process that is inherent within all living systems and should be acknowledged and supported by providers. For example, when the skin is cut, the body will activate regenerative and immunologic signals to help the body protect itself and initiate its innate healing capability. Second, treating the “whole person” is synonymous with the term holism, a perspective of viewing patients within a complex and interconnected web of behaviors, relationships, and environments. This contrasts with the purely reductionist view of disease that still predominates in conventional medicine. Third, beyond a “whole person” and holistic view toward patients, Dr. Weil describes a medicine that acknowledges the role of “all aspects of lifestyle” in health. Lifestyle includes all of the modifiable factors that impact our risk of future disease and illness, and thus the potential for prevention of these risks. Fourth, inherent to almost every health care interaction is a “therapeutic relationship” with a provider, which may be a nurse, doctor, pharmacist, etc. This essential aspect of care has been acknowledged since Hippocrates’ time in early 400BC, and is central to the practice of any healing-oriented field [2]. Finally, IM uses all appropriate therapies to help patients. This is where complementary and alternative medicine (CAM) is nested alongside mainstream medicine, with the goal of being open minded to those therapies with evidence for efficacy while being aware of potential safety issues. As outlined here, the definition of IM includes aspects of incorporating CAM therapies, but simultaneously brings in a broader and more comprehensive perspective toward the healing process, patients, and health care.

 

III. Integrative East-West Medicine at the CEWM

Beneath the umbrella of Integrative Medicine is integrative East-West Medicine (EWM), a specific model that was first practiced in China at select hospitals and medical universities. Since the UCLA Center for East-West Medicine’s (CEWM) founding in 1993, its predominant form of IM practice has been EWM. This is in line with its original mission of “blending the best of Modern Western medicine with Traditional Chinese Medicine (TCM) to provide health care that is safe, effective, affordable and accessible.” The model integrates the expertise of physicians, TCM practitioners (acupuncturists), and body-work therapists to address a variety of complex medical conditions within a comprehensive academic health center clinic. According to Sonya Pritzker, PhD, LAc, the CEWM clinic applies the concepts of person-centered medicine from both East and West by using rational, evidence-based thinking and shared decision-making, as well as patient education, holistic diagnosis, and individualized treatment, including self-care [3]. EWM’s holistic way of approaching patients, which emphasizes balance and homeostasis, has applications beyond a consultative model, as the self-care and lifestyle interventions, many based on TCM principles can be brought into primary care practice. Since 2013, we have included primary care services into the CEWM’s clinical practice, and have been working to best incorporate East-West tools into primary care medicine.

 

IV. Defining “Well-Being”

There is a growing interest in a broader concept of patient health, or well-being. While there is currently no consensus on the definition of well-being, the CDC describes it as “a positive outcome that...tells us that people perceive that their lives are going well” [4]. Exhibiting well-being is more than the absence of disease, it is a more holistic and proactive concept. One comprehensive model of well-being by Mary Jo Kreitzer, RN, PhD, Director of the University of Minnesota Center for Spirituality and Healing (CSH), incorporates six categories of well-being including: Health, Purpose, Relationships, Community, Environment, and Security. This model can be a useful tool to better understand the factors impacting a patient's overall quality of life.

wellbeingchart.revised

The chart above summarizes the well-being model created by Mary Jo Kreitzer, RN, PhD, Founder and Director of the University of Minnesota Center for Spirituality and Healing.[5][6]

Using this model to better understand our personal well-being can be used as a guide to identify areas of our lives where investments could be made to improve our overall health and happiness. The CSH has an award winning website that can help you evaluate your own personal well-being and provides resources to work on these specific areas. Models like Dr. Kreitzer’s have potential direct use for primary care, to move away from the outdated disease-based visits and toward visits focused on more positive health behaviors and goals. As primary care providers who practice IM and EWM, our approach enables us to better meet and address patients concerns and expectations, which are often closely tied to their personal narrative and health goals.

 

V. Applications of IM to the Primary Care Setting

Patients often have their own expectations as to the specifics of what will occur during their initial visit with a primary care physician. Commonly encountered stated goals for the new patient visit in our practice are for a “physical exam” or “screening tests.” The concept of a comprehensive physical exam became popular in the 1940s, yet more recently there has been significant controversy as to the effectiveness of screening physical examinations in asymptomatic patients [7, 8, 9]. The specifics screenings and discussions that are common and recommended are from the guidance of the United States Preventive Services Task Force (USPSTF). For example, when is it recommended for a male to undergo a colonoscopy? and whom is at risk and should be screened for depression? Many of our patients are interested in being more involved with their care, so they can understand some of the more specific patient-customized screenings and vaccinations that are recommended for them. One way easy way is by reviewing the preventive services selector tool or vaccination schedules at the link below.

At the CEWM, we encourage patients to take charge of their health care and review these guidelines before visits. Many of these screenings and vaccinations will have their largest impact on the prevention of disability and death in the future, yet immediate improvements in overall health may be much less directly felt by patients. Moving focus toward patient lifestyle and health goals is often lacking from these “physicals” and in patients expectations for seeing their doctor. Regularly incorporating discussions with patients to support healthy, purpose driven behavior has become an overarching goal of the CEWM primary care clinic.

A newer model for primary care have been developed and are being explored nationally through the support of the Affordable Care Act, also known as “Obama Care.” This is termed the patient-centered medical home (PCMH), which is defined by the National Committee for Quality Assurance (NCQA) as “a way of organizing primary care that emphasizes care coordination and communication to transform primary care into ‘what patients want it to be.’” In the future, we will explore ways to provide innovative primary care to our population of open-minded patients. This may include group visits to foster a sense of community between patients with similar diseases/issues, more sophisticated informational technology tools to empower patients to keep updated on their health, and enhanced access to supportive tools to work on your proactive health goals.

 

VI. Conclusion

The fields of integrative and primary care medicine continue to grow and research is ongoing nationally to determine optimal models of integration of these closely related fields. In 2012, 33.2% of U.S. adults reported use of complementary health approaches [10]. This attests to the increasing number of patients seeking new approaches to support their overall health and well-being. The need for physicians who are trained in integrating these concepts into primary care will continue grow alongside patient interest. As this transition occurs, the UCLA Center for East-West Medicine will remain dedicated to providing the best in integrative, East-West, well-being, and holistically-oriented primary care to serve our local community and open-minded patients.

 

Justin Laube, MD, Felicia Yu, MD, and Katie Hu, MD are accepting new Primary Care patients at the UCLA Center for East-West Medicine in Santa Monica, California. To make an appointment, please call: (310) 998-9118.

 

 

 

VII: References

  1. Maizes V, Schneider C, Bell I, Weil A. Integrative medical education: development and implementation of a comprehensive curriculum at the University of Arizona. Acad Med. 2002;77:851–860.
  2. Goold, S. D., & Lipkin, M. (1999). The Doctor–Patient Relationship: Challenges, Opportunities, and Strategies. Journal of General Internal Medicine, 14(Suppl 1), S26–S33. doi:10.1046/j.1525-1497.1999.00267.x
  3. Pritzker S, Katz M, Hui KK. Person-centered Medicine at the Intersection of East and West. European Journal for Person Centered Healthcare 2013, Vol 1, Issue 1, pp. 209-215.
  4. “Well-being Concepts.” http://www.cdc.gov/hrqol/well-being.htm. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. March 6, 2013
  5. Kreitzer MJ, Koithan M. “Integrative Nursing.” Weil Integrative Medicine Library. Oxford University Press, 2014. 125-136.
  6. “Taking Charge of Your Health & Well-being.” http://www.takingcharge.csh.umn.edu. University of Minnesota Center for Spirituality and Healing. August 28, 2013
  7. Bloomfield HE, Wilt TJ. Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult. 2011 Oct. In: VA Evidence-based Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011-. Available from: http://www.ncbi.nlm.nih.gov/books/NBK82767/
  8. Harriet Hall, MD. Rethinking the annual physical exam. https://www.sciencebasedmedicine.org/re-thinking-the-annual-physical/
  9. Mehrotra A, Zaslavsky AM, Ayanian JZ. Preventive Health Examinations and Preventive Gynecological Examinations in the United States. Arch Intern Med.2007;167(17):1876-1883. doi:10.1001/archinte.167.17.1876.
  10. Clarke TC, Black LI, Stussman BJ, et al. Trends in the use of complementary health approaches among adults: United States, 2002–2012. National health statistics reports; no 79. Hyattsville, MD: National Center for Health Statistics. 2015.

 

 

 

By Justin Laube, MD
UCLA Center for East-West Medicine, East-West Primary Care Fellow

Copy-edited by:

Rosana Chan, MPH, UCLA Fielding School of Public Health
UCLA Center for East-West Medicine, Administrator

Vivianne Chang, Human Biology and Society B.S., UCLA 2014
UCLA Center for East-West Medicine, Administrative Assistant

 

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