Complementary Medicine and Clinical Practice.
Complementary and alternative medicine, or CAM, as it is known, has been an important and controversial topic for allopathic medicine since Eisenberg et al.'s article, "Unconventional Medicine in the United States," was published in the New England Journal of Medicine in 1993. Since that time, many articles and books have been written on this topic. Although the majority of the patients in this country will use one or more forms of complementary medicine, and spend more out-of-pocket money on CAM techniques and practitioners than on allopathic ones, there is still a great deal of uncertainty among practicing physicians about what exactly CAM consists of. This book goes a long way toward helping to clarify this diverse and changing topic. The editors, David Rakel and Nancy Faass, have excellent experience in CAM and are well grounded in evidence-based medicine (EBM) as well. The contributors to the book all have appropriate expertise in their special areas. The book works to make CAM much more "integrated" for all physicians, if physicians are inclined to move in that direction.
Overall, each of the topics in the book emphasizes a refreshing focus on health compared with the antidisease focus of many more traditional medical articles and books. One of the book's purposes is to help introduce allopathic physicians to different techniques that are accessible to their patients. There are articles on ways of incorporating these techniques not only as referrals, but also as integrated aspects of one's own practice. This is an important consideration for physicians, as many patients are looking for CAM modalities as part of their health care. Much patient interest in CAM is because these techniques fit patients' health care philosophy, as documented by Astin in a 1998 JAMA article. This book provides a foundation for ways of incorporating some of these areas into a workable plan of a practice.
Each of the chapters integrates the technique and philosophy of the topic explored into an overall health-oriented approach to patient care. This focus should resonate with family physicians, as many of our core values are at the heart of the techniques reviewed. There is a great deal of emphasis on prevention, nutrition, exercise, massage, breath work, spiritual counseling, health coaching, and patients' responsibility for their own health. Not all of these areas will be accessible to patients or even physicians, but they are important aspects of health that fit with the biopsychosocial/spiritual model. In fact, this promotion of the basic tenets of family medicine, combined with the multidisciplinary and truly integrative approach this book advocates, is exactly what the Future of Family of Medicine Project has been calling for. Rakel and Faass's book creates a template for a new model of medicine. Given its broad scope, it is ideal for family physicians to consider as we envision the evolution of our practices. Especially because practitioners of different healing systems are available in many communities, a family physician could create a powerful network of health care practitioners for his or her patients.
The chapters are easily accessed, with good headings. Many of them are relatively short, providing a quick introduction to some of the different healing modalities. Extensive references are provided and include many articles that appeared in the mainstream medical literature, not just in modality-specific journals. There are many resources for Internet connections and personal digital assistants, which make this book particularly good for the Internet-savvy physician.
Some of the information may be hard to digest, as the philosophy and traditions of the healing systems described are not familiar to many allopathic physicians. However, each chapter is clearly written, and references help create quick access to the tenets and approaches of the healing system reviewed. For chapters on such techniques as massage and manual medicine, including chiropractic, very important information on licensing and requirements in each state is listed. Moreover, attention to the current evidence is referenced. For example, in acupuncture, one chapter emphasizes the research being done in the field and the current EBM rating of acupuncture with respect to certain diseases and conditions. A good summary of some of the available evidence supporting acupuncture for certain indications is provided.
Complementary Medicine and Clinical Practice creates an opportunity for physicians to become aware of and potentially integrate different healing modalities in the care of their patients. If the reader is open minded, this book will help overcome some remaining hurdles. If the physician has already decided that CAM is not worth consideration, it is unlikely that the title or the chapters will stimulate any interest. Unfortunately, some of the physicians who could most benefit from this introduction are unlikely to read it. Physicians who are already supportive of CAM techniques will find much additional information to augment their knowledge. In addition, the research and extensive references will be very useful. A possible use for the textbook would be as a resource on CAM for medical school curricula. As more than two thirds of all U.S. medical schools now have some CAM curriculum component, this information fills a real need for evidence-based instruction in this popular trend.
One weakness of the book is that it does not contain many practical clinical recommendations that can be easily or immediately implemented into a typical practice without more extensive training in the specific area. For example, this is not a good book to use as a reference for approaching a particular medical problem with integrative techniques. As such reference works do exist and are a common way for physicians to begin to use integrative approaches, many readers will find this book frustrating if they obtain it for that purpose. On the other hand, someone who is interested in reaching out to a broader healing community will find this an excellent book to read to prepare for discussions with other practitioners.
Ultimately, as medicine works to become more integrative and uses resources that help patients find better health, this integrative approach is exactly what is needed to open doors and create multidisciplinary processes dedicated to healing. As mentioned above, from a family physician's perspective, this approach is the foundation of the new models of practice that we are being challenged to create. As no one practitioner can be all things to all people, finding ways of reaching out, integrating approaches in a sensible fashion, and supporting our patients' health care choices are the essence of family medicine.
Reid B. Blackwelder, MD
Department of Family Medicine, James
H. Quillen College of Medicine, and
Kingsport Family Medicine Residency,
Astin, J. (1998). Why patients use alternative care. JAMA, 279, 1548-1553.
Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., & Delbanco, T. L. (1993, January 28). Unconventional medicine in the United States--Prevalence, costs, and patterns of use. New England Journal of Medicine, 328, 246.
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|Author:||Blackwelder, Reid B.|
|Publication:||Families, Systems & Health|
|Article Type:||Book review|
|Date:||Sep 1, 2007|
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