One-of-a-kind medical student elective celebrates its 20th anniversary
The national events of 2020 have shifted our priorities back toward healthcare reform with a focus on increasing access and eliminating healthcare disparities. There is an urgency for us to commit to a collective vision for Integrative Medicine & Health. This article continues the series on What is Integrative Medicine? Past, Present, and Future. Please review the first two articles for a comprehensive review of the history and present perspectives in Integrative Medicine.
We can do better
- Start a difficult but necessary conversation about racism and disparities in healthcare
- Attain clarity on goals and focus for the integrative medicine & health movement
- Acknowledge and remove barriers to collaboration
- Support initiatives to increase access to integrative healthcare
Start a difficult but necessary conversation
Systemic racism, specifically, needs to be rightfully declared a national public health crisis within our field
As mentioned in the previous article, Integrative Medicine and Health (IM) has struggled over the years to define itself and its end goals. Various systems of medical or healing practice fall under IM, and, understandably, representatives from each system want a role in shaping the future of the movement. Regardless of differences, the IM subgroups should be able to agree on broad goals for addressing obvious healthcare disparities and promoting practical solutions, implementable across various practice settings and healing arts.
Systemic racism, specifically, needs to be rightfully declared a national public health crisis within our field. Initial steps forward include adopting an attitude of willingness to listen and learn from Black voices in communities who continue to experience disproportionate deaths from COVID-19, a manifestation of a deeper underlying truth--- that systemic racism continues to exist and creates health disparities. We need to look inside ourselves at our own racial biases and how they affect our decisions and the daily healthcare we provide. IM practitioners, generally considered to be more mindful and self-aware than their counterparts, are not exempt from necessary self-reflection in order to change from within before tackling larger issues of changing their communities and the world.
Attain clarify on focus and goals
... patient feedback and input should be central...
Clarity needs to come from IM organization members, thought leaders, and our patient customers about the future focus of the movement. Should the focus be on continued research on “complementary and alternative medicine” therapies? Should the focus be on making effective complimentary medicine therapies affordable and accessible to all? Alternately, should the focus be on developing a validated model of accessible holistic healthcare for whole organizations and systems?
The answer is to focus on all three of these important aspects of integrative healthcare, but keeping in perspective that efforts must be directed at sustainable change on behalf of our patients’ needs, not our own. This brings back full circle the truth that the origins of IM were essentially a “consumer-driven” movement. Thus, patient feedback and input should be central to defining the goals and future focus of the movement.
Acknowledge and remove barriers to collaboration
Scarcity is a fear and illusion that is separating us from creating sustainable change.
The IM community of practitioners is known for being an open, inviting, and close knit group of kindred spirits. One disheartening issue that is rarely brought up in circles is a hidden undercurrent of distrust, competition, and jealousy among some practitioners vying to be the top expert or media personality for their consumer market or healthcare system. Certain IM departments and centers also tend to be “territorial” regarding who they are willing to speak to and work with. As a result, open advice and sharing the best clinical and business practices is not as common as expected. A shortage of mentors is also apparent among practitioners. In order to IM to be a sustainable movement, barriers must be broken down separating practitioners, and a culture of free idea sharing and collaboration must be born. Scarcity is a fear and illusion that is separating us from creating sustainable change. We must acknowledge this fear in order to learn to trust each other and move forward together.
IM networking and organizational groups are the keys to initiating culture change. Free resource sharing and mentorship should be encouraged and nurtured. Ground rules for respectful collaboration should be developed and honored. Practitioners should make an effort to go outside their comfort zones and get to know others within IM who they normally would not interact with. They must also look inward and examine their own false assumptions and biases around relationship building within the IM practitioner community.
Support initiatives to increase healthcare access
... the settings in which IM is delivered create barriers to access.
It is apparent IM strives for inclusion and cross-cultural diversity in its practitioners and healthcare practices, such as Traditional Chinese Medicine and Ayurveda. However, the settings in which IM is delivered create barriers to access. The traditional IM centers housed within a large academic institutions cater to individuals with low to moderate medical complexity, comprehensive insurance coverage, and/or the financial means to pay out-of-pocket for medical care. Those centers who require referrals from other physicians within a health system create yet another barrier. Complimentary therapies, in general, are not widely covered by health insurance and their cost continues to be a barrier.
Furthermore, IM is not well-known or recognized as a healthcare offering in a number of underserved and low income areas, including minority communities of color. Contrast this with the generally well-to-do suburbanites and urban hipsters (mostly white) who frequent IM practices. There is an apparent disparity that should not be ignored. Recognizing this by no means disparages or turns away from our current healthcare consumer market; it simply encourages opening ourselves up to serving those in need and promoting equity.
The first suggestion is simple. Go to IM4US (Integrative Medicine for the Underserved), join, and search their toolkit resources for ideas to implement in your practice. Ask around to see if there are existing programs and initiatives going on locally or nationally and join them. If there are none, develop partnerships with surrounding communities with limited resources and offer to volunteer your services. Then, train or mentor volunteers in those communities to continue providing the services. If you are a non-profit, apply for grants to start a sustainable program or start a crowd funding campaign on social media. If you are in a healthcare organization, take your advocacy all the way up to the C-suite to discover what resources are available to give back.
The time is NOW (a personal note from the author)
The theme of "the time is now" has popped into my awareness recently along with a sense of great urgency. Change MUST happen in our country and world, but I have always known in my heart that change starts within. I cannot remain silent on the need to address the shadow aspects of Integrative Medicine and Health...and in essence our own shadows. We have to recognize the problems before we can open up a dialogue and take action. I'm hoping we can take the steps to eliminate racism, healthcare disparities, and make IM accessible and affordable to all. I'm hoping we can all coalesce around a goal and focus for IM that puts patients first. I'm hoping we can embrace a mindset of abundance instead of scarcity. I'm hoping we can put aside our differences, open our hearts, and check our egos at the door to create better healthcare together!
IM continues to evolve with new questions about the current state of it’s role in healthcare and it’s future viability. This article series will include past, present, and future perspectives on Integrative Medicine. Stayed tuned for upcoming articles in the series!
© 2020 Danielle Zelnik, MD.