STEP PERSPECTIVE, Volume 7, No. 2 -Summer/1995; A Publication of the Seattle Treatment Exchange Project e-mail: step@eskimo.com
Tai Lahans

An outcome of this emergence of alternative medicine has been the growing understanding, especially in the treatment of serious chronic illness, that an integration needs to occur. In Seattle, the main forms used to treat chronic illness have been conventional medicine ("allopathy"), naturopathic medicine ("naturopathy"), and Chinese medicine ("acupuncture, Chinese herbal medicine", etc.,). These are the main alternative forms of treatment that are highly systematized with a long history of practice and over the years, many clients have integrated their own care with these three main forms of medicine. Making choices as to what and when and how has been left to them without input or discussion on the part of the many health care providers they are seeing. This has left our clients the responsibility and the burden of knowing as much as they can about treatment strategies and deciding alone when and when not to use these treatments and in what, if any, combinations. It has been a heavy burden to bear when dealing with a potentially serious illness or when, acutely, ill.

For those of us who practice an alternative form of medicine, there are also frustrating constraints that feed into this scenario and hold us back from our chosen path of treating HIV/AIDS clients. We usually cannot bill health insurance for services. This limits what we can offer, and many of us carry a heavy load of chronically ill clients who can no longer pay for our services out of pocket. After developing a long clinical and caring relationship with clients, we cannot follow them if they are hospitalized, effectively cutting off our care in times when continuity of care is crucial. These issues add to the burden for clients and practitioners.

In January, 1995, the Integrated Care Clinic at Bastyr University was begun to address some of these issues. This clinic incorporates several forms of medicine working with the client to find the best way to maintain health. The patient group has been limited to twenty people who visit three times per month for acupuncture, Chinese herbal medicine and naturopathic treatment. Two MD's are present in this shared space clinic to consult about diagnoses from a western point of view and to provide an interface with the patient's allopathic doctors should they not be the ones on staff. Discussions are held regarding the presentation of medical problems and the best possible strategies for intervention. These discussion include an MD, ND, nutritionist, and the Chinese medicine components. They can be with or without the patient depending on many circumstances. They are educational, informative, negotiative, and fluid. The point is to provide choices to clients that are the least toxic and most effective in a given situation.

In this approach, a highly complex treatment plan is generated out of a group intake. The group intake allows everyone to hear the same information at the same time, ask questions pertinent to their form and thus train each other from the start about their area. A team member acts as the interviewer, and the patient appoints one member to be the main communicant, the person they call in an emergency and, in turn, calls all of the others. This is the lead person for that patient. The treatment plan is an evaluation of all health issues; physical exam, blood work and labs, areas of health, Chinese evaluation and how it fits (or doesn't) with the western evaluation, Chinese diagnoses and treatment possibilities, nutritional possibilities and recommendations, psycho-emotional-spiritual information, and a set of negotiated plans that is a meld of this total evaluation. This plan is then presented to the patient by the team for further discussion, questions and negotiation.

Everything, including our process as a team, is presented to the patient as an informative means by which choices can be made. We see choices as the clients'. Therefore, we are working toward patient-centered medicine rather than medicine-centered medicine. It is quite different in approach and requires a certain amount of letting go on the part of individual providers. We never know what choices clients will make. It is often immediately apparent that one form of medicine is better suited to a given problem than another. Sometimes it is not; here we must educate each other which often includes a discussion about why we chose our particular form of medicine over another and often a discussion on the side effects of western drug therapies versus the benefits. This requires trust and an honoring of each other as individuals and as physicians who care about our clients no matter what form of medicine we practice.

These discussions and the evolution of this new practice of medicine are boundary-shattering, difficult, inspiring, a relief (shared sense of responsibility), complex and revolutionary. It is empowering for all concerned. The decisions made as a team with the patient included an at the center are no longer rote or bland or poorly adhered to; they are alive, strong, and deeply meaningful.

Tai Lahans is a co-founder of the Kang Wen Clinic and the Integrated Care Clinic. She is an acupuncturist and Chinese herbalist in practice now for ten years. The Integrated Care Clinic is at the Natural Health Clinic of Bastyr University. Tai Lahans can be reached at her private practice at 206-726-0269 or at the Natural Health Clinic at Bastyr University at 206-632-0354, extension 816.

These articles were provided by the Seattle Treatment Education Project - Copyright (c) 1997 - Seattle Treatment Education Project. Noncommercial reproduction encouraged. Distributed by AEGIS - http://www.aegis.com
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Copyright © 1995 - Seattle Treatment Education Project (STEP) - All rights reserved. Noncommercial reproduction is encouraged. STEP is published four times a year by the Seattle Treatment Education Project, 127 Broadway East, 3rd Floor, Seattle, WA 98102.    Email: step100@aol.com  STEP web page