The Future of Integrated Medicine in Canada

Check out pages 7-10 of  www.naturopathicnotes.ca/issues/ND-Notes-2-3.pdf  for my article featured in ND Notes by CanPrev Natural Health Supplements that discusses what integrative medicine is and what is looks like within the current healthcare system model.

Or check out  a summary below:

The Future of Integrated Practice in Canada
The hand in hand relationship between ND and MD
By Dr. Laura Anderson ND

The future of healthcare in Canada is integrated healthcare.  
 
Approximately 70% of Canadians are using some sort of complementary and alternative health care such as vitamins and minerals or herbal products to improve health and maintain wellness. The increasing awareness, knowledge and demand of the general public is reaching MD's offices. Patients want natural health options before trying conventional treatments and this is putting pressure on MDs.  They are being forced to investigate these natural options, find appropriate practitioners  to refer to or ideally begin to work in an integrative model.
 
Integrative medicine is defined by using the best conventional and complementary healthcare options to treat the whole patient (body, mind and spirit). The main principles are the following:

• healing oriented
• patient centered
• coordination among health care practitioners
• the use of natural, effective and less invasive options as much as possible
•  to critically research the best options, both conventional and alternative
• treatments should be inquiry driven, based in good science and be open to new paradigms

 
Looking around at the current landscape in the medical, health and wellness field and you will see shining examples of integrated healthcare. A naturopathic teaching clinic in the Brampton Civic Hospital, a magazine publication called Integrated Health Practitioners, a registered charitable organization that conducts scientific research in complementary and alternative medicine called the Canadian Institute of Natural and Integrative Medicine (CINIM), medical students job shadowing at naturopathic clinics, naturopathic doctors working in university health clinics, holistic dentistry practices and medical doctors training or practicing integrative therapies.  
 
 
In fact, back in the early 1990's there were a few medical doctors in Ontario that were practicing reasonable integrative therapies but because these practices were outside of their conventional scope they were subjected to medical licence suspension or loss from the College of Physicians and Surgeons of Ontario (CPSO).  One specific Ontario physician, Dr. Jozef Krop MD is thought to be a major contributor to modern integrative practices and was one of these doctors that faced discipline from the CPSO.  But his patients rallied at Queen's park to not only vindicate him but also to help pass Bill 2 (or the Kwinter Bill).  This bill is an amendment to Medicine Amendment Act, 1999,  that states there is a freedom of medical practice and the freedom to choose the treatment that works best for the individual and that the patient has freedom of choice in their healthcare. It also states that there will be no competition among therapies as it will be the patient that suffers in the end.
 
This bill basically states the use for integrative medicine and how the patient should be at the epicentre of the different therapies available so they can receive the utmost benefit. The competitive egos of the practitioners should not dictate the decisions of what forms of medicine that are to be used or affect what that individual is already doing for treatment. Not surprisingly, there is an increasing number of clinics across Canada that are integrative medical clinics and practicing in this way has revolutionized their practice.  Increased patient compliance, improved patient outcomes, and increased patient treatment options from the various allied practitioners that work in the integrated model.  Simply put, this makes patients happier and practitioners jobs easier.
 
What does this integrated healthcare system look like? It is where there is an solid understanding between all conventional and complimentary healthcare providers of the specialities of medicine that exist and that they complement each other when used properly and effectively under medical supervision. It is having facilities housing these different practitioners who can readily consult with each other on cases for treatment options or have patients see other practitioners for a consult. Or it can exist as an efficient network of referral systems that are in place within a community for patients to easily access and find the treatment options that the referring doctor may think is  a good fit.
And most importantly it is the communication between practitioners on the patient's status of treatment and outcomes to ensure proper patient co-management.
 
I am currently working at Trent University in Peterborough, Ontario. I approached them 4 years ago about integrating naturopathy into their health services team.  After a year of meetings, presentations and discussions, it was determined that I would be given one school year as a trial run. I am now going into my fourth school year and overall demand is increasing for naturopathic medicine and the feedback has been positive. But, I am far from my ideal goal of making it a truly integrative practice. Currently students choose whether to see the MDs, myself  or both and choose which health concerns they want to address.  Sharing patients, whether treating the same concerns and not, allows the MDs to see and hear the outcomes of patient experience with naturopathic treatments. This is a great way for my practice effectiveness to speak for itself and for the MDs to get comfortable with naturopathic medicine and with me as a practitioner.  Ideally, I would want to consult on all the visits, so both the MD and I could make recommendations and prescribe treatments together and then do appropriate patient co-management.  Now, I have started a discussion around integrative medicine and different approaches with the health services team and the challenges that I face really come down to university policies,  limited clinic space and time, resistance to changing a overloaded health system that runs quite smoothly and limited university and student finances. 
 
I realize that I pushed to be at Trent, and the fact that I am there does not mean it's now an integrative practice.  It takes all of the team, especially the medical doctors, to be on board to make it  a true integrative practice. But, I am positive about the future possibilities at Trent as these past 4 years I have been creating professional relationships and laying the ground work for new ventures to be formed.
Through this process at Trent,  and my past 6 years of private practice, I have learned "ND-friendly", more integrative MDs can make a huge difference in the progression of integrative medicine, but we as NDs also have an integral role at creating and maintaining these relationships too (see sidebar).
 
It is truly an exciting time to be in the natural health and wellness field.  Our online and social media culture has increased the ways patients access information, connect with others that have similar health concerns and allow them to research other treatment options.  This promotes the conversation between patients and MDs about other alternative choices and working with additional practitioners in an integrative way. So get ready,  because integrative medicine is the way of the future and you are the ones they will be looking for. 
 
 
 
 
SIDEBAR Section:
So how can you as a practitioner bring this to your patients and clinic. Well, most of you are likely already doing so in some form or another, but here are steps to consider to fully embrace this future of healthcare: 
 
#1:  Patient Recommendation:  With the current patients in your practice, start a conversation with them, asking if they would feel comfortable telling their MD, or nurse practitioner etc, about their experience with Naturopathic Doctors.  This is especially true for challenging cases that the MDs may have felt there were no other treatment options to try. Make sure to tell the patient why you would appreciate them doing this for you. Some reasons could be:  it provides the MD with effective natural alternatives that has worked for his current patients under ND care,  it helps future collaborations between ND and MD,  it helps the MD become increasingly comfortable mentioning another options or referring their patients to NDs.  Make sure to follow up with this patient if they did in fact do this and what the response of the MD was.
 
#2 Writing letters:  Provide a letter to each of the MDs that your patient made contact with. Yes, this does sound like a lot of work, but it doesn't have to be. Simply formulate a  general template that is concise, uses professional language and medical terminology and then simply add in the information that is relevant to your specific patient.  Remember to ask permission from your patient before sending the letter and keep  a copy of the letter in their chart. Don't expect an immediate response, but overtime this MD may start referring to you, because you have been the only ND that has reached out to them in the area or they may mention to you to other colleagues. It's a great way to open a line of communication between practitioners.
 
#3 Current Network:  What health professionals do you currently know in your existing network? Do you or any friends or family members have MDs in their network?  Maybe try to get an informal meeting with them or at least be introduced. Or better yet, set up a formal business meeting to invite them to see your clinic and discuss collaborating. Use who you know to your advantage.  
 
#4:  New Networking:  Whether you are a new practitioner, moved locations or cities, changed focus or need a boost in new patients,  getting out there to network is always an important thing to do. Meeting people face to face, talking with them and having them get a feel for you, goes a long way.  Yes, this process can be time and energy consuming  but friendly on the wallet if you are sticking to a budget.  Make sure to have a business card on hand that will allow them to learn more about you once the introduction is over. Therefore, having a great website and social media content will help to establish who you are and what you do. Opportunities for networking can be found through local business development chapters, speed networking events and at other businesses in your local area.  Also, many local health professionals have monthly meetings and lunch and learns that NDs may be able to speak at. Perhaps write an article or guest blog for their association website or newsletter or social media platform.
 
#5:  Marketing packages:  Sending note pads, magnets, business cards and pamphlets with your contact info can act as a quick resource for MDs to turn to when patients are wanting alternative solutions.  Clearly highlighting the focus of your practice and  how you can uniquely co-manage their patients can provide the MD with effective natural health solutions from a regulated and licensed health professional.
 
#6: Local Events: Picking up the local newspaper or being connected on social media with local news and radio stations to know when and what certain events are occurring. This is a perfect opportunity to be engaged  and partake in community events as a guest or a vendor to talk about what you do and make contacts that way. You never know who you will meet, (it could be MDs), who they will know or what opportunities that can follow after that. This takes some time and energy but is usually free or a minimal cost to attend and a great way to support local businesses and get to know your community.
 
#7: Be loud. Be proud: So often NDs are modest in their amazing and profound ways they are changing the health of their patients. So NDs need to be telling their friends and families and social acquaintances, about their experiences (with limited patient identifying factors of course) and examples of what they are doing and how patients can benefit. Because everyone knows someone who is ill, on medications, or will be diagnosed with a disease that will change their life. So people are searching  for options, and people are going to go to places that their friends, family or MD refer them to get the best medical care they can.  Even for those introverted practitioners, your work and how you have helped patients will speak for itself by way of their conversations to their network of friends, family and co-workers. 


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