Palliative Care and Integrative Medicine: What are they and how do they fit together
After finishing medical school, I trained as an internal medicine physician and then did more training in integrative medicine and then palliative care. Many people are not quite sure what those different specialties are or may be unclear if or how they fit together. I’m going to start with official definitions and then I’ll explain how I think of them and how they fit together for me.
Internal medicine is probably most familiar. Taken from the American College of Physicians website, internal medicine physicians or internists “are experts in complexity. They specialize in adult medicine, and are specially trained to solve diagnostic problems, manage severe long-term illnesses, and help patients with multiple, complex chronic conditions.” Your primary care physician may be an internist or if you are in the hospital, the physician that cares for you there may be an internist (or in a nursing or other spaces). Some internal medicine physicians complete more training to specialize in cardiology or pulmonology or other fields.
What is palliative care? Palliative care “is specialized medical care for people living with serious illness.” It is “focused on providing relief from the symptoms and stress of the illness” with a goal of “improving quality of life for both the patient and the family.” Although many people think of palliative care as “pre-hospice” (and it sometimes is pre-hospice), palliative care is “appropriate at any age and at any stage of a serious illness, and it can be provided along with curative treatment.” As a palliative care physician, most of the patients I meet are quite ill and are having to make difficult decisions about their life and their healthcare. It is often an incredibly difficult and meaningful time to be able to help guide people in their journey.
Lastly, what is integrative medicine. I’m using the definition from the Andrew Weil Center for Integrative Medicine which says that “integrative medicine is healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between the practitioner and the patient, is informed by evidence, and makes use of all appropriate therapies.” Integrative medicine is quite broad and brings together both conventional medicine as well as complementary therapies. Ideally, integrative medicine combines the best of conventional medicine together with other modalities that resonate with the patient to bring about healing.
For me, internal medicine is the all-important foundation for understanding health and disease and taking care of people all along the spectrum of health and illness. My training in internal medicine and years spent practicing medicine as a hospitalist inform my understanding of complex illness and what people with serious illness may be going through. However, one of my challenges as an internist was that I felt I was not able to attend to the body, mind, and spirit in the way that was most compelling to me. I also felt that the conventional toolbox was limited. Conventional medicine is miraculous in many ways and yet for things like chronic pain or facilitating healing, it feels like an incomplete toolbox to me. Integrative medicine has many more tools to stimulate the body’s own ability to heal and to truly tend to body, mind, and spirit. I want to point out that some people use the word alternative to talk about other modalities of healing. Alternative means “instead of” so alternative medicine means choosing another modality rather than conventional medicine. Integrative medicine integrates or brings together all of the tools, the conventional tests and treatment with other modalities. Palliative care is also a specialty that truly tries to care for the body, mind, and spirit. Like integrative medicine, palliative care first treats the person and then looks at the disease or the symptoms. For me, palliative care is often a conversation of “what matters most right now?” This question has different answers at different stages of life and different stages of illness or health. And yet, for me it is a question that can guide us to live our meaningful life and live our priorities, despite limitations we may have because of our physical health. Integrative medicine and palliative medicine both guide people towards healing and wholeness, whether or not a disease is curable.
My approach is to see and know the person, understand their stage of illness or health, ask the question what matters most, and use all the tools in the toolbox to help facilitate healing body, mind, and spirit. Underlying all of this is my belief that the person’s intuitive wisdom is the most important guide and that we come together (me with my experience and my intuitive wisdom and you with your experiences and intuitive wisdom) to move you along your path to wholeness and healing.
References:
https://www.acponline.org/about-acp/about-internal-medicine
https://www.capc.org/about/palliative-care/
https://integrativemedicine.arizona.edu/about/definition.html
