Imagine a future in which your family doctor is as well-versed relieving pain with acupuncture as with anti-inflammatory drugs. If trends in medical schools around the country are any indicator, this change may happen sooner than you think.
According to various surveys, including a May 2000 survey by Consumer Reports magazine, as many as 40 percent of patients are seeking alternative treatments—and they tell their doctors about it. This means that more medical students have tried complementary or alternative medicine (CAM) or are keenly aware that their future patients may be pursuing alternative health care.
“Medical professionals have generally taken the approach of bringing science to the bedside,” says Gregory Plotnikoff, M.D., assistant professor of clinical medicine and pediatrics at the University of Minnesota. “But we’re saying at this point in time it’s important to bring the bedside to science—what are people needing?”
The American Medical Association is also paying attention. The organization issued a 1997 report that stated, “Medical schools should be free to design their own required or elective experience related to alternative/complementary health care practices.” A study in the September 2, 1998 issue of the Journal of the American Medical Association showed that more than half of U.S. medical schools have elective courses in CAM therapies or include these topics in required courses.
Physician, Teach Thyself
Before he enrolled in medical school, Michael Amster had a strong interest in herbal medicine. He was brought up with an appreciation of the outdoors and plants and went on to study botany and molecular biology at the University of California at Santa Cruz, where he found in the community “a mecca for alternative healing education.” He met herbalist and acupuncturist Christopher Hobbs, whom he later worked for as an assistant, researcher, and writer. Amster is now a fourth-year medical student at the University of California at Irvine (UCI) and is actively working to bring new course matter into the curriculum.
Amster says his education should prepare him to be a physician who has a “relationship with the patient and can honor the physical, emotional, and spiritual issues that patient has.” He envisions a practice in which he collaborates with an acupuncturist, herbalist, and naturopath who discuss and work on cases together.
Faculty and students are seeking responsible ways to guide the integration of conventional and alternative medicine.
In his first year of medical school, Amster and his fiancée, acupuncturist Rasa Sammy, wrote a proposal and got approval for an elective introductory course in Oriental medicine. Sammy is now one of five teachers of the course, which exposes students, residents, and faculty to acupuncture and herbal medicine.
Amster also started a student-interest group on complementary medicine that invites speakers to give talks regularly.
In addition, he created an integrative medicine website for physicians and patients and serves on the advisory board for the Susan Samueli Center for Complementary and Alternative Medicine at UCI, a center that conducts scientific studies of alternative and complementary medicine.
Other medical students also feel a need to learn about complementary medicine. In his first year of medical school at the University of California at San Francisco (UCSF), Jonathan Ho and a fellow student started an organization called Students for Integrative and Complementary Medicine. The group invites alternative practitioners to speak and give demonstrations, and its members have visited the Center for East-West Medicine at the University of California at Los Angeles (UCLA) to learn about research and observe.
UCSF medical students, headed by Akilesh Palanisamy, launched The UCSF Integrative Medicine Forum. The first forum was held in 1999, and another is being held this year, with speakers such as James Gordon, director of the Center for Mind-Body Medicine in Washington, D.C., and Dean Ornish, director of the Preventive Medicine Research Institute and clinical professor of medicine at UCSF.
CAM approaches are appearing at universities across the country—including Harvard, the University of Florida, Georgetown University, and the University of Alabama.
At the University of Minnesota, chaplains and nurses have joined together to promote the creation of an interdisciplinary team to better address patient needs. Mary Jo Kreitzer, Ph.D., R.N., and Plotnikoff, respectively director and medical director of the university’s Center for Spirituality and Healing, met with the provost for the Academic Health Center to propose the introduction of a survey course in complementary healing practices.
An outgrowth of this action was the creation of a task force comprising more than 100 faculty members who created a report about integrating mainstream and alternative medicine into the curriculum. The university’s medical school curriculum now includes twenty-three hours of integrative medicine studies.
“Minnesota is blessed with an enlightened faculty that gets it,” says Plotnikoff.
The approach to integrative medicine at Minnesota will help students better understand what questions to ask, Plotnikoff says. “They will be asking what is evidence, what is good evidence, and what counts as evidence in different healing traditions.”
Faculty at UCLA also recognize a need to provide information on complementary medicine. In the university’s three-year doctoring course, presentations include mind-body connection and relaxation, spirituality in medical care, and alternative medicine. The course’s chair, Susan Stangl, M.D., also teaches electives on complementary medicine, including an introduction for first-year students and a clinical observational clerkship for more advanced students. The clerkship takes about ten students a year; more are interested but they can’t be accommodated. Stangl emphasizes the importance of research and a critical eye so that harmful or not-so-effective methods can be eliminated.
Also at UCLA, Ka Kit Hui, M.D., director of the Center for East-West Medicine, teaches an elective on East-West medicine, and medical professor Richard Usatine, M.D., has started a yoga course.
“I think it is important for the students to, at the very least, understand what their patients are doing so they can better relate to them and hopefully advise them in a balanced way about their health care,” Stangl says. “Some of them will want to go beyond this and refer patients to CAM practitioners.”
Other educational opportunities are cropping up in connection with academic institutions. In 1999, seven medical schools formed a consortium of deans and program directors “interested in guiding the development of integrative medicine in a responsible way,” according to Andrew Weil, M.D. in an editorial in Integrative Medicine. These medical schools—Duke University, Stanford University, the University of Arizona, the University of California at San Francisco, the University of Maryland, the University of Massachusetts, and the University of Minnesota—share a commitment to transforming health care and are working on defining and communicating competencies for CAM education.
A two-year postgraduate training in integrative medicine is also available at the Program in Integrative Medicine at the University of Arizona, founded by Weil. The program includes teaching physicians to care for themselves, learn about mind-body medicine, and take part in leadership training that will enable them to launch similar programs at their academic institutions, says Matt Russell, spokesperson for the program. Four people have completed the program and returned to their academic institutions. Eight physicians are currently enrolled.
Weil writes in his Integrative Medicine editorial that the medical school consortium “calls for nothing less than a transformation of medicine and medical education.”
Lynda McCullough is a freelance health writer in Fort Collins, Colorado.
By Lynda McCullough