Western medicine has changed a lot in the past 50 years — including in terms of what actually qualifies as medicine. For those old enough to remember Marcus Welby, MD, or Dr. Kildare, imagine either of those two physicians, kind and caring though they were, recommending a patient see a chiropractor, massage therapist, or an acupuncturist. Imagine them suggesting yoga or tai chi, or perhaps making rounds with a labradoodle.
For today’s physicians, and the hospitals and medical groups that employ them, such practices are not only recognized but also encouraged and aggressively marketed to patients who want and expect such treatments.
Indeed, even the name of this trend has evolved, from what used to be called “complementary” and “alternative” to “integrated” or “functional” medicine. After all, it can’t be alternative if almost everyone wants it.
“What we have heard from patients is frustration that they have reached the limit of what they can do with traditional medicine. They are looking for an alternative approach that may not require pharmacologic intervention.”
—Dr. Sandra Kesh, Westmed Medical Group
Montefiore Health System launched its Psychosocial & Integrative Oncology Program (more commonly known as Bronx Oncology Living Daily [BOLD] Cancer Wellness Center Program) in 2008. “It started with a psychosocial-needs assessment, asking cancer patients what they wanted in their care in addition to oncology care, things like mind-body therapies, exercise programs, and peer support,” explains Alyson Moadel-Robblee, PhD, the program’s director.
By simply asking, they learned that more than 65% of patients wanted mind-body therapies, like yoga, reiki, and meditation. Another 55% wanted physical-fitness counseling; 59% wanted nutrition counseling; about 25% were interested in psychosocial counseling and peer navigation. “When you think about integrative oncology, it’s really defined by what patients want that complements their medical care,” she says.
Though the center, which opened in April, is in the Bronx, Moadel-Robblee points out that it is just four miles from the Westchester border and is easy to get to for most Westchester residents — whether they are a Montefiore patient or not. “Closing the door to people with cancer who may want and benefit from these wellness services is just not acceptable to us,” she says.
In the future, Montefiore plans to bring these psychosocial and integrative oncology workshops and services to all its Westchester sites, through a program they call “BOLD on the Go.” About a dozen workshops, in dance therapy, drum circles, crochet and knitting, yoga, meditation, reiki, arts and crafts, and more, are offered for free. “There are already enough costs to cancer care,” Moadel-Robblee explains. “We made sure [the program] is self-sustaining, through volunteering, fundraising, and small grants.”
Nearly 80 U.S. hospitals now offer reiki, including Montefiore. But as Montefiore currently does not offer the therapy in operating rooms, the hospital plans to soon kick off a clinical trial to investigate whether using a reiki healer during breast surgery improves outcomes. Dr. Sheldon Feldman, chief of the Division of Breast Surgery and Surgical Oncology and director of Breast Cancer Services, is leading the trial. Dr. Feldman says he has seen mastectomy patients who opt for reiki have less post-traumatic shock and recover more smoothly from surgery. Moadel-Robblee says the trial will examine the impact of mind-body interventions on recovery, emotional well-being, and overall health outcomes: “Outcomes for this study will examine mood, distress, fatigue, pain, and post-treatment analgesic use, emergency-department visits, blood pressure, heart rate, and other signs of recovery during the research trial.”
Another physician leader at Montefiore, Dr. Fernando Camacho, the medical director of Integrative Oncology, is a Zen Buddhist, trained in the Vietnamese Zen tradition, who leads mindfulness-meditation classes for both patients and Montefiore staff to alleviate stress and anxiety, and increase mindfulness.
Northern Westchester Hospital (NWH) has been offering similar services for “going on 10-plus years,” says Dr. Maria Hale, associate executive director of the hospital. “We have been on this journey to create an environment that is not alternative; it’s integrated. These integrated modalities really support the quality care that is provided here.” The hospital’s program is staffed with holistic-health nurses, who incorporate healing therapies and techniques as appropriate, to complement conventional Western-medicine treatments. Services offered include acupuncture, clinical aromatherapy, reflexology, reiki, therapeutic suggestion/guided imagery, and music and pet therapy. This year, they added a new service: prenatal yoga. “The feedback from our expecting mothers was that they wanted it,” Hale says. “One of our nurses became certified as a prenatal yoga expert, and that has really taken off.”
Integrative medicine is an integral part of NWH’s Bruce and Andrea Yablon Health and Wellness Program, which is offered free of charge to patients who have cancer. This program offers nutrition counseling, fitness evaluation and planning, acupuncture, oncology medical massage, aromatherapy, reiki, guided imagery, gentle touch, and reflexology. Professionals provide mindful wellness and emotional support through stress reduction, support groups, and meditation. They also connect patients who need psychosocial support, with psychologists, social workers, and psychiatrists.
NWH’s Center for Healthy Living, at Chappaqua Crossing, also offers free healthcare navigation services to anyone in the community. A healthcare navigator works to understand a person’s health-and-wellness needs and can connect them with experts and services that can support those needs, including physician referrals, specific counseling, or support and wellness programs and classes. “To me, as a healthcare administrator, promoting community health in new and innovative ways is very exciting,” Hale says.
In Valhalla, Westchester Medical Center (WMC) and Maria Fareri Children’s Hospital have robust integrated-medicine programs, including services for those who are caring for their loved ones in the hospital. Indeed, during a renovation in 2016, WMC put a newly constructed Caregiver Center right in its Main Concourse. “We need to focus on caring for the family, as well as caring for the patient,” says WMC service excellence officer Gretchen Halstead, who oversees the Caregiver Center. “These are the people who get the phone call at two in the morning. They are almost like second victims: Their lives have changed, like the lives of [the patients] have changed.” Putting the center in the Main Concourse is a “visible commitment” to this, she says.
Not only is it the right thing to do, according to Halstead, caring for caregivers is good preventive medicine. Patricia Boyce, director of the Caregiver Center, says, “We really prevent disease and illness by taking care of caregivers. We also help prevent patients from returning, because the caregiver is not burned out. It means a better outcome for all of us: the providers, the patients, the families, so there is less stress on the whole healthcare system.”
Maria Fareri Children’s Hospital (part of the WMCHealth Network) has had a Child Life and Creative Arts Therapy program for about 25 years, which is when Tricia Hiller came onboard to launch it. The goal of the program is to promote normal growth and development, to reduce the stress of hospitalization, and to provide support to children and families. Hiller, director of the Child Life and Creative Arts Therapy program, says that her seven-person team works closely with the healthcare teams, “because we practice family-centered care.” As she explains, “The family is part of the caregiving team, as well.”
Using art, music, and directed play, clinicians help reduce pediatric patients’ anxiety, facilitate coping strategies, and even improve compliance with treatments. “Play is the work of children. That’s how they learn, how they express themselves,” Hiller says. Physicians were skeptical of the therapy program at first. She notes a time when a doctor was doubtful until he saw [music therapist Laurie Park] play and watched the child’s heart rate go down. “He said, ‘Look at that!’” Hiller recalls.
Such services can even provide comfort when nothing else can. “Staff sometimes has to guide families through end-of-life journeys, which can be challenging for all involved. At times, under these circumstances, there is little the hospital’s caregivers can do via conventional medical means, so the staff incorporates complementary care services,” says Michelle Cacciola, a head nurse at the Children’s Hospital. In the dedicated wing for pediatric hematology and oncology services, a program supported by a grant from the Tom and Agnes Carvel Foundation supports services like proper nutrition, massage, reiki, and guided imagery. In the most trying of times, “these complementary therapies allow patients to relax a bit more and reduce anxiety and pain,” Cacciola says. “With pain and anxiety reduced, the patient is able to have more meaningful interactions with family members. That is of immeasurable value to the patient and family.”
Memorial Sloan Kettering also has a comprehensive integrative-medicine program dating back many years. Its main location, the Bendheim Integrative Medicine Center, is located in New York City. At MSK’s Westchester outpost, in West Harrison, cancer patients can take advantage of acupuncture services, says Eva Pendleton, associate director of Integrative Medicine, adding that MSK is working on partnership arrangements to offer additional services, like yoga.
They also plan to use telehealth services to deliver mind-body programming, like a meditation series, locally. And, of course, patients can take advantage of services at Bendheim, which include massage therapy, fitness classes, private yoga and classes, tai chi, acupuncture, and meditation. Cancer patients get top priority for these services, but other patients have access to them, as well, Pendleton explains.
“When you think about integrative oncology, it’s really defined by what patients want that complements their medical care.”
—Alyson Moadel-Robblee, PhD, Montefiore Health System
Services are increasing, because “more and more evidence is being published, especially in cancer, and more doctors are becoming aware of the work we are doing,” Pendleton says. “Also, younger doctors are using these therapies themselves. There has been a generational shift in medicine.” The same shift has driven patient demand, too. “They want us to have everything, everywhere,” she says, “so we are continuing to respond to patient demand.”
Pets may not directly cure anything, but they have been part of White Plains Hospital’s alternative-medicine program for a long time. “Dogs were here when I started,” about 15 years ago, says Dr. Michael Palumbo, executive vice president and chief medical officer. “The reaction happens every day, whether it’s a visitor or staff member seeing a dog. They are always so well trained and, quite frankly, beautiful animals. It’s such a lovely thing to see patients’ faces light up.”
The scope of services has grown from pet therapy to include acupuncture, general health and nutrition counseling, palliative medicine, and psychosocial services, like art therapy, healing touch, and spiritual and pastoral care. “We have patients and volunteers who knit together; art therapy is offered throughout the building; musicians come in to play; a writing workshop is offered; and there is a drum circle,” says Karen Banoff, vice president, clinical services. All are provided by licensed clinical professionals and volunteers, and most are offered just to cancer patients in the cancer center. (Dog therapy is available to anyone in the hospital.)
When acupuncture was added, “I was surprised that it was not a hit right away,” Palumbo says. “It is accepted as a clinically proven technique, yet it took months before it gained traction among doctors and their patients. Now, it has been here four years, and it’s thriving. I think people have come around to the benefits of alternative healing methods.”
Banoff agrees. “We have a lot of support from oncologists for all our services,” she says, which now include financial navigation and counseling. “There is financial toxicity from the costs of cancer treatment,” she explains. Financial counselors are on-site to help patients and families navigate those costs.
“Medicine is as much an art as it is a science, and what’s right for one person is not necessarily right for another. I tell them, ‘This may or may not serve you; that’s why we need to keep exploring.’”
—Dr. Stephen Thorp, Northwell Phelps Hospital
Many of these services do not contribute to the organization’s bottom line. In fact, they are often loss leaders, and their budgets are largely dependent on outside grants and internal investments that won’t directly bring in profits. Hale says that financial support for NWH’s Integrative Medicine program comes from “the generosity and kindness of others,” noting that philanthropy is the source of the funding. “We are grateful for the philanthropic efforts from our community that support and understand the importance of providing integrative therapies as an integral part of the hospital experience,” Hale says. “Many times, hospitals aren’t able to implement or sustain integrative medicine programs without philanthropic support, as insurance plans do not reimburse for these therapies.”
Palumbo concurs: “In general, we see all these things as support services and don’t expect to be reimbursed for them.” Halstead adds that Westchester Medical Center is also grateful for people in the community who support their Caregiver Center and the organization’s healing arts program, which are not revenue-producing. “These offerings, which are free of charge, provide tremendous benefit,” sahe says.
Though these services may not generate immediate income, they do play a role in healthcare’s shift from a fee-based to an outcomes-based reimbursement model. Organizations cannot charge for, say, reiki, but that service can help produce financial gains if, in the long run, it helps keep patients from returning to the hospital, a metric that goes into payment calculations.
Hospitals aren’t the only organizations integrating these complementary services into their offerings. Large medical practices, like Westmed Medical Group, are striving to meet patient demand for these services. “What we have heard from patients is frustration that they have reached the limit of what they can do with traditional medicine. They are looking for an alternative approach that may not require pharmacologic intervention,” says Dr. Sandra Kesh, Westmed’s deputy medical director. And, with all the conflicting information about some of these services, “they are looking for clarity in what’s legitimate,” she says. “There is a spectrum of nontraditional approaches, ranging from those with more scientific support, like acupuncture, to those with little scientific support, like homeopathic bee venom.”
Westmed is creating a Wellness Center, which it hopes to open by the end of 2020. “It will be a programmatic approach,” Kesh says. “A patient will come to our center, meet with an intake coordinator who does an assessment that includes diet, exercise, and lifestyle, and try to focus on the four big problem areas,” which she lists as stress, nutrition, movement, and sleep. “We will match the patient to what can address that need, whether it’s acupuncture, stress management, or a sleep specialist.”
The key to the program, she says, is that it works in collaboration with Westmed’s providers. “We are not telling patients to stop taking their antihypertensive meds. We are looking for ways to supplement the approach if their conditions cannot be adequately controlled with medication,” Kesh explains. “A 15-minute office visit is not enough time to get into the nitty-gritty of diet. That conversation takes time if you want to do it right. And that holistic approach is something you don’t see often but that a lot of patients are looking for.”
“Some patients are looking for a more ‘natural’ approach to their health.”
—Dr. Minerva Santos, CareMount Medical
Physicians at other practices are embracing integrated medicine, as well. Dr. Stephen Thorp, a pain medicine specialist affiliated with Sleepy Hollow’s Northwell Phelps Hospital, prefers the term “functional medicine” — therapies that get at the root cause of pain. He asks his patients about their diets, exercise, and sleep habits, among other things, to “try to empower people to take care of their own health,” he says. “Education is the number-one thing.” He refers patients to the appropriate source — nutritionist, sleep specialist, physical therapist. The hospital has advanced physical therapy tools, too, including a pool equipped with bicycles for aqua-therapy. “I talk about the pros and cons of all these things,” says Thorpe, “then I let them decide what is best for them. Medicine is as much an art as it is a science, and what’s right for one person is not necessarily right for another. I tell them: ‘This may or may not serve you; that’s why we need to keep exploring.’”
At CareMount Medical, internal medicine physician Dr. Minerva Santos specializes in integrative medicine at the practice’s Jefferson Valley office. She offers herbal and homeopathic therapies, stresses the importance of meditation, and advises patients about daily supplements. She also refers patients to acupuncture, energy medicine, and reiki practitioners in the area. “The driving force, I believe, is the opting out of prescribed medications,” she says. “Patients feel overmedicated, suffering side effects, and the cost for medications can be prohibitive for some. Some patients are looking for a more ‘natural’ approach to their health.”
She and others like her believe that as more research studies support anecdotal evidence for these alternative therapies, more patients and doctors will take them seriously. “I believe this is a trend that is here to stay,” she says.
Freelance writer David Levine is a frequent contributor to 914INC.