Next Generation Integrative MD Leader David Rakel, MD on ABIHM, CAHCIM and Family Medicine

Summary: Integrative medicine is producing its second wave of leaders. Among these is David Rakel, MD. Rakel is a board member of the American Board of Integrative Holistic Medicine, an executive committee member of the Consortium of Academic Health Centers for Integrative Medicine and editor of the 1300 page tome Integrative Medicine. The Integrator spoke with Rakel recently about the movement, and his day job, at the University of Wisconsin School of Medicine, where his focus is on a new model of family medicine.


primary care integrative medicine, family medicine, CAM

David Rakel, MD – integrative leader

David
Rakel, MD
, was a family doctor in Driggs, Idaho, when the term “integrative
medicine” was coined by Andrew Weil, MD, scarcely a dozen years ago. Rakel’s
current resume suggests how far that movement has advanced.


I spoke
with Rakel recently about his overlapping set of activities in a field which
didn’t exist when he began his practice in Driggs.
Rakel is board certified in family medicine, sports medicine, in holistic medicine
and in interactive guided imagery. He has been awarded a number of teaching
awards including the Baldwin E. Lloyd clinical teacher award, the UW Department
of Family Medicine faculty excellence award, the Marc Hansen lecture award and
the resident teacher-of-the-year award.
Rakel has a special focus on moving integrative practices into primary care. Here is the interview.

_______________________________________

Integrator: How did you
get into the integrative medicine field?

Rakel:
I was a country doctor in Driggs, Idaho. For 5 years, I practiced womb-to-tomb
medicine. I learned a lot about people.
I saw the psychosocial nature of things, of auto-immune disease. I saw how pharmaceutical
drugs dampen the mind-body connection. I also saw how some of my patients were
taking supplements, getting acupuncture from others. I was curious. I began to
read Andy Weil’s books, books on holistic medicine and mind-body medicine and
traditional Chinese medicine.

Integrator: You’re a
graduate of the University of Arizona residential fellowship in integrative
medicine, correct?


“To me the goal – and this is a focus

of our
program – is how do we bring

integrative
medicine, or healing oriented

medicine into primary care.

So the approach, with
either incorporating

therapies or practitioners such as

chiropractors or
naturopathic physicians,

is through a patient-centered care model.”

– David Rakel, MD

Rakel:
I was in the 3rd class of the two-year residential training. The
residential program isn’t there any longer. The fellowship is now a mix of
onsite and distance learning. The program was excellent for me. It was like a
two-year sabbatical in which I could be involved in a conversation about how to
improve health care. I did most of the work compiling the Integrative
Medicine
book in the second year.

Integrator: What did you learn clinically in the program?
How has your practice changed?

Rakel: The fellowship was a good, humbling
experience. We had a lot of focus on our own health and wellness. We also had
the opportunity to experience various treatments. I was drawn to some more than
others. Osteopathic manipulative therapy and especially strain-counter-strain I
learned from an osteopath in Tucson. Another area that attracted me is
interactive guided imagery. I have since become certified in this practice.
Health psychology and nutrition are the other main areas of my interest. In
retrospect, the (integrative medicine) field at that time – a decade ago – was
premature for systems-based learning.

Integrator: How are these incorporated in your practice?

Rakel: To me the goal – and this is a focus of our
program at the University of Wisconsin – is how do we bring integrative
medicine, or healing oriented medicine into primary care. So the approach, with
either incorporating therapies or practitioners such as chiropractors or
naturopathic physicians, is through a patient-centered care model. We use a
health-oriented team which values relationship-centered insights into the
person. We focus on quality of life measures and in understanding what will
empower the individual to find health for themselves.

Integrator: Say more about
the strategy with primary care.

Characteristics of the S.O.S. –
“Salutogenesis Oriented
Session”


  • Create health, not suppressing
  • Relationship-centered
  • Usually a 45 minute session
  • Get patients comfortable telling their story
  • “Not everyone
    needs or wants an SOS”


A model for exploring cost,

quality and provider satisfaction

Rakel:
We’re trying to create health in specific populations – trying to create health
instead of waiting for disease to come through the door. We know that just
suppressing the pain is not getting to the root of things. We have an
integrative medicine consult which we call an S.O.S. – Salutogenesis Oriented
Session. This is usually a 45 minute session. We try to get patients to be
comfortable telling their story. We also
incorporate the standard 15 minute and 30 minute slots, because not everyone
needs or wants an SOS. We’re also looking at creating healing oriented teams.
We have grants out for team care in diabetes, but we want create teams of
professionals who focus on how to create health as well as manage disease.

Integrator: The “medical home” model seems to be taking
off in primary care, backed by family docs, pediatricians, osteopaths and
internal medicine doctors. What role do you see for integrative medicine and
specifically the distinctly licensed complementary healthcare providers in this
model?

Rakel:
We need to all agree on what we want to accomplish with our work. If a common
goal is to create health for the communities we serve, we need to address the
barriers that are preventing us from achieving it. Once the team agrees on a
common mission or goal, it becomes the focus that a trans-disciplinary team can
work towards as a group. This will encourage professionals to come together and
in doing so, learn from one another while we create something new. One
specialty can’t do this alone. We need to learn how to work together to create
health-oriented teams. How this team is defined, depends on the needs of the
community we intend to serve. The challenge is that we all believe everyone
needs what we know. This is a good example of the importance of recognizing our
own bias so it does not get in the way of what our patients need most to heal,
which may or may not be what we have to give.

Integrator: I believe you
are the sole person is presently serving in the leadership of both the
Consortium of Academic Health Centers for Integrative Medicine and the American
Board of Integrative Holistic Medicine – through which you have certification.
How do you envision the optimal relationship between these two entities?

Rakel:
Each of these organizations has individual missions that resonate a common
theme. The ABIHM focuses on educating clinicians to deliver healing-oriented
care while the CAHCIM is focused on transforming medical education towards
health and healing. The optimal relationship is collaboration and sharing
insights and strategies on how to create this shift in each of their areas of
focus.

Integrator: I am curious
about how your text, Integrative Medicine, is doing. It is quite a
compendium of thinking and practice by medical doctors about medical practice.
Can you share some numbers – total sales, number of academic or integrative
programs that have adopted it as core text, etc.

Rakel:
I don’t know how many have been sold, but I was recently notified by the
publishers that it is being translated into Spanish, which seems like a good
sign. The main goal for this text was for it to be a tool for clinicians to
feel more comfortable incorporating unconventional therapies into practice. It
is a sad state of our current system and the economics of health care that
physicians have become most comfortable using one therapeutic modality
(pharmaceuticals). As we analyze the evidence and address potential harm,
hopefully we will become more comfortable prescribing other therapies that have
less [potential for harm].

Integrator: As you know,
under another hat I work closely with academics from the complementary and
alternative healthcare disciplines. To date, there remains a good deal of
segregation in the so-called integrative medicine dialogue. For instance, the
ABIHM course. What steps or recommendation do you have that will help us best
bring a deeper integration of other practitioners into the integrative medicine dialogue?

“Changing how we look at our job”

“In our culture, we
have identified

three major health care needs:
achieving ideal weight, maintaining ‘

optimal body function with less pain ‘
and to be happy. We are
trying to

change how we look at our job.
I could also call these things
obesity,

myofacial pain and mental illness.”

– Rakel


Rakel:
I believe it is easier to understand who to invite to the party when we know
what we want the party to accomplish. In our culture in Madison, Wisconsin, we
have identified three major health care needs: 1. Achieving ideal weight, 2.
maintaining optimal body function with less pain and 3. to be happy. We are
trying to change how we look at our job. I could also call these things;
obesity, myofacial pain and mental illness. But we want to pull out what is
right with the person instead of treating what is wrong. For example, for
myofascial health, my culture may best be served by a team that consists of a
body worker to address physical imbalance, a mindfulness instructor or
psychologist to address how the body sympathizes when our mind is under stress
and a spiritual guide to help the individual connect with those things that
give life meaning and purpose. This team is mobilized by the primary clinician
who has invested in a relationship that creates insight into what is needed for
self-healing mechanisms to unfold. The
professionals involved will have talents that will most effectively facilitate
health for the needs of the community. If we are successful, our patients will
need the team less, which will reduce long-term costs and make everyone happy……
and then number 3 is achieved as a side effect! And hopefully we will all enjoy
each other’s company and have fun at the party.

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John Weeks Written by John Weeks

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