True North’s Integrative Medicine Team Offers Perspective on a Democratic Model of Clinical Integration

Summary: One never knows what a discussion will engender. Witness this contribution from the multidisciplinary, clinical/administrative “Decision Circle” of the True North Health Center in Maine. The 9-person group is responding to a portion of the Integrator dialogue on who owns “integrative medicine.” A writer offered a view of an ideal integrative medical model in which members from various disciplines are each respected and then opines that it “doesn’t exist”? The True North team begs to differ. Here we have a look at an existing model. The piece is co-signed by the medical director Bethany Hays, MD, an ND associate medical director, 2 nutritionists (one a nurse midwife), another MD, a social worker and 3 administrators. They describe value that has come from “sitting in circle” for major decisions.

I have followed the activities of the Maine-based True North Health Center – Maine’s Center fior Functional Medicine and the Healing Arts, from a distance for a number of years. The integrative center offers a widely-respected conference every year, the most recent October 15-18, 2008. Medical director and obstetrician Bethany Hays, MD was honored this year as the 14th recipient of the Linus Pauling Award from the Institute for Functional Medicine. I have on my desk an exceptional commentary of Hayes, from Integrative Medicine: A Clinician’s Journal, on the state of birthing practice in the United States (Is there still a place for normal birth?).

But it was the heated Integrator dialogue about who owns “integrative medicine” that offered a chance to look inside the True North operation. The precipitating event was the description by Peter Glidden, ND, of an ideal integrative medical model which he opined “doesn’t exist”? Here is the response, co-signed by Hays and the rest of the True North Decision Circle: the MD medical director (Hays), an ND associate
medical director, 2 nutritionists (one a nurse midwife), another MD, a
social worker and 3 administrators.
The clinic has been subject of numerous features, including articles in the Townsend Letter, one in the Liebert “Green Journal” and elsewhere.

Image

From L-R: Evelyn Rysdyk, Susan Fekety, MSN, CNM, Catherine Valenza, Kathryn Landon-Malone, MSN, CPNP, Peter Knight, ND, C. Allie Knowlton, MSW, DCSW, LCSW, Charles deSieyes, MD, Cynthia Atkinson, CEMP/S/I, CHTP, Bethany Hays, MD, FACOG, Chris Bicknell Marden Missing: Tom Dahlborg, Miles Simmons, MD, B. Joseph Semmes, MD

________________________________________________



Yes, the Model Exists:

A View of Integration from the True North Practitioner Community



-True North “Decision Circle”

We read with great interest the exchange in your last issue
and felt compelled to add to the conversation. When we read Peter Glidden’s
description of how an Integrative Medical model would look and his comment “Too
bad it doesn’t exist” we wanted to set the record straight – True North’s model
is like the one he describes; only (we think) better.

True North’s practitioner
community is varied: six physicians, two advanced practice nurses, one
naturopath, one chiropractor, two mental health professionals and 5 CAM
therapists practicing massage, acupuncture, energy medicine and shamanic
healing; plus three affiliate members who offer HeartMath®, psychotherapy and
addiction and trauma recovery. Patients come in to True North through many
different “doorways” – some see MDs for primary care, some come for
complementary treatments only – some come to see multiple practitioners.


While our original business model
described a case manager
role

much like Glidden’s “gatekeeper”
we found that patients wanted

direct
access to practitioners

more than they wanted a case
manager type person to
assist

with a care plan.

While our original business model described a case manager
role much like Glidden’s “gatekeeper” we found that patients wanted direct
access to practitioners more than they wanted a case manager type person to
assist with a care plan. Patient charts are integrated at True North so
practitioners all see each other’s notes and we are working on ways to
integrate more effectively.



As an integrated center, we are a work in process. As a
research nonprofit organization we are working to track our results in
meaningful ways. What has kept our collegial relationships rich (and for the
most part healthy) is our choice to use “circle process” as a governance model.
Sitting in circle has given us literally years of listening to each other, learning
from one another and respecting each other across disciplines. We have found
that coming together as a practitioner community is one of the most meaningful
things that we do as a group. One example of this richness is when we hold
collaborative case presentations where we hear a case and then offer each
disciplines’ perspective on how to handle the patient’s presenting problems.


In addition, our governance model

means that everyone has a
seat

at the same table in determining


how the organization runs.



Having
practitioners and administrators


at the same table is no less fraught


with
historical tensions than is having

practitioners from different disciplines.


We would like to see groups of practitioners spring up all
over the country in similar practice settings because we think the patients and
the practitioners are best served when their health care providers are learning
from each other. We think a setting where multiple services are available under
one roof gives each modality equal weight in the public’s eye and we take care
to credential each service in a rigorous way. Clearly the issue of equality or
more precisely, lack thereof, is what spurs passionate reactions like the ones
in this blog.




In addition, our governance model means that everyone has a
seat at the same table in determining how the organization runs. Having
practitioners and administrators at the same table is no less fraught with
historical tensions than having practitioners from different disciplines is.
Still, we learn a lot from each other and through creating and sustaining
relationships we manage to get a lot done and serve patients well.



We hope the Integrator Blog will keep being a forum for this
kind of discussion. If other practitioners want to learn more about how we’ve
been doing it – we’re happy to share our experiences.



Sincerely, True North’s “Decision Circle”



Tom Dahlborg, Executive Director


Charles deSieyes, MD


Susan Fekety, MSN, CNM

Bethany M. Hays, MD, FACOG, Medical Director

Peter Knight, ND, Associate Medical Director


Kathryn Landon-Malone, MSN, CPNP


Chris Bicknell Marden, Director of Marketing and Development


Evelyn Rysdyk and C. Allie Knowlton, MSW, LCSW, DCSW


Catherine Valenza, Business & Operations Manager

Image

From L-R: Catherine Valenza, Kathryn Landon-Malone, MSN, CPNP, Cynthia Atkinson, CEMP/S/I, CHTP, C. Allie Knowlton, MSW, DCSW, LCSW, Bethany Hays, MD, FACOG, Evelyn Rysdyk, Charles deSieyes, MD, kneeling in front L-R: Peter Knight, ND, Susan Fekety, MSN, CNM, Chris Bicknell Marden Missing: Tom Dahlborg, Miles Simmons, MD, B. Joseph Semmes, MD

________________________________________________


Comment: I hope that this letter will serve to open the eyes of any non-MD practitioners who believe that working with medical doctors necessarily means working as subjects to them. The model described here is, in my experience, extraordinary; yet at the same time, the inclusive, democratic intention is shared by many integrative MDs. One of the more interesting aspects of the model, as the Decision Circle members note in the commentary, is not the integration of practitioner types but that of clinical and business personnel:
Having
practitioners and administrators at the same table is no less fraught with
historical tensions than is having practitioners from different disciplines.
Fine guidance here. Thanks for this warm wind in what had become a sometimes chilly dialogue. Any other perspectives on integrative clinic decision processes?

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