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An Integrated Clinical Approach to Optimum Health

by Dr Rajendra Sharma(more info)

listed in integrated medicine, originally published in issue 30 - July 1998

The Background

The word Holism, derived from the Greek word Holos meaning "the whole", has surpassed alternative, complementary or integrated medicine as the term to best cover today's view of medical care. No longer are non-orthodox medical practices considered as alternatives, nor are they seen as complementing orthodox treatment, nor is it necessary to integrate traditional techniques with modern medicine to produce the best health care.

However, the word Holistic carries connotations of orange robed, sandal wearing vegans that the average Western individual automatically shies away from in favour of the white-coated practitioner. We now prefer the less accurate term of an Integrated Practice.

Diversification has only arisen since "modern medicine" came to the fore with the advent of the basic understanding of chemistry and physics around 150 years ago. Before that time the Art of Healing knew no boundaries and everything that helped was used.

Traditional techniques of medicine have developed all over the world but all have a common thread in basing their diagnostic and treatment techniques on the concept of "energy", as well as anatomy and physiology, all of which affect health and dis-ease in the being. The 3000 years of documented evidence of the efficacy of Chinese, Ayurvedic (Indian) and Tibetan medicine immediately belies the misconception of "alternative" medicine having little scientific basis. Much of the evidence is empirical or observational but then you show me a double-blind, placebo controlled or surgical technique study that is not. There are now nearly 40,000 studies, papers and publications on Holistic therapies and medicines of which the majority show positive effects.

The West is now integrating Holistic medicine into its health care by forming departments within hospitals and introducing practitioners of complementary techniques into general practice. Most teaching hospitals now have acupuncture departments, for example. Hospitals in the East have, conversely, integrated Western Medicine into their hospitals.

The advent of world wide travel and the Internet has allowed knowledge to spread at a remarkable speed and, with wisdom, the future can clearly be seen to be Integrated.

Dr Sharma using a combination of Chinese and Ayurvedic Diagnostic Pulse taking during a Gate-Keeper Consultation

Dr Sharma using a combination of Chinese and Ayurvedic Diagnostic Pulse taking during a Gate-Keeper Consultation

Current Status

At the moment there is an estimated £2 Billion per annum being spent throughout Western Europe alone by individuals and corporations on Holistic medical care. Considering this alongside the 80 million working days lost in Britain through stress related conditions it can be concluded that Holistic care is not only popular but needed. There are an estimated 15.4 million consultations with Holistic practitioners specialising in complementary/alternative techniques each year in Britain alone.

There are many Health Farms and Spas that offer complementary/alternative therapies with little or no orthodox medical supervision. Conversely, no hospital facility in Britain offers a Holistic view. There are many Holistic clinics but none have acceptable in-patient facilities. It would appear that, at this time, most institutions are falling between two stools.

Discussions with the heads of Holistic Medical Organisations (ironically the same initials – HMO – upon which the American health system is now being based), strongly suggests a demand for a more integrated approach at both general practice and hospital level. The general population are putting their after-tax money into this area which clearly suggests an interest in facilities that cover an entire range of treatments. This is often due to the failure of one type of treatment or the recommendation by successfully treated friends. Studies have shown that patients are drawn by necessity, not ideology since alternative practitioners flourish in areas where medical service is of a high standard and availability.

Treatment using Craniosacral Therapy

Treatment using Craniosacral Therapy

The Integrated Practice

There is a considerable amount of information available for the general public concerning most of the popular forms of complementary medicine (homoeopathy, osteopathy, acupuncture, etc.) and, for those who look, adequate advice and information on the less established practices (for example healing, crystal therapy, Shiatsu). This leads to a persistent flow of calls from expectant patients who have heard or read about the success of a treatment either through the media or through personal contacts. An individual may call up the 101 Group and ask for a recommendation to a specific therapy and be assured of the quality of the practitioner.

The patient who knows the form of therapy they require and having been directed to the correct therapist will be pleased to know that if improvement is not forthcoming they will be referred onwards. A sore throat not resolving under homoeo- pathic care may well need a herbal consultation or possibly an antibiotic, a back pain unaffected by osteopathy may resolve under the care of a chiropractor or vice versa. The big advantage of an integrated practice, I feel, is the likelihood of finding the correct therapy or therapist for the individual problem or patient.

Quality of Practitioner

This is one of the most important factors in integrating a practice. Until there is a regulatory body and a criteria of educational excellence one is always at risk of being treated by sub-standard therapists. The main forms of alternative/ complementary practice now have regulatory bodies to which therapists may become affiliated, but this is not essential. There is also the lack of need of continual education or assessment that can put into doubt the expertise of a practitioner qualified many years ago – although experience generally reduces any risk.

The advantage of an integrated practice is partially the ongoing education created by inter-communication and shared patients but also that a poor practitioner is unlikely to be supported or recommended by their peers all be it they from different specialities.

The "Gate Keeper" Consultation

Many patients are unaware of the type of therapy that they need or have tried and failed on their own cognition. It is here that the integrated practice really comes into its own. An individual may sit with an eclectic therapist or practitioner, doctor or otherwise, and discuss the options. In our practice Dr Gaier and I have either had formal training or working experience in most forms of alternative/complementary medicine and feel comfortable in assessing a patient and referring accordingly. Working with a team allows us a sense of confidence in referring onward and in 9 out of 10 cases the patient would remain under our watchful eye creating, we believe, a sense of safety for the patient and the practitioner alike.

When treatment is not necessarily to be initiated by the Gate Keeper the consultations usually last 20–30 minutes, simply to establish the basis of the complaint and discuss the options. Through this consultation a personal history will be taken to include all the factors listed in Box 1.

Once the correct practitioner for the patient is selected an initial consultation would include a full examination by that practitioner. The examination would include any or all of the parameters described in Box 2.

Alternative Diagnostic Techniques and Investigations

I am sure it is frustrating for most practitioners of complementary medicine that courses do not at least include a brief introduction to available investigations. To be taught how and when to organise a radiograph (x-ray), a basic blood test to check for anaemia or liver function, must be extremely frustrating. It is almost like being given the ingredients of a meal without the equipment to cook it.

The integrated practice allows access for any practitioner to suggest, recommend or order any investigative procedure.

The alternative techniques of live blood analysis, Bioresonance investigation through Quantum CI or BiCom computers and Kirlian photography are all available and a useful adjunct to the iridology, pulse, tongue, Hara and Reflexology diagnostic techniques employed by the practitioners. A patient with, say, double vision, would have a preliminary examination to rule out any obvious and clinically recognisable neurological condition. Treatment by an acupuncturist, an osteopath or craniosacral therapist would be employed perhaps with a diet plan, remedy or breathing technique before being moved on to more thorough investigations under the care of an associated neurologist with their MRI or CT scanning techniques if the problem is not resolving.

The Practice Team

There are certain essential components to such an integrated practice the principle requirement being the eclectic, Gate Keeper function. There are, at this time, very few such therapists, most of us being educated in only one or two areas of speciality. Acupuncturists are rarely formally educated in the theories of osteopathy, homoeopaths have no formal training in herbal medicine and even chiropractors are not versed in Alexander technique or Yoga despite their interest in structural matters. However, broadly knowledgeable practitioners do exist, all be it through their own training, and these individuals form the linchpin for a truly integrated practice.

The essential core of an integrated practice therefore, I believe, must include a fully qualified accredited General Practitioner with a full understanding of orthodox, life saving medication. Ideally this GP would be trained in at least one alternative/complementary therapy and be aware of the uses and principles of all other therapies available at the clinic. This practitioner acts as the Gate Keeper. As many of the practitioners as possible named in Box 3.

There is, obviously, a need for an administrative and support staff. An integrated practice requires the support and input of those in Box 4. The size of the practice establishes the number of employees but it is essential to have a happy and stress free management team. Under-staffing, poor pay and poor facilities (lack of staff room for example) inevitably leads to discontent and a high turnover of staff. The receptionists and Practice Manager are often the first people that patients come into contact with and their attitude can play a great part in a patient's well-being. See Box 4.

For Discussion

Before such practices as the 101 Group can multiply and serve a wider population certain basic and fundamental attitudes have to change. We need to look closely at several areas.

  1. Less science, more healing. There needs to be a change from the current scientific approach where people are treated as a condition or a disease rather than a whole person. The successful therapies and practices from our past have been forgotten or ignored and these need to come back into play with the best of modern science.
  2. The concept that everything must conform to modern scientific trials is incorrect. We have been led into a strong belief in the "germ theory", i.e. a cause for an effect. This is not the case. Many conditions are created by a multiple of causes and, fundamental to Holistic belief, we have forgotten about the individual's immune system as being the most effective of defences. Health is about continuing to fight the germs but also in re-establishing our work as medical personnel in boosting the immune system.
  3. Availability of a broad range of services. At this time most of the public do not have direct access, knowledge or confidence in complementary/alternative therapies. Most of these have well established and successful techniques of treatment but are unavailable to those that cannot afford them. Most doctors have at best little knowledge of alternatives and at worst are antagonistic. We most often fear that which we do not know.
  4. Financial change. Poor administration in association with high pharmaceutical/technological costs have eroded the NHS. Individuals are wasteful within the system because their own well-being and financial state are not tied into it. The NHS has become an impersonal organisation with wastefulness and theft clearly apparent. The last government believed that more administration would deal with this but increased wages and further alienation of the patient were the outcome. The American HMO system is probably the way forward although fundamental differences must be established.

Salaries paid to practitioners can lead to laziness and avoidance of work, per capita payment inhibits the inclination to cross refer. The ideal format would be a low basic retainer, a small per capita inducement and a payment for success or accurate onward referral.

Projection

There is no doubt the population will continue to demand, at an increasing rate, Holistic health care. Modern science is beginning to show that health is governed by energy as much as by biochemistry and the public are learning by experience that complementary/alternative techniques work.

Holistic medicine is of benefit to the health of individuals and corporations and in an Integrated Practice safe and efficient. The need for integrated clinics is, I feel, easily substantiated although, without market research, it is difficult to assess accurately the popularity of such institutions to the majority of people brought up in a society where health care has always been one of reaction to illness rather than prevention of loss of health. The National Health Service would more accurately be depicted as the National Illness Service.

There is hope. One in six GPs offer some type of complementary medicine. 40% of practices have associations with complementary therapists and 70% of GP surgeries regularly refer to complementary therapists. We are on our way.

HIstory


My father was brought up in a small village in India under the watchful eye of a father and grandfather who, amongst many offices, were the local Ayurvedic physicians. He qualified in regular medicine and migrating to the United Kingdom he moved into homoeopathy shortly after I was born. I was, therefore, brought up in an integrated, Holistic environment. Brown and white faces (my mother is English) looked down at me in the cot, trans-cultural influences pervaded my upbringing and the house was frequented by both alternative and orthodox practitioners creating an environment of mixed emotions from antagonism and antipathy to conciliation and integration. I describe all this because, I believe, it far more justifies my invitation to write this article than does my orthodox medical degree, membership of the Faculty of Homoeopathy here in London and the experience I have gleaned in the last 12 years of Holistic practice.

My father died in 1986 four months after I finished my NHS stint and I had moved to join his practice. I did not have the necessary experience to carry on where he left off and, more inadvertently than intentionally, built up a clinic structure by asking experts in various fields to join me. I was aware that, for example, osteopaths and chiropractors were more likely to fix an injured back than I could as a homoeopath and that Chinese herbs may do the trick in say, cases of eczema, where homoeopathy seemed to fail. Within two years we were working out of a seven consulting roomed clinic with day patient care facilities. A team of 15 or so practitioners were busy and enjoying an expansive education from occasional intra-clinician meetings and persistent shared-patient care. The 101 Clinic, as we became, outgrew itself and the 101 Group moved to our new home within the Hale clinic. Teresa Hale created a post of Medical Director into which she invited me and along with Harald Gaier ND DO, the director of medical research, we are constantly expanding the integrated group by introducing new practitioners with new theories and practices.

 

Box 1
Personal History
must include

Presenting complaints
Social history including: occupation, life style, relation- ships, abuses i.e. alcohol, drugs, exercise regimes
Psychological state
Spiritual state
Drugs, remedies and medications used
Allergic history
Therapies previously or currently used

The availability of investigations both from the orthodox and alternative world helps in deciding which treatments and therapies are liable to be beneficial.


Box 2
Parameters for a full examination by a practitioner

Observation of skin, hair and gait
Measurement of height, weight, blood pressure
Palpation
Auscultation
Percussion
Examination of skeleton and soft tissue
Iridology
Aura
Tongue diagnosis
Pulse diagnosis
Hara diagnosis
Reflexology diagnosis


Box 3
The preferable range of practitioners for the Integrated clinic

Homoeopaths
Herbalists
Osteopaths
Acupuncturists
Shiatsu Practitioners
Meditation teachers
Yoga teachers
Nutritionists
Psychological Counsellors
Chinese/Tibetan/Ayurvedic specialists
Bioresonance diagnosticians
Any other form of therapy or practitioner that space allows.


Box 4
Administrative and Support Staff

Practice Manager
Practice Secretary
Receptionist
Dispenser
Maintenance Staff

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About Dr Rajendra Sharma

Dr Rajendra Sharma MB BCh BAO LRCP&S(Ire) MFHom is a fully qualified doctor with a specialist interest in Integrated Medicine. He is a fully qualified doctor trained in conventional medicine with post-graduate qualification in Homeopathy and training and practice in Functional & Complementary medicine. His special interest is working with patients with chronic disease and illustrating it’s underlying causes particularly CFS/ME, cancer and other difficult conditions that respond poorly to conventional medicine. Treatment of conditions focuses on encouraging the body’s innate healing ability using life-style, exercise, nutritional and non-pharmaceutical medicines whenever possible. Until recently he was the Secretary to the British Society for Ecological Medicine (the largest body of conventionally trained doctors working in Integrated Medicine) and was the Education Moderator – in charge of continual professional development and training doctors wishing to enter the field. This involved teaching about diagnostic investigations into environmental causes of disease such as metal toxicity, food allergy, pollution, chronic infection and mitochondrial dysfunction – all very relevant to CFS – and non-conventional therapeutic approaches.

He is the author of The Family Encyclopedia of Health and in 2014 published the ‘all you need to know’ healthy ageing book, Live Longer Live Younger. It won “The Janey Loves 2016 Platinum Book Award” (Radio 2’s Steve Wright in the Afternoon’s Health Advisor – Janey Lee Grace). He was the Medical Director at The Hale Clinic in the 1990s and, until 2012, Medical Director of the pioneering The Diagnostic Clinic where new care initiatives in health screening were forged. These included the broader introduction of investigating underlying causes of epigenetics in genomics, cancer and mitochondrial testing. Please visit  www.drsharmadiagnostics.com

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