The Integrator Blog
Home
Share |
about
Contact Me, Experience, Mission, Sabbatical in Central America, plus
Editorial Advisory Board
Columnists
Michael Levin
Taylor Walsh
background resources in PDF
Insurance, Integrative Clinics, Industry Summit Reports, News Files '99-'04
some organization links
Professions, Academia, Research, Policy
some CAM/IM publication links
Electronic, Peer-Reviewed, Blogs, More
Bradly Jacobs, MD, MPH, Revolution Health Blog
supported conference
Institute for Health & Productivity Management - Integrative/Complementary Healthcare
Guest Columnist Tom Ballard: We Need More than "Relationships" to Reform Medicine PDF Print E-mail
Written by John Weeks   

Guest Columnist Tom Ballard: We Need More than "Relationships" in the New Medicine

Summary: Is relationship-centered care the critical element in the reform of medicine? Tom Ballard, RN, ND doesn't think so. Ballard writes in response to an Integrator column in which Stephen Bollles, DC, states: “What we do doesn't matter a whole lot compared to how we do it.” Ballard responds: "It's more than convincing practitioners to spend quality time with patients. We need to radically change the way medicine is practiced." Ballard then presents his view of a "New Healthcare Paradigm" which is in fact an "old" perspective inside his own profession. I wonder whether the typical integrative medical doctor, or NCCAM researcher, would agree that this is where the value in integrative practice will be found?
Send your comments to
for inclusion in a future Integrator.

Image
Tom Ballard, RN, ND
Tom Ballard, RN, ND, has a unique relationship to the Integrator. His home is six doors from the Integrator's worldwide offices here in West Seattle. My 16-year-old mows his lawn, when he gets around to it. Ballard also is an individual who made the sign of the cross at me in 1984 when he was freshly minted out of the then John Bastyr College of Naturopathic Medicine's first graduating class (1982) and I was a cub development officer for Bastyr, trying to get him to slip his patients some Bastyr donation envelopes. My persistence didn't create the break-through. What did was a chance meeting at a political gathering, when he decided maybe since we hung in similar political circles he'd let me chat him up about helping his alma mater.*

I was also interested in meeting Ballard back then because his status as a two-fer - registered nurse and naturopathic doctor - was extremely valuable in those years in helping establish credibility for Bastyr and his new profession. Ballard's experience as a hospital nurse and as a community-based, primary care naturopathic physician also informs and sometimes inflames his writing. (See
"Integrative medicine: Who writes the peace treaty?" July 29, 2008.) Ballard writes this piece in response to a column from Stephen Bolles, DC. entltled Bolles: 4 Questions on Integrative and Health Reform and an Answer - "It's the relationship, stupid" (January 27, 2009). I view Ballard's column as a core statement of value from his second profession. 

*For those of you on the edge of your chair for the end of this story, a couple dozen of Tom's patients donated that first year, representing a significant fraction of Bastyr's first ever annual fund drive.
_________________________________
  
Time for a New Healthcare Paradigm

- Tom Ballard, RN, ND

I think I agree with one of Stephen Bolles’ points, if I interpret his writing correctly, that the relationships between a practitioner and a patient can create a powerful healing environment (or, bedside manners matter) but I disagree that “what we do doesn't matter a whole lot compared to how we do it.”

   
"In essence what we now
have is an economically
and culturally dominate
medical system built on
treating signs and symptoms
rather than causes."

- Tom Ballard, RN, ND
 
 
We have an opportunity with the current economic and health care crisis and a new, seemingly more open, administration to truly do what has been talked about for the past 30 some years – i.e. change the medical paradigm. Sorry, I know this word has been ridden hard, but it is appropriate. More than convincing practitioners to spend quality time with patients, we need to radically change the way medicine is practiced.

In essence what we now have is an economically and culturally dominate medical system built on treating signs and symptoms rather than causes. The instrument of first choice for suppressing symptoms is pharmaceuticals. This system has also been called anti-medicine – anti-inflammatories, antacids, antidepressants, anti-hypertensives, etc. The doctor need not pay attention to the intricate chemistry that increases cholesterol; just lower it at any cost. And by cost I mean monetary as well as side effects.

What we could have, instead of this antiquated, reductionist, 19 Century, interventionist model of medicine, is a modern whole-systems medicine that, simply put, addresses the basic, “Why?” Why is this blood pressure high? Why this is joint painful? Let’s talk to the patient, take advantage of our advanced knowledge of biochemistry, and find the core issues. Let’s treat this patient’s disease rather than suppress what the body is trying to tell us. Symptoms are like fire alarms. They’re not the disease; they’re the warning of a deeper problem. Don’t ignore the fire alarm, but don’t mistake it for the fire.  This is, of course, what the best of natural medicine has been doing for centuries. What we have now is the advanced science to transform this old wisdom into modern wholistic medicine.

   
 
"If we care about cause, then we
seek to understand the complexity
of a specific patient, knowing that
their blood pressure may be high
for entirely different reasons than
the next patient’s, and that restoring
this person’s health requires nurturing
their natural healing systems."

- Ballard

The paradigm is not personal vs. institutional or health vs. disease or natural vs. allopathic or any of the other fashionable integrative medicine talking points, but cause vs. symptom. If we care about cause, then we seek to understand the complexity of a specific patient, knowing that their blood pressure may be high for entirely different reasons than the next patient’s, and that restoring this person’s health requires nurturing their natural healing systems.

This is a health caring model that asks such questions as: This patient still has a thyroid gland, what nutritional elements necessary for its production of thyroid hormone are missing? What disruption of metabolism is interfering with conversion of inactive thyroid (T4) to active thyroid (T3)? Is a deficiency of vitamin D or omega-3 oils preventing the hormone from delivering its message?  If we understand the patient’s specific ecosystem, we can come up with individualized, meaningful therapies.

If we ask fundamental questions like these, we’re addressing the health of an individual, recognizing their symptoms, and curing them in a way that supports their long-term health. The alternative, continuing with a system that simply prescribes thyroid, misses nutritional deficiencies and metabolic disruptions that, while no longer able to send warning signs and symptoms, continue to erode the patient’s health. That is, the patient feels well, but their low vitamin D, for example, continues to predispose her/him to breast/prostate cancer. This is the fundamental flaw in the current medical system that will not be alleviated by a sympathetic bedside manner.

We have an opportunity to replace the interventionist model of health care with an ecological model: organic, sustainable, nurturing (in the broadest sense). A place to start this change is to derail the current health care debate from “Who will pay for more drugs and surgery?” to “How do we shift away from paying for drugs and surgery and focus health resources on preventing and treating the causes of disease?”

Changing the dialogue and transforming the paradigm will not be easy. The medical-industrial complex has many friends in high places, but natural medicine has history, science, and a growing, dissatisfied public on our side. There’s an ad running in magazines now that refers to a future when ‘alternative energy’ will be known simply as ‘energy’. Will that also be when ‘alternative medicine’ becomes ‘medicine’?

Tom Ballard, RN, ND
Seattle
_________________________________

Comment: My own bias is also toward the importance of changing the therapeutic order of the nation, as urged here, and by the naturopathic profession in their submission to Obama's healthcare team. (See
A new therapeutic order for the nation?)

   
 Why are neither integrative MDs or
naturopathic NDs routinely using
group-based clinical services?

This would change not only the
therapeutic order of the nation but
also the therapeutic organization.

Is one-on-one care by definition
a non-optimal relationship?

 
 
That being said, I do think that the modern naturopathic profession can sometimes lose touch with patients amidst its obsession with the obscure functional medicine pathways of "green allopathy." I have observed a drift, particularly in the insurance-based naturopathic practices, away from the time and energy needed to connect with and help empower patients in their own journeys. A more thorough teaching of the relationship and mind-body technologies and practices which are core to integrative medical instruction may be in order.

In addition, to the extent that relationship (and presumeably the empowerment of the patient which is a critical end toward which "relationship" is a means), why are neither integrative MDs or naturopathic NDs being taught about, and routinely using, group-based clinical services? This would change not only the therapeutic "order" of the nation but also the therapeutic organization.  Is one-on-one care by definition a on-optimal relationship?


Send your comments to
for inclusion in a future Integrator.


 
< Prev   Next >
Search
Advertisement
Advertisement
Sponsors
Integrative Practitioner
The Westreich Foundation
voluntary contributions
Support the work!
Archive
All Integrator Round-ups
Integrator Top 10 Lists 2006-2015
Issues #140-#142 Oct-Dec 2015
Issues #137-#139 July-Sept 2015
Issues #134-#136 April-June 2015
Issues #131-#133 Jan-March 2015
Issues #127-#130 Sept-Dec 2014
Issues #123-#126 May-Aug 2014
Issues#119-#122 Jan-April 2014
Issues #116-#118 - Oct-Dec 2013
Issues #113-#115 July-Sept 2013
Issues #110-#112 April-June 2013
Issues #108-#109 Jan-March 2013
Issue #105-#107 Oct-Dec 2012
Issues #102-#104 - July-Sept 2012
Issues #99-#101 - April-June 2012
Issues #96-#98-Jan-March 2012
Issues #94-#95 Nov-Dec 2011
Issues #92-#93 Sept-Oct 2011
Issues #90 and #91 - July-Aug 2011
Issues #88 and #89 - May-June 2011
Issues #86 and #87 - March-April 2011
Issues #84 and #85 - Jan-Feb 2011
Issues #82 and #83 - Nov-Dec 2010
Issues #80 & #81 - Sept Oct 2010
Issues #78 & #79 - July August 2010
Issues #76 & #77 - May June 2010
Issues #74 & #75 - March-April 2010
Issues #73 & #73 - Jan-Feb 2010
Issues #69, #70 & #71 - Nov-Dec 2009
Issues #67 and #68 - Sept-Oct 2009
Issues #65 and #66 - July-August 2009
Issues #63-#64 - May-June 2009
Issues #60-#62 - March-April 2009
Issues #57-#59 - Jan-Feb 2009
Issues #55-#56 - Nov-Dec 2008
Issues #51-#54 - Sept-Oct 2008
Issues #47-#50 - July-August 2008
Issues #46 & -#47 - May-June 2008
Issues #43-#45 Mar-April 2008
Issues #41 & #42 - Feb 2008
Issues #39 & #40 - Dec-Jan '08
Issues #37 & #38 - Nov 2007
Issues #35 & #36 - Oct 2007
Issues #33 & #34 - Sept 2007
Issues #30-#32 - July-Aug 2007
Issues #28 & #29 - June 2007
Issues #26 and #27 - May 2007
Issue #25 - April 2007
Issues # 23 & #24 - March 2007
Issues #21 and #22 - Feb 2007
Issues #19 and & 20 - Jan 2007
Issues #17 and #18 - Dec 2006
Issues #15 and #16 - Nov 2006
Issues #13 and #14 - Oct 2006
Issues #11 and #12- Sept 2006
Issues #9 and #10 - Aug 2006
Issues #7 and #8 - July 2006
Issues #5 and #6 - June 2006
Issues #3 and #4 - May 2006
Issues #1 and #2 - April 2006
All Articles by Subject: 2006
All Articles by Subject: Jan-June 2007
IAYT-Sponsored Series on the Future of Yoga Therapy