Integrative Care at Israel's Davidoff Comprehensive Cancer Center: Report from Nimrod Sheinman, ND
Written by John Weeks
Integrative Care at Israel's Davidoff Comprehensive Cancer Center: Report from Nimrod Sheinman, ND
Summary: Two Israeli's leave their country to be trained in integrative practice. One, Nimrod Sheinman, ND, the author of this article, attends a naturopathic medical school in the mid 1980s. A dozen years later the other participates in a residential integrative medicine fellowship. Each are pioneers. Each returns then to their own country where they are presently collaborators in the Davidoff Comprehensive Cancer Center at the Rabin Medical Center. Here is Sheinman's account of the Center, the clinical services and the broader public responsibilities, including keeping the practitioners who serve these cancer patients from being ground down in their practices. Take a look.
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Sheinmanis a 1986 graduate of the naturopathic medical program at the National College of Natural Medicine (NCNM), Portland, Oregon. He subsequently completed a residency at Bastyr University where was later a member of the faculty. Sheinman is the founder of the Israel
Naturopathic Association and co-founder of the Israel Center
for Mind-Body Medicine.
_____________________________
Integrative Medicine at Davidoff Comprehensive
Cancer Center, Israel
- Nimrod Sheinman, ND Director, Mind-Body Unit, Integrative
Medicine, Rabin Medical Center
Author Sheinman: Director of mind-body program
Four years ago, the first Integrative Oncology
Unit in an Israeli Hospital was founded at the Davidoff
Comprehensive Cancer
Center, part of Rabin Medical
Center. The Rabin Center
is owned by Clalit HMO, the biggest HMO in Israel, with about 4 Millions
insurers. The Integrative Unit offers cancer patients a wide variety of
complementary therapies, integrated with their state of the art oncological
medical care.
The Davidoff
Cancer Center
is the most sophisticated and innovative facility in the Middle East for the
treatment of malignant diseases, delivering comprehensive medical treatment to
approximately 15% of Israel's
cancer patients.
The Integrative Medicine Unit was founded and
is headed by Opher Caspi, MD PhD, a board certified internist who completed
seven years of training at the University of Arizona, and in China. The Unit is
now seeing more than 12,000 patient's visits a year, and is serving about 1000-1500
new patients each year.
Caspi: U Arizona Fellow runs program
Integrative therapeutic services & treatment process
The Unit's functional design was inspired by
programs that operate successfully in leading cancer centers such as Memorial
Sloan Kettering, M.D. Anderson,
and Dana-Farber, with various features that are unique to the Israeli
Unit. The complementary medicine modalities and methods
include:
Traditional
Chinese Medicine, including Acupuncture and Chinese herbs
Naturopathic
Medicine, including clinical and functional nutrition, supplements and herbal
medicine
Mind-Body
Medicine, including MBSR, Interactive Guided Imagery, Health Psychology,
medical Hypnosis, and preparation and support for surgery or other invasive
procedures.
Manipulative
and Body-based Therapies, including Shiatsu, Massage, Reflexology, and
Integrative Pain Management
Movement
Activities, such as Yoga, Chi-Qong and Tai-Chi, Pilates and Feldenkrais.
Group
sessions, such as Meditation, Imagery, Nutrition and Lifestyle groups.
The initial visit at the unit is dedicated to
designing each patient's individual integrative treatment plan, based on the
nature of the cancer, the specifics of the oncology treatment plan, the timing (i.e.
before or after surgery, radiation, chemo-therapy etc.), and each patient's unique
situation, preferences and needs. This intake is being performed by an oncology
nurse (with extensive knowledge in natural and mind-body medicine), and the
Unit's Medical Director.
The tailored-made treatment plans
usually involve at least 2-3 modalities, chosen with the patient at the end of
his first visit. The treatment sessions, given by a competent team
of some 30 CAM providers, may last for periods
between weeks (i.e. preparation for surgery), to over a year (support during
chemotherapy, radiation and after). Cases are discussed or supervised in small
group meetings or in the whole unit's meetings, which are a two hours session,
each week. Complicated cases have a case manager.
Rabin's logo
Business model
The business model is based on
the patients paying for their visits, and then being reimbursed by their health
insurance plan (being on Health Insurance is required by law), according to
their insurance policy program. Price per visit is about 200 shekels, which is
about 50$. Typical local fees in a private CAM practice in Israel is about
300 Shekels for a Naturopathic or Chinese Medicine.
Each patient's visit is
documented in an Electronic Medical Record (EMR) system, which was designed specifically
to accommodate the different therapeutic "languages" available in the
unit. We are now in the process of assessing patients' profiles (such as
disease stage, chief complaints, needs and hopes), therapeutic combinations'
profiles and patient's processes. We recently went through a process of
defining our outcome and assessment measures, and we began delivering them to
each new patient.
Other core tasks, including self-care for practitioners
Beyond the focus on clinical services,
the Unit's other three main tasks are:
Research Both
qualitative and quantitative research is under way.
Education Two post
graduate courses, one in Chinese Medicine and Integrative Oncology, and one
on Touch therapies and Shiatsu in Oncology Care, has been conducted last
year.
Policy Contribution to Health
Policy through lectures in medical schools, contributions in local and
international conferences, participation in local and international boards
and committees, and more.
Working non-stop with cancer
patients is not always easy. Therefore, we create yearly events to support our
own psycho-spiritual well-being and sense of connectedness. This last year
only, for instance, we've opened a Balint 'support group for the therapists' project,
created a whole unit Nature Walk, enjoyed a one day Buddhist meditation retreat,
and (before the Jewish New Year) had a midnight-to-sunrise walk through
Jerusalem Synagogues.
If you are around, come visit us!
Peace, Shalom,
Nimrod Sheinman, ND
(
)
Comment: Interesting to note that both Sheinman and Caspi were educated in the United States. The former attended the mothership of naturopathic medicine, NCNM, back in the day, as well as its well-known offspring, Bastyr. A little over a decade later, Caspi attended the University of Arizona program founded by Andrew Weil, MD that has had a similar generative relationship to the spread of its practice; in this case, that of integrative medicine as practiced by (principally) MDs. Each is a pioneer in his own field who went abroad to study then brought it all back home. I had the good luck to encounter each of them back in their early years.
Reflections aside, I am sure I am not the only person who would like to go fishing inside the Davidoff Center's electronic medical record. The Integrator will be open to sharing such useful data or outcomes as you would like to make available. Thanks, Nimrod.
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