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holistic/integrative physician (M.D./D.O.)

What Is It?
How Does It Work?
What You Can Expect

Health Benefits
How To Choose a Practitioner

References

Evidence Based Rating System

 

What Is It?

Holistic medicine embraces the philosophy that a person's physical, mental, emotional, and spiritual well-being are all important--and interdependent--aspects of one's overall health. Although the term "holistic" wasn't widely used until the 1960s, when Westerners began to seek alternatives to conventional medical treatment, holistic philosophies of health and medicine have prevailed in countries such as India and China for more than 5,000 years, and, more recently in Western medicine, in the philosophies of homeopathic and anthoposophic medicine. Even the Greek philosopher Socrates had this to say on the subject, "You ought not to attempt to cure the eyes without the head or the head without the body, so neither ought you to attempt to cure the body without the soul . . . for the part can never be well unless the whole is well."

In holistic medicine, symptoms are often seen as "messages” to be carefully explored rather than suppressed by conventional therapies or the surgical removal of the symptomatic part. Even when these therapies are necessary, the goal of the holistic physician is to know each patient as an individual and to understand the circumstances under which the symptoms occurred in order to help prevent their recurrence. Holistic physicians practice in all of the medical specialties.  What unifies many of them is the belief that “unconditional love is life's most powerful healer” and that it must be given a place to flourish in our health-care system.

Practitioners of integrative medicine knowledgeably integrate the full range of conventional and complementary health-care and wellness disciplines available, utilizing the best of conventional and alternative treatments. Physicians can be “integrative” in the sense that they recommend alternative therapies such as acupuncture or chiropractic without being “holistic” in their approach to evaluation of the "whole person" in an attempt to address both the current symptoms and the underlying imbalances that contribute to illness. The “ideal” physician may incorporate both holistic philosophies and integrative approaches.

Today, integrative holistic physicians--both MD and DO (Doctor of Osteopathy) who have conventional Western biomedical training as well as expertise in traditional and complementary therapies --continue to believe that illness and disease can result from imbalances between mind, body, and spirit. They recognize that a combination of therapies may be most beneficial in treating the entire biopsychosocialphysical complex of etiologies and symptoms that are defined as disease in Western medicine.

How Does It Work?

There are two key elements that should define a patient's treatment in a holistic practice. The first is the respectful, caring spirit of cooperation that exists between patient and physician. The second is the physician's role in educating and encouraging the patient to choose therapies and lifestyle practices that will lead to a vibrant state of well-being. Consulting a holistic physician is a good choice if a working partnership with your doctor is important to you.

What You Can Expect

An appointment with a holistic physician begins much like a conventional doctor's visit, with the physician taking a thorough medical history, performing a complete physical exam, and ordering any necessary diagnostic tests. However, a holistic physician will also probe more deeply into the emotional and spiritual aspects of your life and carefully consider their role in your health. There also may be more focus on your lifestyle, nutrition, the environmental influences in your life and your unique reaction to them. This leads to an individualized treatment regimen based on your specific needs and life experiences. According to the principles established by the American Board of Integrative Holistic Medicine, holistic physicians should "expend as much effort in establishing what kind of patient has a disease as they do in establishing what kind of disease a patient has."

While conventional drugs and surgery will be used when necessary, holistic physicians prefer to draw upon a range of disciplines -- physiology, biochemistry, nutrition, exercise, psychology, and sociology, among them -- in determining treatment. Complementary therapies such as chiropractic, acupuncture, massage, homeopathy, herbal medicine, Guided imagery, and hypnosis are also commonly recommended (see the WholeHealthMD Reference Library for more information on these and other modalities).

Health Benefits

Holistic approaches are especially relevant when you have an acute illness or require surgery. A holistic physician will make sure that the mind/body aspects of healing are addressed in concert with the best acute biomedical/surgical treatments.

When you have a chronic illness such as arthritis, back pain, fibromyalgia, insomnia, or migraines, for which modern medicine has no instant cure, it is even more important that a doctor be able to tap into all of the patient's personal resources for well-being. Medical and osteopathic family physicians have been schooled in this biopsychosocial approach, and modern integrative holistic physicians expand on it when directing their patients to proven complementary therapies and adjunct practitioners.

A two-year follow-up study of more than 700 patients who sought medical evaluations at American Whole Health centers from 1998 to 2000 found significant improvement in many areas of their self-assessed health and well-being. These included not only the physical activities of daily living and maintaining vitality, but also emotional health and pain reduction. And a 2008 survey of 85 patients at the University of Michigan Integrative Medicine Clinic found an integrative approach (focused on patient well-being, from the clinic's physical environment to increased communication between patients and staff) led to high patient satisfaction. Results of the survey found that customizing integrative medicine treatment plans based on individual needs resulted in improvements in physical, mental and emotional well-being across a wide spectrum of illness, from menopause and poor mood to bowel issues and cancer. (1) Examples of a holistic treatment approach to several chronic conditions follow.

Rheumatoid arthritis (RA) is an autoimmune condition that causes severe joint inflammation and can be debilitating. Studies have shown that environment, physical and mental factors may impact RA and alter the perception of pain in arthritis sufferers. Holistic practitioners believe treating all of these underlying factors is necessary to treat the disease. In a 2000 study of 47 elderly patients with RA, researchers examined the effects of social, emotional and physical impacts on arthritis, as well as the impact of learned resourcefulness (thoughtful acknowledgment, awareness, positive attitude, etc.) and spirituality on a patient's general health perception. Results indicated that social, emotional and physical impact together predicted a patient's health perception; and spirituality and health perception were significantly correlated. (2) A 2001 Canadian survey asked 416 residents if they had used, expect to use, or are opposed to the use of holistic therapies, especially in a conventional medical setting. The survey revealed arthritis was one of the top three reasons that 37% of respondents had used at least one holistic therapy in the previous year. (3) A 2002 review of 25 studies evaluating the efficacy of psychological interventions such as biofeedback, cognitive-behavioral therapy, and relaxation techniques to treat RA found significant benefits of these interventions. Significant effects were noted after treatment in symptoms such as pain, functional disability, psychological status, coping, and self-efficacy. At an average of 8.5 months follow-up time, significant effects were also reported for tender joints, psychological status and coping. These results indicate such psychological integrative interventions may be useful as adjunct therapies in the treatment of RA. (4) Subsequently, a 2007 study of 63 patients with RA evaluated the use of Mindfulness-Based Stress Reduction (MBSR), on depressive symptoms, psychological status, and disease activity. Patients were randomized to either an MBSR group (an 8-week MBSR course, plus a 4-month maintenance program), or to a wait-list control group (attending all arthritis assessment visits and receiving a free MBSR course at the end of the study). All patients continued usual care from their rheumatologists during the study. While no significant differences in depressive symptoms or other assessments were observed at two months, the MBSR group had significant improvements in psychological distress and well-being after the 4-month period of MBSR reinforcement compared to the control group. (5) However, a systematic review of acupuncture and electroacupuncture to treat RA failed to show any significant benefit, (6) exemplifying the distinction between holistic and integrative approaches to care.

In contrast, osteoarthritis, an age-related deterioration of joint cartilage, is the leading chronic condition of disability in the United States. The most promising alternative therapy for osteoarthritis is acupuncture. Recent trials of acupuncture for osteoarthritis suggest that acupuncture for osteoarthritis of the knee can bring significant pain and symptom relief either alone or as an adjunctive to drug therapy. (7, 8) In the largest scale trial of acupuncture conducted in the US, researchers at the University of Maryland demonstrated that acupuncture for osteoarthritis of the knee is both safe and effective. (9) In their study published in the Annals of Internal Medicine, the research team compared the efficacy of true acupuncture, to sham acupuncture, and patient education in 570 patients. At 26 weeks the true acupuncture group showed significant improvements over the other conditions on measures of pain, function, and global improvement.

Several holistic disciplines have shown promising results in treating back pain. One of the largest trials involved acupuncture treatments for more than 11,000 patients. After 3 months of treatments, researchers concluded that acupuncture eases back pain, improves back function and is cost effective. (10, 11) Additionally, the NIH determined at a1998 Consensus Conference on acupuncture that acupuncture may be useful as an adjunct treatment to a comprehensive management program. (12) Chiropractic care also has been shown to be effective in managing back pain; one study reported definite improvement in 75% of study patients after three months of treatment. (13-17) A meta-analysis of three randomized controlled trials on massage therapy for back pain found it to be effective in cases of both sub-acute (pain that builds up gradually overtime) and chronic back pain. (18) Massage therapy also has been shown to be more effective when combined with back strengthening exercises and education, such as through Swiss ball exercises, Pilates or yoga. (19-21) A combination of these therapies may be recommended by an integrative physician to treat back pain.

Many patients with fibromyalgia have used alternative approaches to relieve their symptoms of chronic muscle pain, non-restorative sleep and profound fatigue – often with excellent results. Anecdotal reports have indicated potential efficacy for modalities such as Bodywork techniques, chiropractic, massage therapy, energy healing (reiki, reflexology, acupressure), movement therapies, meditation, and tai chi. Several reviews of treatment approaches for patients with fibromyalgia found that while treatment should start at the tissue level, a holistic approach is necessary to treat the issues, the patient as a whole, and any contributing stressors. (22-25)

Chronic insomnia can be caused by tension, anxiety or depression, so treatment focuses both on treating the sleep disturbances and the underlying cause of insomnia. Several holistic therapies that promote relaxation – acupuncture, homeopathy, massage, meditation, yoga, – have shown promise in helping to treat insomnia. In a four-year German study, 100% of patients undergoing acupuncture treatments for insomnia for a year and a half reported significant improvement in sleep without the aid of medications. (26) However, a Cochrane Database meta-analysis of seven trials including 590 subjects with insomnia found current evidence is not conclusive for support of acupuncture to treat insomnia. Preliminary evidence indicates the calming effects of yoga can lead to improved sleep; mindfulness meditation may help to ease anxiety associated with insomnia; and tai chi helps to reduces stress and improve sleep. (27-32) Some patients have also reported benefits of bright-light therapy and of homeopathic medicines. Results are preliminary and some have been conflicting, but a combination homeopathic medicine is the third leading over-the-counter product in sales of sleep aids. (33-37) 

Many behavioral, emotional and environmental factors can lead to migraines – intense, often debilitating headaches. While migraines are biologically caused by muscle contraction or dilated blood vessels, factors such as stress, insufficient sleep or hormonal changes can trigger migraine attacks. Integrative physicians may recommend various behavioral management and relaxation techniques to treat migraine headaches in conjunction with conventional medications. Studies have shown migraine sufferers can benefit from biofeedback, a mind-body technique in which a monitoring machine is used to teach patients how to control bodily functions, such as heart rate, blood pressure and muscle tension. Biofeedback has been shown to help reduce the frequency of migraine headaches by 37-50%. (38) Acupuncture also is gaining attention for the treatment of migraines. One study of 401 patients receiving acupuncture treatments showed persistent clinical benefits that lead to a better quality of life when compared to a non-acupuncture group. (39) Patients also have indicated favorable results from relaxation techniques such as yoga, massage, meditation, but more research is needed in these areas to confirm or refute efficacy.  A few case studies have shown that an integrative approach, or combination of these methods, led to a reduced frequency of migraine headaches and improvements in quality of life. (40, 41)

How To Choose a Practitioner

As in choosing any type of practitioner, look for a holistic physician with whom the patient feels comfortable, who is compassionate, and who addresses the patient's individual needs. Finding a doctor with the proper credentials is also critical.

The most important credential for a holistic physician is primary training and certification in conventional biomedicine: The physician must hold a current, valid, unrestricted state license, either as a medical doctor (MD) or as a doctor or osteopathy (DO). If your state licenses naturopathic physicians (NDs), a naturopath may also be a good choice. Although naturopaths are not usually trained in acute hospital-level biomedical care, those who graduate from a four-year medical school are trained to manage conventional medical problems with a holistic approach.

In addition to the criteria mentioned above, it is also important to keep the following guidelines in mind when considering an integrative holistic physician: such a physician should have at least 200 hours of study in complementary therapies, have been involved in a holistic or integrative practice for at least a year, and be a member of a holistically oriented professional society such as the American College for Advancement in Medicine, the American Holistic Medical Association, or the American Institute of Homeopathy.

The American Board of Holistic Medicine was founded in 1996 and officially changed its name to the American Board of Integrative Holistic Medicine in 2008. The board was formed to establish and certify basic standards for expertise in the fields of integrative and holistic medicine. The ABIHM offers a qualification exam, which tests a physician's knowledge of physical medicine, behavioral medicine, and spiritual/social health. Practitioners must also demonstrate the ability to integrate conventional and complementary therapies into their personal health practices. Once certified, the ABIHM requires continued recertification in Integrative Holistic Medicine, evaluating proficiency and growth in the practice every seven years.

To find a holistic or integrative physician, get references from friends, check the Find a Practitioner feature on the WholeHealthMD home page, or look at the websites of the above associations or the ABIHM. (See also the WholeHealthMD Reference Library entries on Acupuncture, Homeopathy, Naturopathy, and Osteopathy.) 

References 

1. Myklebust M, Pradhan EK, Gorenflo D. An integrative medicine patient care model and evaluation of its outcomes: the University of Michigan experience. J Altern Complement Med. 2008 Sep;14(7):821-6.
2. Potter ML, Zauszniewski JA. Spirituality, resourcefulness, and arthritis impact on health perception of elders with rheumatoid arthritis. J Holist Nurs. 2000 Dec;18(4):311-31.
3. Lewis D, Paterson M, Beckerman S, Sandilands C. Attitudes toward integration of complementary and alternative medicine with hospital-based care. J Altern Complement Med. 2001 Dec;7(6):681-8.
4. Astin JA, Beckner W, Soeken K, Hochberg MC, Berman B. Psychological interventions for rheumatoid arthritis: a meta-analysis of random-controlled trials. Arthritis Rheum. 2002 Jun 15;47(3):291-303.
5. Pradhan EK, Baumgarten M, Langenberg P, et al. Effect of Mindfulness-Based Stress Reduction in rheumatoid arthritis patients. Arthritis Rheum. 2007 Oct 15;57(7):1134-42.
6. Casimiro L, Brosseau L, Milne S, Robinson V, Wells G, Tugwell P. Acupuncture and electroacupuncture for the treatment of RA. Cochrane Database Syst Rev. 2002;(3):CD003788.
7. Vas J, et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ. 2004; Oct 19 [Epub ahead of print]
8. Tukmachi E, Jubb R, Dempsey E, Jones P. The effect of acupuncture on the symptoms of knee osteoarthritis--an open randomised controlled study. Acupunct Med. 2004 Mar;22(1):14-22.
9. Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004 Dec 21;141(12):901-10.
10. Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K, et al. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epedmiol. 2006; 164:487-496.
11. Thomas KJ, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, Fitter M, Roman M, Walters S, Nicholl JP. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technol Assess. 2005 Aug; 9(32):ii-iv,ix-x, 1-109.
12. NIH Consensus Conference. Acupuncture. JAMA. 1998 Nov 4;280(17):1518-24.
13. Brien S, Lewith G, Walker A, Hicks SM, Middleton D. Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evid BasedComplement Alternat Med. 2004 Dec; 1(3):251-57.
14.  Hurwitz EL, Morgenstern H, Harber P, et al. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine. 2002;27(20):2193-2204.
15.  Hsieh CY, Adams AH, Tobis J, et al. Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Spine. 2002;27(11):1142-48.
16. Haas M, Sharma R, Stano M. Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain. J Manipulative Physiol Ther. 2005 Oct;28(8):555-63.
17. Leboeuf-Yde C, Axen I, Jones JJ, Rosenbaum A, Lovgren PW, Halasz L, Larsen K. The Nordic back pain subpopulation program: the long-term outcome pattern in patients with low back pain treated by chiropractors in Sweden. J Manipulative Physiol Ther. 2005 Sep;28(7):472-8.
18. Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med. 2003 Jun 3;138(11):898-906.
19. Furlan AD, Brosseau L, Imamura M, Irvin E. Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2002 Sep 1;27(17):1896-910.
20. Marshall PW, Murphy BA. Evaluation of functional and neuromuscular changes after exercise rehabilitation for low back pain using a Swiss ball: a pilot study. J Manipulative Physiol Ther. 2006 Sep; 29(7) 550-60.
21. Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ther 2006 July; 36(7): 472-84.
22. Rosen NB. Physical medicine and rehabilitation approaches to the management of myofascial pain and fibromyalgia syndromes. Baillieres Clin Rheumatol. 1994 Nov;8(4):881-916.
23. Kenner C. Fibromyalgia and chronic fatigue: the holistic perspective. Holist Nurs Pract. 1998 Apr;12(3):55-63.
24. Littlejohn G. Fibromyalgia. What is it and how do we treat it? Aust Fam Physician. 2001 Apr;30(4):327-33.
25. Lempp HK, Hatch SL, Carville SF, Choy EH. Patients' experiences of living with and receiving treatment for fibromyalgia syndrome: a qualitative study. BMC Musculoskelet Disord. 2009 Oct 7;10:124.
26. Fischer MV. [Acupuncture therapy in the outpatients-department of the University Clinic Heidelberg (author’s transl)]. Anaesthesist. 1982 Jan;31(1):25-32.
27. Khalsa SB. Treatment of chronic insomnia with yoga: a preliminary study with sleep-wake diaries. Appl Psychophysiol Biofeedback. 2004;29:269-78.
28. Manjunath NK, Telles S. Influence of Yoga and Ayurveda on self-rated sleep in a geriatric population. Indian J Med Res. 2005;121:683-90.
29. Yook K, Lee SH, Ryu M, et al. Usefulness of mindfulness-based cognitive therapy for treating insomnia in patients with anxiety disorders: a pilot study. J Nerv Ment Dis. 2008 Jun;196(6):501-3.
30. Ong JC, Shapiro SL, Manber R. Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment-development study. Behav Ther. 2008 Jun;39(2):171-82.
31. Li F, Fisher KJ, harmer P, et al. Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial. J Am Geriatr Soc. 2004 Jun;52(6):892-900.
32. Erwin MR, Olmstead R, Motivala SJ. Improving sleep quality in older adults with moderate sleep complaints: A randomized controlled trial of Tai Chi Chih. Sleep. 2008 Jul 1;31(7):1001-8.
33. Waldschütz R, Klein P. The homeopathic preparation Neurexan vs. valerian for the treatment of insomnia: an observational study. ScientificWorldJournal. 2008 Apr 20;8:411-20.
34. Hansen T, Bratlid T, Lingjärde O, Brenn T. Midwinter insomnia in the subarctic region: evening levels of serum melatonin and cortisol before and after treatment with bright artificial light. Acta Psychiatr Scand. 1987 Apr;75(4):428-34.
35. Lack L, Wright H. The effect of evening bright light in delaying the circadian rhythms and lengthening the sleep of early morning awakening insomniacs. Sleep. 1993 Aug;16(5):436-43.
36. Campbell SS, Dijk DJ, Boulos Z, et al. Light treatment for sleep disorders: consensus report. III. Alerting and activating effects.
37. Montgomery P, Dennis J. Bright light therapy for sleep problems in adults aged 60+. Cochrane Database Syst Rev. 2002;(2):CD003403. Review.
38. Penzien DB, Rains JC, Lipchik GL, Creer TL. Behavioral interventions for tension-type headache: overview of current therapies and recommendation for a self-management model for chronic headache. Curr Pain Headache Rep. 2004 Dec;8(6):489-99.
39. Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R. Acupuncture for chronic headache in primary care: large, pragmatic, randomized trial. BMJ. 2004 Mar 27;328(7442):744. Epub 2004 Mar 15.
40. Ventegodt S, Merrick J. Clinical holistic medicine: the patient with multiple diseases. ScientificWorldJournal. 2005 Apr 12;5:324-39.
41. Woolhouse M. Migraine and tension headache – a complementary and alternative medicine approach. Aust Fam Physician. 2005 Aug;34(8):647-51. 

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

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Date Published: 04/19/2005
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