Blending in: is integrative medicine the future of family medicine?

The face of health care is changing. A variety of trends in recent decades, both within the world of conventional medicine and beyond, are altering the nature of health care and the context in which physicians practise. Total spending on drugs is increasing at an alarming rate. So is our appreciation of the scope of the problems of drug side effects and drug-related deaths.1 Meanwhile a consumer-led movement, fueled by access to health information over the Internet, has led to a substantial rise in interest in complementary and alternative medicine (CAM). The public is spending enormous sums of out-ofpocket money on CAM.2 The rise in obesity and its complications in the last 15 years is another alarming trend, adding further evidence to the conclusion that the biggest threats to health today cannot be adequately addressed with medications and surgery alone. Many problems physicians encounter in primary care involve lifestyle, social, or spiritual factors.3 On the provider side, physician stress and job dissatisfaction are increasingly recognized as key problems within our profession that need to be addressed if we are to deliver optimal care. Physicians are responding to these changes in their work context in a variety of ways. Many are reappraising their priorities and making changes to promote greater balance in their personal lives. Others are seeking training in alternative modalities and are providing these services to their patients in turn. Some are acquiring advanced skills in lifestyle and wellness counseling and health promotion. At present, however, these changes are optional, inconsistently implemented, and medical education has not systematically embraced them. A new movement in health care has gathered these disparate trends together and attempted to formally articulate a new vision for medicine—a vision that both grows out of and seeks to address the problems we currently face. This movement is most commonly referred to as integrative medicine (IM). The first textbooks have been written. A consortium of medical schools has been established to transform undergraduate curricula so they reflect the vision of IM4; some 20% of US and Canadian medical schools currently belong. What exactly is IM? A meeting of practitioners in the field at the pioneering Program in Integrative Medicine at the University of Arizona in Tucson came up with the following defining statement: “Integrative medicine [is] healing oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.”5