Conventional medicine is changing and two Rutgers schools are leading the way to a broader definition of what constitutes good patient care.
Rutgers New Jersey Medical School (NJMS) and Rutgers School of Health Related Professions (SHRP) teamed up to create a novel eight-week rotation for second-year residents in preventive medicine/public health that introduces them to some of the therapies now dubbed “alternative” and “complementary” and to the practitioners of those therapies. The unique program is supported by a $150,000 grant, awarded to NJMS and SHRP in September 2012 as part of IMPriME, the National Coordinating Center for Preventive Medicine/Integrative Medicine programs, funded by the Health Resources and Services Administration.
The program’s creators – Polly Thomas, co-director of the residency program and an associate professor at NJMS, and Gwen Mahon, an associate dean and associate professor at SHRP – are helping to change the status quo in the medical world. Recognizing that physicians often have trouble communicating with other health care providers, and vice versa, they set about analyzing the whys and wherefores. A lack of familiarity with each other’s work and existing hierarchies in the health care world that restrict interaction climbed to the top of their list. In fact, Thomas and Mahon found that they themselves felt some of these same constraints when sitting down to discuss their plans.
“Respect. It’s largely about respect,” says Mahon. “Familiarity is key to eradicating barriers and fostering respect.”
In a first step toward change, a five-member team developed a survey, which was distributed in 2012 to faculty members of NJMS, SHRP, the School of Nursing and Rutgers School of Dental Medicine to assess their knowledge and attitudes toward complementary and alternative medicine (CAM). About 300 surveys were completed. In addition to Thomas and Mahon, team members included: Virginia Cowen, assistant professor of primary care at SHRP; Susan Gould Fogerite, associate professor of primary care at SHRP; and Marian Passannante, PhD, chair of the School of Public Health’s Department of Quantitative Methods and an NJMS associate professor in the Department of Preventive Medicine and Community Health.
Survey results indicated that faculty are interested in integrative medicine and would like to incorporate aspects of it into their practice. Many have had some training in the use of nutrition, diet, exercise, and physical activity in patient care. The survey also indicated that physicians and dentists are less likely to refer patients for integrative medicine services than other health care providers.
Mahon, who was born in Ireland, and raised in Ireland, Toronto and Vancouver, and whose family moved frequently while she was growing up, was taught by her father to “reach for the moon” and “not to fear change.” She brings that mindset to her work. Trained as a cancer researcher, she nevertheless likes to work outside the lab, where the “experiments” are broader in scope and often more impactful. She sees health care as an area where a willingness to think outside the box can translate into big dividends for large groups.
The new rotation is also a reflection of Thomas’s chief interests – encouraging lifestyle changes to promote health and prevent disease, building teams of physicians and other experts to care for patients in contrast to the current segmented system, and making changes at the population, rather than the individual, level. The preventive medicine/public health residency that she heads up with William Halperin, MD, chair of the Department of Preventive Medicine and Community Health, is the only one in New Jersey and accepts just one or two applicants each year. Most of the applicants are interested in working for a local, state, or federal agency such as the CDC; working directly with patients to provide preventive medicine services; and doing public health research.
In the eight-week integrative medicine rotation, residents observe and work closely with professionals in such specialties as physical therapy, occupational therapy, and psychiatric rehabilitation. They also attend wellness centers and clinics that provide an array of health care services – including alternative and complementary care — under one roof. “Relationships are formed between these physicians and other health care providers and a level of respect is built,” says Mahon. “It’s a start.”
Among the sites hosting physicians in the program are the student-run physical therapy clinic at SHRP in Newark; St. John’s Clinic in New Brunswick, where physician assistants are the primary caregivers; the Oral Health Nutrition Clinic in Newark; the Center for Well Being at Morristown Medical Center; and Atlantic Health System Integrative Medicine. The residents must also complete a research project.
“This is a new field,” says Mahon. “There is no model yet for including integrative medicine in preventive medicine residency programs.”
At the end of the day, the team that launched the new rotation wants to build bridges among health care specialists and tip the system toward preventive care.
The grant gives the team credibility and allows them to be part of a large consortium that is wrestling with this issue on a national scale. “This is more complicated than it sounds,” says Mahon. “We are tackling a host of questions.”
It is necessary to have strong evidence that CAM therapies work and are safe in order to include them in a treatment plan, but how is that evidence best obtained? Do CAM practitioners need to be licensed and educational programs accredited? Who should lead the new health care teams? If the physician is the leader, are there ways to create an environment of inclusion where others can comfortably bring their thoughts to the table?
“For primary care providers, integrative and preventive care are traditional and essential,” says Thomas. “But they need knowledge about when and where to refer patients for services they cannot provide.”
A version of this article originally appeared in Pulse Magazine, a publication of New Jersey Medical School, Summer 2014