Patient centered care institute of medicine

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Integrative medicine and patient-centered care
Written by ::
Victoria Maizes, M.D.
David Rakel, M.D.
Catherine Niemiec, J.D., L.Ac.

PRINCIPLES OF INTEGRATIVE MEDICINE∗
1. Patient and Practitioner are partners in the healing process.
Care is based on a continuous healing relationship informed by scientific
knowledge and implemented through a partnership that recognizes the
uniqueness of each person (Heidemann et al., 2008; Khaw et al., 2008; Maizes
et al., 2002; Schroeder, 2007).
∗Principles originated from a working document of the University of Arizona Center for Integrative Medicine.
Maizes, Rakel, Niemiec

2. All factors that influence health, wellness, and disease are taken into consideration,
including mind, spirit, and community, as well as body.
These multiple influences on health have been firmly documented in the literature
(Anonymous, 1948; Astin and Forys, 2004; Egolf et al., 1992;
Grossman et al., 2004; Kivimaki et al., 2006; Kirsch and Sapirstein, 1998) but
are not often recognized as important in medical practice. Conventional medical
care tends to focus on the physical influences on health. An integrative approach
also addresses the importance of the nonphysical (e.g., emotions,
spirit, social) influences on physical health and disease.

3. Appropriate use of both conventional and alternative methods facilitates
the body’s innate healing response.
Integrative medicine recognizes the body’s profound healing mechanisms and
seeks to mitigate barriers to healing by using nutrition, activity, mind-body
medicine, and, where appropriate, conventional and alternative therapies
(Maizes et al., 2002; Snyderman and Weil, 2002).

4. Effective interventions that are natural and less invasive should be used
whenever possible.
There is great potential for harm among our current medical treatments
(Fisher and Welch, 1999; The Action to Control Cardiovascular Risk in Diabetes
Study Group, 2008; Lazaro et al., 1998). Integrative medicine orders
therapies ranking first those that have the greatest potential for benefit with
the least potential for harm. Examples include nutrition, movement, stress
management, and a focus on spiritual pursuits. Acupuncture has been recognized
by the U.S. Food and Drug Administration as having few or no side effects
from its use (U.S. FDA, 1996).

5. Good medicine is based in good science. It is inquiry-driven and open to
new paradigms.
Practical and pragmatic research models that evaluate systems of care and investigate
the interaction of multiple health influences are needed. Randomized
controlled trials cannot answer questions about cost effectiveness. Nor are
they the most useful method to study therapies such as acupuncture and meditation
which are already in common use and for which true “placebos” cannot
be created (Tunis et al., 2003; Paterson and Dieppe, 2005; Pincus, 2002; Roland
and Torgerson, 1998).

6. Ultimately the patient must decide how to proceed with treatment based
on values, beliefs, and available evidence.
Maizes, Rakel, Niemiec
Integrative medicine honors the individual’s right to choose a healing path for
him. Practitioners offer options, share their experience and insight, and partner
with informed patients (Maizes, 2007).

7. Alongside the concept of treatment, the broader concepts of health promotion
and the prevention of illness are paramount.
The majority of medical education and treatment focuses upon disease
mechanisms. Integrative medicine addresses the mind, body, and spirit with
an emphasis on supporting balance, maintaining health, and promoting longevity
(Antonovsky, 1979; Lindstrom and Eriksson, 2005; Rakel, 2008; Snyderman
and Weil, 2002).

8. Practitioners of integrative medicine should exemplify its principles and
commit themselves to self-exploration and self-development.
It is difficult to facilitate health and healing in others if we have not explored
how to do this for ourselves. Medical training should encourage self-reflection
that results in health for the learner (Givens and Tjia 2002; Rakel and Hedgecock,
2008; Roberts et al., 2001; Rosenthal and Okie, 2005). Integrative medicine
believes that this “heal the healer” approach is the most efficient method
of empowering professionals to develop an understanding of the self-healing
mechanism (Ball and Bax, 2002; Chaterji et al., 2003; Frank et al., 2004).

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Contact details ::
Institute of Medicine
2101 Constitution Ave NW, Washington, DC, United States ‎
+1 202-334-2000

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