York County Medicine Summer 2019 - 30

YO R K C O M E D S O C . O R G

FEATURE:

INTEGRATIVE
MEDICINE
by D. Scott McCracken, MD

"Any cravings or use in the past month?"
It wasn't the first time I'd asked this question, and certainly it was
not the first time she heard it. But despite its routineness, the effect
was different today. Her posture slouched and eyes teared. After
many months of sobriety, she had relapsed. The ensuing catharsis
was hard to piece together... the baby wasn't sleeping, she wasn't
sleeping... a counseling appointment was missed... her husband lost
his job, there were arguments... utility bills went unpaid... some
long-lost friends showed up... no, she hadn't missed any doses of
buprenorphine...
Where do I start? Do I need to order more tests? Add a
medication? Change a dose?
As we all know, this line of questioning can feel confusing and
even hopeless. And any tests or medication changes are, at best,
weakly supported by the standards of "evidence-based medicine."
So, instead, I called up the Duke Integrative Medicine Wheel
of Health on the patient's cell phone. We used this to identify
strengths, like relationships and nutrition, and talked about how
those strengths help her stay well. We then talked about the ways
she became an "expert" in those areas, and how we could use that
approach in areas of weakness, like spirituality and exercise and
sleep.
We closed the visit having set goals to reconnect with key
community resources, and look into a new support group that uses
a spiritual approach to addiction. And we identified a friend who
could help keep her on track to getting to that group.
The cynic might roll their eyes, because my assessment and
plan didn't include a new ICD-10 code, no reference to a study,
and had no changes to medication. But at the same time, they'd
have to admit that I didn't stray far from the traditional role of
a physician. First, I did no harm (made no unnecessary medicine
changes), then I listened and reflected the patient's concern, and
used shared decision-making to identify some specific, achievable
goals. We even capitalized on a strength (relationship to a friend) to
improve a weakness (a group to focus on spirituality).
I think this patient's story illustrates the strength of an integrative
medicine approach. There's no doubt that, well applied, a prescribed
medicine can help a person suffering with a disease. But often,
failing health, at its root cause, is greatly influenced by an imbalance
in wellness. "Looking for all the causes that lead to distress or dis30

York County Medicine | SUMMER 2019

'ease' calls for an unraveling of your journey in life to this point,
to find another path," says Deborah Bernal, MD, who practices
Physical Medicine and Rehab in York. Dr. Bernal is trained in Reiki,
meditation, and Colorpuncture, and uses her integrative health
background to help patients reframe their approach to health. She
also steers her patients to the My Strength app (mystrength.com), to
engage them in their well-being. For Dr. Bernal, "pain is a warning
sign like the indicator light on your car dashboard, and integrative
healers help you navigate that problem."
How about a massage to improve our mind-body connection?
Or an acupuncture session to help align our spirit, to manage
chronic pain?
And - good news - this works for physicians, too.
Overwhelmed by piles of authorizations? Having trouble
balancing your call schedule with family commitments? Struggling
to be at the gym early enough to still make 7:00 am rounds?
Physicians are notorious for neglecting our own disease; we
are also often guilty of deprioritizing our health and wellness. We
tend to over-focus in one or two areas, sometimes in places where
we have no control (read: EMR!), but over time that can lead to
a serious imbalance, and other parts of the wheel of wellness start
to tip out of control. Most of us would agree that, unfortunately,
medicines only occasionally can help "rebalance the wheel."
This week, take some time to rebalance your wheel. Get the My
Strength app on your smart phone, or e-mail yourself the Wheel of
Health. Look at it each day, and take a few minutes to think about
wellness in your life.
What are your strengths? Why are you good at those? Which
one is the most important to you?
What is your biggest weakness? What change or stress might
come your way, that challenges your balance?
"Change is inevitable."
http://www.YORKCOMEDSOC.ORG http://www.mystrength.com
York County Medicine Summer 2019

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