Academic journal article Health Sociology Review

Trials and Tribulations on the Road to Implementing Integrative Medicine in a Hospital Setting

Academic journal article Health Sociology Review

Trials and Tribulations on the Road to Implementing Integrative Medicine in a Hospital Setting

Article excerpt

Introduction

An Integrative Medicine Centre represents two distinct medical systems and philosophies. Biomedicine, with its disease focus and fairly homogeneous, vertically organised hierarchy of specialists and generalists, traces its philosophical roots and practices to rationalistic quantitative Western scientific traditions. In contrast, complementary and alternative medicine (CAM) represents a loosely organised aggregation of heterogeneous practices based on global medical systems and philosophies that approach health and illness from an individualised but holistic perspective (Kaptchuk and Miller 2005; Coulter 2004). Despite these paradigmatic differences, this 'integration' has been occurring in some form for over a decade (Eisenberg 2006; Jonas 2005; Ruggie 2005; Coulter and Willis 2004; Singer and Fisher 2007; Cohen 2004; Collyer 2004; Barrett 2003; Dalen 1998). This case study examines an attempt to institutionalise this process of integration by establishing a hospital-based Integrative Medicine (IM) Centre.

Definition of integrative medicine

While there is no agreement about what constitutes IM, most commentators agree it has something to do with bringing CAM into some form of relationship with biomedicine. An immediate difficulty is that there is no uniform definition of CAM (Coulter and Willis 2004), let alone a consensus of what constitutes integration. The distinction between CAM and biomedicine is increasingly problematic (Coulter and Willis 2007). There is also increasing difficulty in naming the alternative to CAM. We concur with Wiseman (2004), who suggests that the term biomedicine is the least evaluative of the labels and does at least denote a medical paradigm within which the biological sciences are a core component and where explanations for disease and illness are predominantly biologically-based (Mead and Bower 2000). Further, the diversity of practices included under the rubric of CAM lessens its usefulness as an umbrella term. These practices range from very focused therapies to whole medical systems.

To call the combination of two paradigms 'integrative' is, as Coulter and Willis (2007) have noted, problematic:

... the use of the term 'integrative' may bear more relation euphemistically to the term 'takeover' in much the same way as in the business world, the term 'merger' of two companies conceals the reality of takeover and on occasions hostile takeover at that.

Institutional integration

In the United States, institutional IM is being developed in a highly individualistic manner and a body of literature documenting attempts to establish integrative centres is growing (Barrett 2003; Weeks 2001; Muscat 2000; Moore 1997:114; Blanchet 1998).

In 2003, a national survey of 1,007 US hospitals documented that 16 percent provided IM and over one-quarter (26.7 percent) offered some form of CAM (Larson 2005). Novey (in Larson 2005), suggests the models of integration that have been implemented can be delineated into five types: a 'virtual' model (a clinic without walls); consultatory models (which rely on referrals from staff physicians to in-house CAM providers); primary care units integrating CAM and biomedicine; fitness or wellness centres; and expensive CAM services in a retreat-like environment.

Vohra et al (2005) studied nine IM programs in North America. Twelve key themes related to successful integration were identified. In contrast to the focus on implementation factors for success, Barrett (2003) used a literature review to identify potential barriers and facilitators to the successful institutional integration of CAM. In the United Kingdom, the Prince of Wales brought together a steering committee and working groups to examine the issue of integrative health care (Dalen 1998). None of these studies, however, delineates what constitutes 'successful' integration.

Methods

In order to examine how a Centre for Integrative Medicine (or IM Centre) fits into a larger medical centre and community of stakeholders, a case study methodology was utilised (Yin 1984). …

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