Integrating alternative modalities into Western clinics (Proceedings)
Complementary and alternative medicine (CAM) is viewed by many veterinarians as an "us against them" proposition. In reality, an integrative approach combining conventional medicine and alternative modalities often yields the best results. Some CAM modalities such as Traditional Chinese Medicine have their own unique diagnostic methods which evaluate the body in a different manner, thereby providing veterinarians with an alternative way to view a disease or disease process. In some cases, Western medicine may not have an etiology or treatment for a particular problem while a CAM modality may be able identify, treat and even prevent the same problem.
Integrative medicine is a multidisciplinary approach to health care, utilizing Western medicine in conjunction with non-traditional medical modalities such as herbal remedies, Traditional Chinese Medicine, homeopathy, chiropractic, etc. According to the 2002 National Health Interview Survey conducted by the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Heath, and the National Center for Health Statistics (part of the Centers for Disease Control and Prevention), 62% of American adults use some form of CAM including megavitamin therapy and prayer. A recent survey by AARP and NCCAM found that almost two-thirds of people 50 years or older are using some form of CAM. According to Dr. Lynn S. Peck, research associate in the Department of Materials Science and Engineering, University of Florida, a 1997 survey of animal owners revealed that 42% of animal owners utilized some form of CAM. Clearly, there is a demand for alternatives to Western medicine alone and veterinarians must recognize and accommodate this growing interest.
In most cases, conventional medicine and alternative modalities can be utilized together safely and effectively. Many CAM modalities focus on treating the root of the problem, not just the symptoms, and strive for prevention of future disease. In some instances, Western intervention is critical. However, follow-up care utilizing alternative modalities may improve recovery. Integrative medicine practitioners must still adhere to recognized standards of care and investigate the underlying problem and should stay current with the latest advances in Western medicine to ensure they are able to offer or recommend the best health care options possible.Responsible integration of alternative modalities into a purely Western clinic requires educated decision-making. One must be aware of and consider American Veterinary Medical Association guidelines, national and state requirements and legal issues, the quality of education that is available, if certification exists and the validity of the modalities. Other selection criteria include personal experience with a modality, current popularity of and anticipated acceptance by clientele and local veterinarians of the selected CAM modality.
CAM education and training varies significantly in quality, quantity and philosophy. Two programs in the same field may vary wildly in material covered, requirements for passing the course and in receiving certification if any exists. Certification conveys credibility and promotes confidence in both the modality and certified practitioner, but does not necessarily guarantee or endorse competence in either the education received or ability of the practitioner. Investigation into the certification process, the required number of training hours, and what body or organization determines and awards the certification will enable you to better assess the validity of the certification. Additionally, requirements for practicing specific CAM modalities varies from state to state. In some states, non-veterinarians are allowed to perform some CAM therapies.
Each CAM modality should be evaluated cautiously and independently. Critical evaluation is often difficult due to the lack of double-blinded control studies and inaccessibility of studies due to publication in foreign journals and foreign languages, or in journals that are not included in the Medline data base. Additionally, some modalities do not lend themselves to the same experimental protocols that are applicable to Western medicine. Regardless, CAM therapies should be critically appraised prior to incorporation into the veterinary practice.
Once the decision has been made to integrate CAM modalities into the practice, staff members, colleagues and clientele must be educated about the therapies offered. Staff members must be "on board" and be able to discuss services offered in order to educate clients, arouse interest in and promote the new therapies. Colleagues in-house and in the local area need to be aware that alternative treatment options are available at your facility. Promotion at the clinic can easily be achieved by hanging posters or artwork that convey the new modalities practiced, hanging certifications that practitioners have earned in specific modalities, handing out informational brochures, and creating an alternative medicine corner with relevant books, magazines and newspaper articles. Tabletop water fountains, exotic plants and wind chimes will also add interest to an alternative medicine corner. Brochures or fliers announcing inclusion of CAM modalities at your clinic should be mailed to local veterinary clinics, veterinary colleges and schools that offer veterinary technician courses. The local media (newspaper, regional magazines, television stations) should also be made aware of the new services that are offered at your clinic. Lectures and demonstrations in the local community are an excellent way to promote CAM modalities and the services your clinic offers. Venues which should be considered include: