One Physician’s View
Some of our most respected, even legendary, physicians of the past are famous for their exquisite performance of “the art of medicine.” As contemporary technology has developed, it has been the “science of medicine” that has thrived; some say it has dominated the profession.
Fantastically clear, rapid imaging technologies like MRI and CAT scans, combined with the ever-increasing miniaturization of optical devices and computers, continue to make some of our procedures that were “state of the art” just a few years back look fairly crude and brutish now. More and more every year, new “non-invasive” diagnostic tests and therapies replace inserted tubes, whirring saws, burning probes and the like.
Along with this burgeoning of western technology, spurred by the interests of the profession and patients, there has been a resurgence of non-technical therapies spurred by the interests of consumers. Consumers sometimes become patients, and in the context of increasingly “depersonalized” medical technology, these “hands-on,” non-technical therapies, many of which are attributed to ancient Eastern medicine, became known as “alternative medicines,” clearly meaning “instead of.”
As initially skeptical nurses and physicians began to appreciate the safety of these therapies, observed their positive outcomes in many cases, and heard their patients’ increasing requests for their availability, the therapies became more widespread. They became known as “complementary medicine,” meaning “in addition to.”
No longer viewed as a competing system of care that required a rejection of traditional medicine (nor causing a traditional physician to automatically “reject” the patient), Reiki, massage therapy, reflexology and other energy work became considered adjuncts to traditional medicine. The last part of this evolution of names occurred when individual practitioners, programs and clinics began to offer both traditional and complementary medicine in the same place or during the same encounter. This has come to be called “integrative medicine,” the current politically correct moniker for Complementary Alternative Medicine, or CAM.
The professional skepticism about CAM is based on two fundamental traditions of medicine: efficacy and safety…or “do good,” and if you’re not so sure about that, then make certain that “you do no harm.” It is no surprise that the less invasive, less intrusive, “external” CAM therapies have been accepted first by hospitals’ nurses and physicians. Indeed, CAM therapies now are offered at Cape Cod Hospital and Falmouth Hospital.
A recent report of serious potential side effects from chelation therapy is one example that affirms our caution in using controversial “internal” treatments. Chelation therapy involves the injection of a chemical into a person’s vein. This treatment has been used successfully to treat lead poisoning, but has been extended as a treatment that theoretically can lower the risk of a second heart attack. The problem is that the chelation therapy also can lower both glucose and calcium blood levels—low enough to cause seizures. This therapy with unproven, theoretical benefit but known potentially serious side effects is not one of the CAM modalities offered at either of the Cape’s two hospitals.
The National Institutes of Health recently awarded a $30 million grant over five years to 100 research sites to test both the efficacy and safety of chelation therapy in response to this particular controversy in CAM.
Both Cape hospitals provide massage, therapeutic touch, Reiki, reflexology, healing touch and, at Falmouth Hospital, aromatherapy modalities. Individual professional nurses (RNs) who became trained in one of these modalities have championed their institution’s responses to patients’ interests and requests by offering the CAM therapies to one patient at a time as part of their regular nursing duties. Nurse Jeanne Jackson started offering Reiki and Therapeutic Touch as an adjunct to pain management for post-op patients at Falmouth Hospital. Services soon were expanded to include anxiety reduction for pre-op patients and stress reduction for employees.
Community and professional educational programs were developed, other therapists were invited to provide their services and Jeanne is now Falmouth Hospital’s full-time Integrative Healing Coordinator. At Cape Cod Hospital (CCH), nurse Barbara Low, an ex-ICU and now a Recovery Room nurse, and nurse Carolyn Russet, an ex-CCU nurse and now Director of Nursing Education, are trained CAM therapists who wished to make such therapies more available to CCH patients. They founded the Cape Cod Hospital Complementary Healthcare Committee (CCH-CHCC) in 2001, a multi-disciplinary hospital-wide group that includes two CCH medical staff physicians.
Besides resisting the almost overwhelming urge to call itself the “chi-chi” committee, it focused on outpatient services and helped introduced massage therapy to the Oncology Infusion Center and Reiki to the Pain Management program. A somewhat unexpected impetus for these services was the interest of other hospital employees. As part of a stress reduction program for employees, Friday massage sessions started by the CCH Customer Service Committee have proved to be very popular.
In Oncology, the first massage therapist became very quickly overbooked. She is so busy with patients that she has had little time to win over the few remaining physician skeptics by giving neck and back massages, but efforts are under way to add another therapist.
Both hospitals have labored diligently and with speed to devise a method of “qualifying” community complementary therapy practitioners to serve as a guide for Cape residents. Again, the paramount interest was to safeguard safety, since data about efficacy is mixed at best.
All CAM therapists providing services to patients at CCH must successfully complete a qualifying process developed in collaboration with the medical staff. Four physicians participate in the Qualifying Sub-Committee of the CHCC that reviews the training, experience, scope of practice and expertise of any therapists requesting permission to provide services at CCH. This process mimics in many ways the medical staff’s formal credentialing process as required by JCAHO, the hospital accrediting body.
After reviewing training and experience, the CCH-CHCC has qualified 26 CAM practitioners. Falmouth Hospital has just published its Directory of Complementary Alternative Medicine Providers for the Upper Cape Region. It lists 33 CAM providers who meet the quality standards established by their multi-disciplinary Integrative Health Committee, and it briefly describes the 17 most popular therapies, from Acupuncture to Yoga.
In its first year, the CCH-CHCC wrote and distributed a pamphlet for patients called “How to Choose a Complementary Therapy Practitioner.” It stresses the importance of considering the safety of the CAM therapy and urges all patients to freely disclose to their physician any complementary therapies they are receiving. Both hospitals have conducted experiential sessions for the community, the employees and the professional staff.
At a time when open-heart surgery is beginning at Cape Cod Hospital, when additional radiation therapy machines are being considered, and when investments in telemedicine are just beginning, what is the future of CAM in the Cape Cod Healthcare system?
Well, if the marketplace is any indication, CAM therapy will continue to grow. Integration of CAM into the offerings of Wellness Centers is common now and is already happening on the Cape. The CCH plan for a new diagnostic and surgical center at Hadaway Road includes a Wellness Center that will incorporate complementary medicine therapies.
In the short term, acupuncture may be the next therapy offered by the hospitals. Acupuncture in Massachusetts is licensed by the Board of Registration in Medicine and is accepted as part of physician practice here. It has been proven to be safe if strict aseptic techniques are followed and it has been shown to reduce pain and other symptoms in some conditions. The medical staffs at either hospital could currently credential an anesthesiologist or an internist or a neurologist who is trained in acupuncture. The standards for training, experience and scope of practice of a physician acupuncturist are well defined and accepted.
Such is not the case for non-physician acupuncturists, and the comfort level of most Cape physicians with non-physician acupuncturists remains very low. As a result, it is likely to take a traditionally trained physician to act as a champion for acupuncture before it is accepted as a safe and efficacious practice by a non-physician.
Meanwhile, expect to see more massage therapists, more Reiki practitioners and more energy work specialists providing services to both in- and out-patients at our hospitals as more and more patients request it, and more and more physicians and nurses realize that it is safe and sometimes beneficial.
By H.O. Mathewson, MD
Herbert O. Mathewson, MD is a pediatrician practicing in Hyannis since 1972. He has been the Medical Director of Cape Cod Hospital since 1988. In that role and as a member of the Senior Management Team of Cape Cod HealthCare, he helped develop their current policies on Complementary Medicine. His Email address is hmathewson@capecodhealth.org.
