This article will explore the development of alternative patient care philosophies and will attempt to explain the differences between the terms used to describe the various approaches. This article will begin will a discussion of conventional health care and then the following models of health care will be described:
- Holistic health care
- Complementary and alternative practices.
- Integrated health care.
The conventional or mainstream medical approach to treatment is based on scientific theory and model. It focuses mainly on the physical aspects of a disease and the cure for that disease. Medical practitioners rely on observable and objective outcomes, and define success or cure by measurable factors. Cure is defined scientifically according to set criteria. Conventional medicine can also be known as allopathic or Western medicine.
There is a growing awareness that the desired outcome in patient care and treatment is more than a set of clinically observed factors. Included in this awareness is that the patients themselves should have some say in his or her health care outcome.
The Flexner report of 1910 did much to increase standardization of medical education and as a positive result increased its quality. However the report also clearly discouraged alternative forms of therapy, such as naturopathy and eclectic medicine, to the point of jailing its proponents. Conformity in health care became the norm, diversity was discouraged. Studies have noted this affected access to both education and medical care for women and minorities.
In the 100 years since the Flexner report that encouraged conformity and standardization of healing therapies, much has changed in US health care.
Since then there has been a gradual shift towards team approaches and more patient centred health care. This has been as result of both necessity and a desire for more compassionate health care. Such medical approaches have been pioneered by the hospice and palliative care movements.
Perhaps in reaction to mainstream health care, at the opposite end philosophically speaking is holistic health care. Although the word holistic means considering the body, mind, and soul the term has been usurped by practitioners to mean any alternative therapy that doesn’t follow conventional medicine, is against pharmaceutical solutions and surgery, and stresses the consideration of the state of the mind and soul on the physical body. Practitioners consider themselves outside the mainstream medical system and do not see themselves as partners with medical doctors. Practitioners have adopted Eastern medicinal practices such as acupuncture.
Complementary Alternative medicine (CAM) is therapies, practices and products that are not considered a part of conventional medicine. Examples of CAM are chiropractic, massage, diet therapies, and natural products.
CAM medical practitioners have endeavored to bridge the gap between alternative and conventional medicine by using alternative patient centred therapies but working in conjunction with mainstream medical doctors. CAM practitioners use unconventional healing therapies and strive to ‘diversify the conceptual framework of medicine.’(Ernst 1995) This philosophy is slowly gaining acceptance at medical schools, where courses are being taught in alternative therapies, and the National Institutes of Health has established the Office of Alternative Medecine. The budget of this department has increased steadily in the almost 2 decades it has been open. Health plan insurers are also starting to cover alternative health care therapies. In 2007 the National Center for Complementary and Alternative Medicine and the National Center for Health Statistics reported that 38% of adults in the US used some form of complementary alternative therapy. Natural products were the number one therapy used.
The combination of CAM and conventional health care is known as integrated health care. The four key components of integrated health care are:
1.Philosophy and values: These are diverse and encompass a wider range due to the many disciplines involved. Treatment is not strictly physical based and takes into account the social and cultural context of the patient. Integrated health care also recognizes the number and variety of good health determinants. There is also a decreased reliance on the biomedical model of disease.
2. Structure: Its application will deviate significantly from the hierarchical approach that has been used in the past where there was one decision maker.
Organizational processes will be geared to teamwork and consensus decision making.
3. Process: Communication between team members and with the patient is emphasized.
4. Outcomes: The patient has input and shares the responsibility into what will be considered a successful treatment outcome and there is an understanding that there are multiple aspects of well being.
For a wider acceptance of integrative health care, more than anything prevailing attitudes will have to change and there will have to be an understanding that the current status quo will not address the future challenges of the US health care system.
The World Health Organization’s statistics from 2006 show that the US has a lower life expectancy for both men and women than several countries in the developed world, at 75 for men and 80 for women. More unsettling is the healthy life expectancy, which at 67 and 71 shows that in the last years of life the elderly will be coping with less than optimal health. The demographic shift towards an aging population will put pressure on the health care system that is already showing stress.
Even though the US at present does not have universal health care access, the US spends over 1 trillion dollars on health care. Yet countries other than the US have both higher life and healthy life expectancies. Clearly there will have to be a major organizational and attitudinal shift if higher quality later in life and efficiencies are to be achieved, because the money being spent is not translating into a healthier nation.
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