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 Next Generation Integrative MD Leader David Rakel, MD on ABIHM, CAHCIM and Family Medicine 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series


Integrator: How did you get into the integrative medicine field?

Rakel: I was a country doctor in Driggs, Idaho. For 5 years, I practiced womb-to-tomb medicine. I learned a lot about people. I saw the psychosocial nature of things, of auto-immune disease. I saw how pharmaceutical drugs dampen the mind-body connection. I also saw how some of my patients were taking supplements, getting acupuncture from others. I was curious. I began to read Andy Weil’s books, books on holistic medicine and mind-body medicine and traditional Chinese medicine.

Integrator: You’re a graduate of the University of Arizona residential fellowship in integrative medicine, correct?

"To me the goal – and this is a focus
of our program – is how do we bring
integrative medicine, or healing oriented
medicine into primary care.

So the approach, with either incorporating
therapies or practitioners such as
chiropractors or naturopathic physicians,
is through a patient-centered care model."

- David Rakel, MD

Rakel: I was in the 3rd class of the two-year residential training. The residential program isn’t there any longer. The fellowship is now a mix of onsite and distance learning. The program was excellent for me. It was like a two-year sabbatical in which I could be involved in a conversation about how to improve health care. I did most of the work compiling the Integrative Medicine book in the second year.

Integrator: What did you learn clinically in the program? How has your practice changed?

Rakel: The fellowship was a good, humbling experience. We had a lot of focus on our own health and wellness. We also had the opportunity to experience various treatments. I was drawn to some more than others. Osteopathic manipulative therapy and especially strain-counter-strain I learned from an osteopath in Tucson. Another area that attracted me is interactive guided imagery. I have since become certified in this practice. Health psychology and nutrition are the other main areas of my interest. In retrospect, the (integrative medicine) field at that time – a decade ago - was premature for systems-based learning.

Integrator: How are these incorporated in your practice?

Rakel: To me the goal – and this is a focus of our program at the University of Wisconsin – is how do we bring integrative medicine, or healing oriented medicine into primary care. So the approach, with either incorporating therapies or practitioners such as chiropractors or naturopathic physicians, is through a patient-centered care model. We use a health-oriented team which values relationship-centered insights into the person. We focus on quality of life measures and in understanding what will empower the individual to find health for themselves.

Integrator: Say more about the strategy with primary care.

Characteristics of the S.O.S. –
"Salutogenesis Oriented Session"

  • Create health, not suppressing
  • Relationship-centered
  • Usually a 45 minute session
  • Get patients comfortable telling their story
  • "Not everyone needs or wants an SOS"

A model for exploring cost,
quality and provider satisfaction

Rakel: We’re trying to create health in specific populations – trying to create health instead of waiting for disease to come through the door. We know that just suppressing the pain is not getting to the root of things. We have an integrative medicine consult which we call an S.O.S. – Salutogenesis Oriented Session. This is usually a 45 minute session. We try to get patients to be comfortable telling their story. We also incorporate the standard 15 minute and 30 minute slots, because not everyone needs or wants an SOS. We’re also looking at creating healing oriented teams. We have grants out for team care in diabetes, but we want create teams of professionals who focus on how to create health as well as manage disease.

Integrator: The “medical home” model seems to be taking off in primary care, backed by family docs, pediatricians, osteopaths and internal medicine doctors. What role do you see for integrative medicine and specifically the distinctly licensed complementary healthcare providers in this model?

Rakel: We need to all agree on what we want to accomplish with our work. If a common goal is to create health for the communities we serve, we need to address the barriers that are preventing us from achieving it. Once the team agrees on a common mission or goal, it becomes the focus that a trans-disciplinary team can work towards as a group. This will encourage professionals to come together and in doing so, learn from one another while we create something new. One specialty can’t do this alone. We need to learn how to work together to create health-oriented teams. How this team is defined, depends on the needs of the community we intend to serve. The challenge is that we all believe everyone needs what we know. This is a good example of the importance of recognizing our own bias so it does not get in the way of what our patients need most to heal, which may or may not be what we have to give.

Integrator: I believe you are the sole person is presently serving in the leadership of both the Consortium of Academic Health Centers for Integrative Medicine and the American Board of Integrative Holistic Medicine – through which you have certification. How do you envision the optimal relationship between these two entities?

Rakel: Each of these organizations has individual missions that resonate a common theme. The ABIHM focuses on educating clinicians to deliver healing-oriented care while the CAHCIM is focused on transforming medical education towards health and healing. The optimal relationship is collaboration and sharing insights and strategies on how to create this shift in each of their areas of focus.

Integrator: I am curious about how your text, Integrative Medicine, is doing. It is quite a compendium of thinking and practice by medical doctors about medical practice. Can you share some numbers – total sales, number of academic or integrative programs that have adopted it as core text, etc.

Rakel: I don’t know how many have been sold, but I was recently notified by the publishers that it is being translated into Spanish, which seems like a good sign. The main goal for this text was for it to be a tool for clinicians to feel more comfortable incorporating unconventional therapies into practice. It is a sad state of our current system and the economics of health care that physicians have become most comfortable using one therapeutic modality (pharmaceuticals). As we analyze the evidence and address potential harm, hopefully we will become more comfortable prescribing other therapies that have less [potential for harm].

As you know, under another hat I work closely with academics from the complementary and alternative healthcare disciplines. To date, there remains a good deal of segregation in the so-called integrative medicine dialogue. For instance, the ABIHM course. What steps or recommendation do you have that will help us best bring a deeper integration of other practitioners into the integrative medicine dialogue?

"Changing how we look at our job"

"In our culture, we have identified
three major health care needs:
achieving ideal weight, maintaining '
optimal body function with less pain '
and to be happy. We are trying to
change how we look at our job.
I could also call these things obesity,
myofacial pain and mental illness."

- Rakel

Rakel: I believe it is easier to understand who to invite to the party when we know what we want the party to accomplish. In our culture in Madison, Wisconsin, we have identified three major health care needs: 1. Achieving ideal weight, 2. maintaining optimal body function with less pain and 3. to be happy. We are trying to change how we look at our job. I could also call these things; obesity, myofacial pain and mental illness. But we want to pull out what is right with the person instead of treating what is wrong. For example, for myofascial health, my culture may best be served by a team that consists of a body worker to address physical imbalance, a mindfulness instructor or psychologist to address how the body sympathizes when our mind is under stress and a spiritual guide to help the individual connect with those things that give life meaning and purpose. This team is mobilized by the primary clinician who has invested in a relationship that creates insight into what is needed for self-healing mechanisms to unfold. The professionals involved will have talents that will most effectively facilitate health for the needs of the community. If we are successful, our patients will need the team less, which will reduce long-term costs and make everyone happy…… and then number 3 is achieved as a side effect! And hopefully we will all enjoy each other’s company and have fun at the party.

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 About The Author
Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
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