How to practice integrative care with success
Meet Dr Maya Marza, General Practitioner and integrative care advocate. Maya shares with us her experience. She answers all the question you might have on the best way to approach integrative care and what to expect from it. Here she shares insights on how to practice it.
Hi Maya, thanks again for talking with us. This is part 2 of our interview. First do you have a system in place before determining the best integrative course of action?
Yes, I have created a questionnaire that is inspired by both my personal experience and hypnotherapy. I start by separating the patient's past, present, and future That way I can better understand why they are seeking treatment today. To me, making a projection is important, as it allows me to assess whether a chronic symptom or illness is, in a sense, an initiation where there is a resilience to be found. This is still work in progress mind you. I ask patients to be introspective, and to start autonomizing their life.
Down the road, I wish to find a way to integrate the patient's autonomy into the questionnaire, but I have not found appropriate terms to do so yet. I believe there is a growing number of people that are progressing in terms of autonomy although this is very culture dependent. This is important for a successful integrative medical treatment.
Do you educate patients on your intentions before starting?
It depends. There are still a lot of patients for whome I don't know the outcome. For instance patients experiencing chronic pain or depression. For these specifically, I'm facing powerful secondary benefits hindering the healing process.
Let's take the example of someone wanting to lose weight. To start with, people who want to lose weight don't necessarily have a medically obvious interest in solving a situation that bothers them. So they have little initial commitment. On top of that abdominal fat is often linked to a lack of self-confidence. That complicates the healing process since now you also need to address lack of confidence. Since this can't be solved in one month, patients become discouraged. So, yes, setting up a plan is feasible in the short term, not so much for the long term. For that reason, it's not always easy to educate patients.
Do you help patients understand the benefits and risks of the therapies you put in place?
Yes. You have to understand that at the hospital symptoms are more pronounced and the illnesses are more deeply rooted, so it's perhaps easier to rely on evidence-based medicine. General practitioners like myself have to "tinker" more than hospital specialists. "Tinkering" in the sense of inventing protocols. So yes, I help patients understanding risks and benefits. It allows them to understand the process I'm using and to take their own health into their own hands.
Do you measure outcomes? If so, how do you do it?
Yes, I really try to do my best there. It can be challenging for a patient to track outcomes, but I think it also motivates them. It's like a coach telling them, "Hey, you're not happy with yourself, let's work together to reach the goal set for you." There's always at least one variable you can measure. For instance weight loss or abdominal circumference. The patient has to tell me what's most important to them, and we'll figure out how to measure it. In some cases, I have to decide what to track myself and be creative. For Ehlers-Danlos patients, I use the Pichot scale. Some times, I also use sleep apnea scales. The Visual Analogue Scale is great too, as it's easy to use and everyone understands it. But overall, for Ehlers-Danlos we'd need to create dedicated scales since patients are so specific.
And how often do you track outcomes?
Typically, I do check-ups every three months. However, it depends on the condition. For instance, I think if I had an obese American patient who weighed 400 pounds and fasted for a year, I'd want to weigh him regularly to keep a close eye. On the other hand, someone who only has to lose 20 pounds, I may just let him measure progress himself. So, it varies. But generally, it's good to take some readings every three months.
Can you name fields where you think integrative care should absolutely be considered?
Hypnosis to deal with phobia has always been effective in my experience. Every single time. There are plenty of situations where integrative medicine is very effective. Most cancer treatments are integrative now. Because of that cancer treatments have improved a lot over the last few years. There are so many non-medicinal or therapeutic interventions recognized in oncology today. We have sports, support groups, aesthetic reconstruction, supplements to assist cancer patients and so much more. Most patients don't even know that cancer care is integrative. Same for benign prostatic hyperplasia. Providers prescribe pygeum africanum. Which is completely natural. That's where we should be going in the future. Alternative care being so deeply embedded that patients don't even know about it and it has become the new conventional.