Integrating clinical specialties for optimal patient outcomes

In integrative and functional medicine, there are vast practitioners but confusion on how to break down silos and work together, said Robert Silverman, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, at the 2020 Integrative Healthcare Symposium in New York City.

Silverman led a panel of integrative healthcare experts, including Carl Germano, CNS, CDN, vice president of Verdant Oasis; Mimi Guarneri, MD, FACC, ABOIM, co-founder and medical director, at Guarneri Integrative Health; David Perlmutter, MD, FACN, ABIHM, neurologist, author, and lecturer at Empowering Neurologist; Marc Grossman, OD, LAc, co-founder of Natural Eye Care; and David Bouley, chef at Bouley Test Kitchen.

Fragmented medical care is why we have high disease rates and healthcare costs, Germano said. “Communication is essential,” he said. “It all boils down to communication.”

In line with communication, at the beginning of every patient consult, Guarneri, a cardiologist, said she includes a medical doctor and naturopathic doctor in the room. She said patients may question why a naturopathic doctor is present, and she takes it as an opportunity to communicate how cardiovascular disease has a root in inflammation and why a naturopathic doctor is uniquely qualified to address inflammation.

“Patients start to understand how everything is connected,” said Guarenri, “and they become more open to other healing modalities.”

She said optimal patient care is about building relationships and education. When someone is hesitant to, for example, acupuncture, Guarneri said she offers to go with the patient to their appointment or work with the acupuncturist to create a plan for that patient.

Guarneri also said she spends time talking to patients to understand what their day is like. “We can say these wonderful things, but then we have patients in our office who have two jobs or kids in daycare and feel their life is so complicatied that, frequently, our ideal principles are not readily available to them,” she said. “I listen to people about how they spend their day and potential challenges that might present obstacles to maintaining health—body, mind, and spirit.”

Grossman said he believes all disease in the body and mind has to do with relationships, to themselves, to the community, and to the environment.

“It’s all about balance and harmony,” he said. “When imbalance occurs, we get disease.”

A natural eye doctor, Grossman said in vision care practitioners tend to label conditions and the patient becomes that condition, rather than looking at the underlying patterns of what the condition exhibit. In western medicine, practitioners focus on “how did x cause y.” In Traditional Chinese Medicine (TCM), the focus is “what is the relationship between x and y.”

Grossman said he tells his patients that they have to put together their care team. He may refer to several other practitioners as a result.

“In TCM, the eyes are the windows of the soul,” Grossman said. “When we’re treating somebody’s vision, we are treating their soul.”

Germano said practitioners cannot be complacent. They must take an active role in communicating information to practitioners, including bringing studies and information to providers who may not be up to date.

“Be very active and do be complacent in your care,” said Germano. “Communication is important and that includes you as well.”

Silverman asked the panelists to share their top takeaway for practitioners to take back to their practices. Here’s what they said:

“Hone in on the discovery of the endocannabinoid system, the master communicator of the body. It is going to govern nutrition and medicine for a long time.” – Germano

“Understand how influential inflammation is in decision making. Keep in mind, there are always two sides to every story.” – Perlmutter

“Food is powerful. Think about components, put it together thoughtfully, eat in a smaller window, and celebrate the food. You have to enjoy.” – Bouley

“Start to educate patients on causes of inflammation and think about doing a My Symptom Questionnaire [before treatment]. If you put some of these principles in place, the MSQ will change and give patients a gauge of how they’ve improved and how much they’ve accomplished. And don’t forget that stress affects the microbiome, and in turn our decisions on how we treat our bodies. Look at what’s driving the train before making recommendations for that individual.” –Guarneri

“The number one food for the eyes is kale. We also need to pay attention to visual hygiene, survive and thrive in a technological world. Function affects structure. Inner vision affects outer vision. Eyes are tools for the mind. If we can change our minds, we can change our vision.” –Grossman