A revolutionary clinic design

Townsend Letter for Doctors and Patients,  Feb-March, 2005  by Jule Klotter

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Complementary and Alternative Medicine Clinic Design

by Robert A. Roush, PhD

The Haworth Integrative Healing Press, 10 Alice Street, Binghamton, New York 13904-1580 USA; 800-429-6784

www.haworthpressinc.com

Soft/Hard bound, c. 2003, pp. 158, $24.95 (soft); $39.95 (hard)

As conventional and CAM medicine edge toward integrative medicine, a question arises: Is it possible to design a holistic clinic that avoids many of the pitfalls of the current medical model? Robert A. Roush, PhD, says it is and offers all practitioners a cost-effective clinic model in his instructive book Complementary and Alternative Medicine Clinic Design. Dr. Roush, Clinical Director and Co-Founder of the 7 Senses Health Center (Bethlehem, Pennsylvania), has a master's degree in nonprofit administration and has administered several nonprofit health service programs.

The clinic that Dr. Roush envisions offers patients at least one therapy from each of five CAM domains, identified by NIH, and has conventional physicians on staff or closely allied with the clinic. For readers who are unfamiliar with CAM, Complementary and Alternative Medicine Clinic Design contains brief descriptions of established alternative medical systems, mind/body interventions, biologically-based interventions, body-based manipulation therapies, and energy/metaphysical therapies. Alternative medical systems (Chinese medicine, Ayurveda, naturopathy, homeopathy, and Tibetan medicine), like conventional medicine, have methods for assessing health and diagnosing illness. Because thorough assessment lies at the heart of good medical care, Dr. Roush recommends that practitioners of one of the alternative medical systems, or an MD, DO, DC, or nurse practitioner perform the client intake and assessment. After assessing the client, Dr. Roush encourages practitioners to take time to consider the course of treatment. In his model, the practitioner offers the client a few treatment suggestions after the intake and asks permission to consult with the clinic's team of practitioners. After team consultation, the practitioner contacts the client within 72 hours and offers secondary recommendations, which may include referrals, peer-support, and group discussion or classes. "It may seem irregular to the client," Dr. Roush writes, "but when explained that this process encourages quality and thoroughness, it is believed that this new approach will be considered preferable." Complementary and Alternative Medicine Clinic Design includes forms for health assessment that draw from conventional, Ayurvedic (Dr. Roush's discipline), psychological, and social-service models. In addition, the book provides information about working as a team, charging clients for services, and avoiding malpractice litigation.

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In choosing which therapies to provide at a clinic, Dr. Roush recommends surveying patients and community members to discover their interests and then offering those therapies that are not provided by conventional doctors or hospitals. Dr. Roush conducted a survey of 438 patients in 1999. His survey asked about interest and use of several CAM therapies. He found that spiritual counseling and prayer, music and art therapy, and nutrition topped the list, followed by body-based/manipulation interventions; mind/body interventions (yoga, tai chi, chi gung, meditation, and holistic psychology), herbs, acupuncture, reiki and therapeutic touch, and homeopathy. He also learned that people suffering from obesity, headaches, anxiety, allergies, and fatigue were the ones who were most interested in CAM. Because of this interest, Dr. Roush suggests that CAM clinics provide therapies that address these conditions. To generate more interest in a specific modality, he recommends that practitioners give free lectures or demonstrations to the community at least twice a year. Although a clinic can gradually add modalities that reflect each of the five NIH domains, referrals to other CAM practitioners who are willing to work cooperatively is another way to provide holistic care. One advantage, however, of having several modalities within one clinic is that one fee can cover the entire treatment plan. Otherwise, clients end up paying for each referral and exercise class that has been prescribed.

CAM modalities are only one part of a holistic clinic. The difference between a holistic clinic and conventional one extends to the way practitioners and clients interact and the overall atmosphere. A clinic that promotes healing of body, mind, and spirit encourages clients to relax, center in the present, turn inward, and listen to an inner voice as they consider their options and think for themselves. Dr. Roush says, "Many people seek CAM and perhaps most people seek CAM because they are already taking the next step in their own spiritual development." A holistic clinic can recognize the existence of 'nonlocal mind' (as Dr. Larry Dossey calls the effect of thought and intention on the physical) without probing into religious cultures.