Revolution in the Desert

Four doctors in Arizona have learned a radical new way of practicing medicine--a way so different that 1,000 patients have lined up to be treated by them. This summer the doctors will bring their brand of medicine to the masses.

LAST YEAR RANDY FENTON'S DOCTORS GAVE HER THE GRIM NEWS: She had breast cancer. Because Fen ton had lost a sister to the same disease just two years before, the wife and mother of three knew she was in real danger. Her doctors quickly recommended chemotherapy and radiation. But Fenton, 45, a self-described medical minimalist who shuns even Tylenol for a headache, wanted to know all her options.

A sister-in-law suggested she make an appointment with the nearby clinic run by the Program in Integrative Medicine at the University of Arizona College of Medicine in Tucson. Here, experienced medical doctors practice integrating the best of conventional and alternative therapies as part of a trailblazing fellowship program established by Andrew Well, M.D. The first four doctors are due to graduate from the two-year program this June.

Fenton got in to see Russell H. Greenfield, M.D., a former emergency physician and one of the program's senior fellows. Fenton right away learned that this was not an ordinary doctor's office visit, nor was Greenfield an ordinary doctor.

"At my first visit, Dr. Greenfield spent two hours with me uninterrupted," she says. "Two hours without a nurse knocking on the door, without the phone ringing, without looking at his watch. He took into consideration every aspect of my life: my past, my present, my future."

Greenfield concurred with Fenton's oncologist that chemotherapy and radiation were the right choices. But he felt she would also benefit from guided imagery, herbs, and nutritional work. Fenton chose to follow the advice of both Greenfield and her oncologist.

In order to stay calm as the chemotherapy drugs dripped into her veins, she practiced the breathing exercises that Greenfield had taught her and the guided imagery exercises she had learned from another practitioner. On Greenfield's recommendation, she took milk thistle (Silybum marianum) to protect her liver from the chemotherapy and the antioxidant supplement coenzyme [Q.sub.10] because of its possible anti-cancer benefits, and she saw a nutritionist who helped her develop an immunity-building diet. "When I was going through my first round of chemotherapy, I was terrified. Dr. Greenfield not only helped me physically, he helped me psychologically," she says.

"He asked me to bring my children into the clinic so he could reassure them and let them know who was taking care of their mom," she adds. "He held my hand through this horrendous experience and nurtured me.... He has been my doctor, my partner, my friend."

With her cancer now in remission, Fenton is convinced that integrating conventional and alternative medicines gave her the best possible health care. "People have the impression that the Program in Integrative Medicine is a voodoo program with hippie doctors. It's not," says Fenton. "It is nothing less than the future of health care."

In Need of Change

To Andrew Weil, a 1968 graduate of Harvard Medical School in Boston and a leader of the country's mushrooming alternative medicine movement, a new kind of medical training that would create real healers is well overdue. "To be in the medical world right now, either as a patient or as a physician, is to be unhappy," Weil says. "It's a terrible time to practice medicine and a frustrating time to seek medical attention."

Medical schools, Weil says, often fail to prepare their students to be good doctors. Even teaching them something as basic to health as nutrition is often not done. According to a 1994 report to Congress by the U.S. Public Health Service, attempts made in the last three decades to offer adequate nutrition education have mostly failed. Schools also fail to instruct doctors how to communicate with their patients. Only 28 percent of the time are patients able to fully explain their concerns to their doctors, according to a survey published in January in the Journal of the Ameri can Medical Association. The same survey reported that doctors allowed their patients to talk for an average of only 23 seconds before interrupting them and redirecting the conversations.

Complicating the situation is health insurance. "The economics of the managed care system have been destructive to the doctor-patient relationship," Weil says. Last year in the Archives of Internal Medicine, a majority of physicians surveyed reported that under managed care they feel less able to place their patients' best interests first and are concerned that the quality of care is compromised. According to numerous studies, doctors spend an average of less than IO minutes with each patient.

Weil isn't surprised that a recent national survey shows 42 percent of Americans are using alternative therapies. He argues that both patients and doctors are demanding a new definition of "good medicine." Weil and his colleagues propose that this new brand of medicine combine both conventional and alternative therapies, while recognizing the importance of conventional medicine in treating trauma and acute illness. But it should do more than offer a smorgasbord of treatments. It should try to heal the whole person, physically, emotionally, and psychologically, as well as cure the immediate illness, and emphasize prevention and wellness.