The value of patient-centered care

In her homey office on the second floor of a quaint, arts-and-crafts style house on Charlotte Street that serves as the home of holistic medical practice Family to Family, Dr. Susan Bradt talks about integrative medicine as a model of health care. She has an open, engaging manner and speaks with quiet conviction about problems facing the current health care system.

Board-certified in family medicine and integrative holistic medicine, she brings an integrative approach to her primary care practice with children, adults and families. Dr. Susan, as she is known by patients, uses tools from Western medicine as well as complementary strategies involving nutrition, botanicals and lifestyle choices. She also draws on principles of functional medicine to treat chronic diseases.

Silhouetted against her office window with trees in the background, Bradt shared with Xpress her views about integrative medicine and how it can improve health care.

Mountain Xpress: What is integrative medicine, and how does it offer a new model of health care?

Susan Bradt: Integrative medicine (also referred to as holistic medicine) is about patient-centered care and focuses not on one aspect of health but the whole person — body, mind and spirit. In my opinion, true integrative care requires a good relationship between the patient and physician so the practitioner can understand the whole picture of what is going on with a person and their health. It utilizes conventional medicine but focuses foremost on improving health through wellness and prevention of disease. Instead of just diagnosing and treating a disease and its symptoms, integrative medicine treats the whole person, taking into account their nutrition, exercise, sleep, stress, environment, relationship, genetics, etc. We may recommend a variety of treatments, including changes in diet, exercise, vitamins, herbals, mental health counseling, acupuncture, chiropractic  and massage, as well as conventional therapies such as medication or surgery.

What is functional medicine, and how does it differ from integrative medicine?

Like integrative medicine, functional medicine is holistic, looking at the whole person. However, it takes integrative care a step further by looking at how chronic disease occurs — what systems are involved, such as the hormones, the HPA (hypothalamic-pituitary-adrenal) axis, the digestive tract or the immune system.  It utilizes state-of-the-art integrative diagnostic testing to get a more complete picture of the health and function of these body systems.

It is a bottom-up type of treatment, as it identifies and focuses on the underlying causes of disease and then utilizes a variety of treatments. These treatments may include changes in diet, lifestyle modifications, stress management, vitamin/mineral/nutrient supplementation, etc. Functional medicine is bringing about a huge paradigm shift in medicine by focusing on the treatment of chronic disease, where true healing can occur. More and more physicians around the country are receiving training in functional medicine and are incorporating these principles into their practice. The functional medicine paradigm holds the potential for real healing and for truly changing the course of chronic diseases.

What do you see as the major problem with the current health care system today?

The biggest problem on a larger sense is the sobering statistic that the United States spends the most money per person on health care of any other developed nation, and our health outcomes are among the worst.

The prevailing health care system spends enormous amounts of money on unnecessary testing and on overpriced pharmaceuticals while not emphasizing the importance of preventive care, including nutrition and lifestyle changes to prevent and treat chronic diseases. Rates of chronic diseases such as heart disease, diabetes, hypertension and cancer are higher than ever and are all largely a product of poor diet and lifestyle. Reimbursement rates for preventive/wellness visits are among the lowest. Health care in the U.S. is also getting farther and farther from patient-centered care. Physicians have very little time to spend with patients, and factors other than care for the individual are driving medical decisions and medical costs. Doctors are faced with pressure from various sources to see certain numbers of patients, to meet criteria for insurance reimbursement, etc. Physicians are getting burned out because they’re not able to really care for people — to sit down with them, understand what’s going on and really help — the reason why most of us went into medicine to begin with.

What’s the answer? What do we need to do to improve the quality of health services?

I wish there was a simple answer to this very complicated issue. Different practice models are emerging, though, as doctors begin to search for better ways to care for patients and people demand better options. Some medical practices are opting out of the insurance networks, and patients are paying out of pocket for their more comprehensive visits while keeping a high-deductible health plan for emergencies. This allows physicians to spend more time with patients, focus more on wellness and prevention of disease and look at the whole person. Patients are better satisfied and begin to improve their health in sustainable ways. While it may not be the overall solution to the larger problems our health care system faces, it provides a model that can work within the system and allow physicians and patients to focus together on attaining healthier lives.