When people talk about the Integrative Medicine
Department at Evanston Northwestern Healthcare System, their voices
change. “I chose
to work here specifically to be in a team environment, because I like
to share information, I like to learn from others, and I think it’s
the best way to give patient care,” says nutritionist Karen Raden,
MS, RD, with enthusiasm. Cheryl Oulehla agrees. “The people here
are so committed to what they do. All of them are concerned about their
patients on a personal level, and they seem to have a great deal of
depth in what they do.” Oulehla, a 52-year-old woman, was diagnosed
with breast cancer 18 months ago.
What makes this clinic so different?
In addition to the director, Karen Koffler, MD, the staff includes three Chinese
medicine practitioners, six body workers, a nutritionist, an integrative
Licensed Clinical Professional Counselor, a family systems therapist, an
Ayurvedic practitioner and an herbalist. Koffler is board-certified in internal
medicine and used to care for very sick patients at a teaching hospital in
Denver. Then she graduated from the first class of fellows in integrative
medicine at the University of Arizona (Andrew Weil’s program) and was
recruited to start this program in Chicago. The department opened its doors
in January, 2001, and has a growing case load, seeing about 350 patients
The sense of commitment Oulehla experiences comes in part from Dr.
vision of what a healing institution should be. “In order to take good
care of patients, you need to inculcate a culture of care, and I mean from
the front desk staff that greets them right on through to the lab tech taking
their blood,” she says. “Let’s face it: it’s a rare
institution that really has that viewpoint imbued throughout.”
Even though staff members at the Evanston Northwestern program have very different
backgrounds and training, they’re learning to work together as a team.
They meet weekly at two-hour sessions to discuss their patients. Twice a year
they schedule a half-day “retreat” to brainstorm together about
the future direction of the organization. They all write in the same chart.
At the inception of the clinic, the team spent time together exploring what
integrative medicine meant to them. They analyzed the eight dimensions that
comprise good health, including nutrition, breath, movement, environment, awareness,
spirituality, love and relationships, and rest and recreation. They committed
themselves to investigating those eight dimensions with every patient. “Since
we all share the same chart, when we present a case we all allude to these
eight domains, and we are all on the same page,” Koffler says.
Over half the patients Raden sees are dealing with obesity, but she doesn’t
believe in putting them on a diet. “Diets only work for a short period
of time,” she says. “Instead, I work with patients to help them
change their relationship with food. I give them meal plans, but more than
anything else I offer new concepts on how to eat.” For example, she doesn’t
focus on calories. Instead, she focuses on nutrient-dense foods that help prevent
illness as well as promoting a healthier weight.
Koffler and Raden share many patients. When one of Koffler’s patients
has potential food sensitivities, she sends them to Raden. When one of Raden’s
patients is especially complicated due to a special medical history, she’ll
refer them to Koffler.
Recently, the department began asking some patients to come in for an evaluation
by a healthcare team of three, four or five practitioners. “At first
we’re taking the most complicated patients, or patients who have tried
many things but are stalled out in their ability to heal,” explains Koffler.
First the patient tells their story and talks about how they feel. Then they
leave the room and the team discusses their observations. “Because we
come from different paradigms, we see different things,” says John Chamness,
NCTMB, who practices several forms of massage and bodywork. “We put our
different recommendations together, and the patient is invited back in the
room to discuss them.” He believes these team evaluations are an especially
valuable way to work together, because they go beyond an intellectual discussion,
and involve interacting with the patient in the present moment.
Cheryl Oulehla is one patient who’s benefited from this unusual team
approach. When she first came in, she was feeling drained after chemotherapy
and radiation therapy for her cancer. A nutritionist helped her improve her
diet, but she continued to feel exhausted. Then the integrative counselor suggested
that perhaps she wasn’t getting enough REM sleep, and Koffler referred
her for a sleep study. Oulehla learned she had restless leg syndrome.
Over time, she saw many of the different practitioners at the program, and
found several different modalities which had something to contribute to her
healing. “When I first came here, I was so tired I was lucky to make
it to the end of the day,” she recalls. “I’ve improved 90%
since then. Now I have all sorts of energy. When I look back, I realize I was
in a deep hole.”
She emphasizes that a combination of varied elements led to this improvement. “I
was treated by a counselor, an acupuncturist, a massage therapist, a nutritionist
and an energy worker. During this time, I completely changed my diet. I utilized
guided imagery, vibrational healing and meditation, together with an attempt
to exercise regularly. My experience in this program teaches me that I can
have a great influence in my own healing.”
While the clinic accepts Medicare, it doesn’t accept other insurance.
Patients must pay out of pocket and then seek reimbursement from their insurers,
and Oulehla has paid out of pocket for almost all her care. Is it worth it? “Yes,
it is,” she says. “I don’t feel that you’ve done justice
to yourself until you’ve explored all the avenues for healing. The practices
I’ve learned through this program have made profound changes in my life,
and I suspect there will be more to come. My only regret is that I did not
discover this program sooner.”
Zablocki is the editor of CHRF News Files, a bimonthly e-mailed
newsletter about the emerging integrative medicine industry, published
Collaboration for Healthcare Renewal Foundation.