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From the Townsend Letter for Doctors & Patients
April 2004
Pathways to Healing
by Elaine Zablocki

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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 per month.

The sense of commitment Oulehla experiences comes in part from Dr. Koffler’s 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.”

Elaine Zablocki is the editor of CHRF News Files, a bimonthly e-mailed newsletter about the emerging integrative medicine industry, published by the Collaboration for Healthcare Renewal Foundation.




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