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From the Townsend Letter for Doctors & Patients
May 2005

Pathways to Healing
by Elaine Zablocki
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True North Health Center Practices Upstream Medicine

When you walk in the door at True North Health Center, in Falmouth, Maine, you enter a large room with a skylight, a number of trees, and a waterfall. With 7,500 square feet, the facility has room for ten exam and treatment rooms, a patient resource area with high-speed internet access, and two conference rooms for classes and workshops. It has a 700 square-foot "teaching kitchen" where a natural foods chef demonstrates healthy, tasty cooking during regularly scheduled weekend workshops.

Bethany HaysBut the most important thing that draws people to this integrative health center is the way they focus on their patients. "Our practitioners spend about an hour and a half with new patients, and as long as they need with follow-up visits. That allows us to go into some depth with people, hear their full story and build a relationship with them," says Bethany Hays, MD, medical director.

Some people seek out this clinic because they are coping with a difficult health problem, haven't found solutions, and hope that True North can help them. Others are healthy people who want to take charge of their health so they can continue to be healthy. "Many people who come here have been specialist-cared-for-to-death," Hays says. "They've seen the rheumatologist and the gastroenterologist and the dermatologist and their family doctor, and while they may have a sense that all of their problems are tied together, none of their doctors have had the opportunity to see the whole picture." Hays herself practices functional medicine, which means she looks at problems not as isolated symptoms, but as aspects of body systems. "I look at whether the majority of symptoms relate to nutrition, or stress, or the gastrointestinal system, or an inflammatory response. I ask each patient, 'if you had a magic wand and could get rid of three symptoms, which would you choose?' Then I make sure we focus on those three symptoms."

Hays uses functional medicine to give patients a unified understanding of why events in their life have led to these symptoms, and what can be done about them. She calls this "upstream medicine." "Instead of offering prescriptions and surgery to people as they go over a waterfall, we go upstream and help them not fall in the river," she says.

The Complex Patient
Many of the patients who come to True North have a complex presentation with several different symptoms, and that makes it difficult to trace the underlying cause of their problems. Hays recalls one woman who had asthma, headaches, and chronic diarrhea. She was taking lots of medications and had recently been hospitalized for pancreatitis. Hays ordered lab tests, and while waiting for results asked the patient to try a special diet, using a protein drink for breakfast and lunch, and brown rice and steamed vegetables for dinner. "We gave her a diet with good protein/carbohydrate balance, plus lots of vitamin supplements, but very low in potential allergens. It's not a dangerous fast, but it is a radical departure from the way most people eat, and I wasn't sure she would do it. A week later, she came back in and said, 'the pain I've had that goes from my front to my back, the pain I've had for so long I took it for granted, has gone away! Whatever you want me to do, I'm here to do it!!"

An allergy test found that this patient was extremely sensitive to a number of molds that are often found in foods, but also in the environment. When she went on a strict diet her GI tract cleared up remarkably and the pain and pancreatitis went away, but she was still having asthma and headaches. She looked at the list of molds and said, "I think this mold affects the building I work in." She took a leave of absence from work, and within about six months all her health problems resolved. Eventually she was able to convince the building owners that it was dangerous, and they shut it down.

Valeri SafferTo help other healthcare practitioners learn how to deal with patients who have a constellation of several different conditions, True North is holding its fourth annual integrative medicine conference this fall, entitled "The Complex Patient: Biology, Relationships, and Healing." It will be held October 19-22, 2005 at the Black Point Inn, an oceanfront resort in Scarborough, Maine. It is approved for 20 CMEs. "Our goal is to offer practitioners tools they can use with their most challenging patients," says executive director Valeri Saffer. The conference usually includes a mix of people. "We want to create a venue where practitioners of different types can interact with each other and explore new ideas in a non-judgmental way," adds Hays. "We want to bring conventional and alternative practitioners together in the same room, so they can explore each others' work with mutual respect." Last year, about two hundred people attended the conference.

The Cost of Care
True North doesn't bill insurance. Patients pay out-of-pocket, and receive reimbursement if their insurance companies cover out-of-network providers. Typically, a new patient visit with a physician lasts 90 minutes (and costs $250) while a follow-up visit lasts an hour. Most complementary sessions last an hour and cost $75. "We hope to play a role in changing healthcare, and insurance gets in the way," explains Saffer. "We're encouraging patients to think not just about what their insurance will cover, but about what will really bring them long-term, sustainable health."

However, for patients who cannot afford to pay cash for care, the clinic has partnered with the New England Time Dollar Bank, an alternative monetary system based on barter. "Members of the Time Dollar Bank can barter an hour of their time for an hour of our time," explains Hays. "This system isn't just located in Maine, it's all over the world. What's really great about it, is the way it builds community." The clinic also has a small fund from private donors to cover services such as lab tests or supplements, which can't be paid with Time Dollars.

With 17 providers and 10 administrative staffers, the clinic's annual budget runs just below $1 million per year. They hope to reach breakeven about two years from now. Meanwhile, they raised $30,000 last year in grants, and $500,000 from individual contributions. "We have a full-time director of development, and we raise funds from donors nationwide," Saffer says. "Why does someone from Oregon or New York give to an integrative clinic on the Maine seacoast? Because they want to help one clinic develop as a living model, and show that this model of healthcare is truly possible."

True North Health Center:
For more information about the Integrative Medicine Conference, call 877-821-4488 or email conference@ truenorthhealth
For more information about the Maine Time Dollar Network,

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


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