What is the Difference and Why is this Important?

by Lise Alschuler, ND, FABNO

Integrated healthcare, integrative practitioner, integral health… all buzzwords of complementary and alternative medicine.   But what do these words really mean and what are the implications of these words to the development of integration in our healthcare system?

integrativeAll of these descriptors are variations of the word, integrate.  Integrate is defined as:

  1. To make into a whole by bringing all parts together; unify.
  2. To join with something else; unite.
  3. To make part of a larger unit.

In the context of healthcare, the National Center for Complementary and Alternative Medicine (NCCAM) refers to medicine as integrative (or integrated) medicine when it “combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness.”1 According to Andrew T. Weil M.D., a well-known proponent of integrative medicine, “Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.”2 Integral health is a term in use, and perhaps coined, by the Aspen Center for Integral Health.  They defined this integral health as a broad approach to health and healing that takes into consideration all aspects of the human condition. Combining these three definitions, one might define integrated/integrative medicine as: the evidence-based merging of conventional and complementary therapies for the good of the whole person in the context of a therapeutic relationship between provider and patient.  Accepting this definition for now, it is clear that this describes an end-state.  Integrative/integrated medicine describes the attributes and qualities of a destination to which one has arrived.  We will know we are experiencing integrative/integrated/integral health when we experience being in a therapeutic relationship with our healthcare provider(s) that advocates for the use of diverse therapies to support our total health and our overall well-being.  For advocates of integrative/integrated/integral healthcare, there is little about this definition with which we would disagree.  Things become interesting however, when one considers the means to this end.

‘Integrative’, ‘integrated’ and ‘integral’, when applied to the process of integration carry very different connotations and dictate diverse prescriptions for the architecture of healthcare.  Let’s start with integrative.  An integrative practice implies a practice that offers multiple and diverse therapies – both conventional and complementary.  The use of the word ‘integrative’ grants specific allowance to a centralized mode of delivery.  Thus, one practitioner, with training in both conventional and complementary practices and principles is an integrative practitioner.  His/her practice then becomes an integrative practice.  In contrast, an integrated practice emphasizes the combination of diverse practitioners and their different therapies into one practice.  ‘Integrated’ would rarely be used to describe one individual, but instead, describes a practice of diverse practitioners.  Going back to the definition of integrate, an integrated practice embodies the definition “To join with something else; unite.”  An integrative practice/practitioner personifies the definition, “To make into a whole by bringing all parts together; unify.”  Finally, ‘integral’ implies a sense if indispensability and fundamentalism to integrative/integrated healthcare without implying the methods or means needed to achieve this goal.

It is my assertion that the emphasis on integrative versus integrated makes all the difference in the world.  Integrative healthcare relies upon practitioners who have amassed enough knowledge and experience to encompass the worlds of conventional and complementary medicine.   These practitioners have within themselves the capacity to integrate the healthcare of their patients.  There is no need for interdisciplinary collaboration or cross-referrals.  Integrative practitioners can, in theory, exist as solo practitioners and offer integrated healthcare.

While there are many excellent programs that train integrative practitioners and while there are, in fact, practitioners who are able to practice from an incredible breadth of perspective, philosophy and practice, it is my contention that this is rare and, in fact, may not be the optimal expression of integrative/integrated healthcare.  Conventional medicine alone is so complex that the majority of allopathically trained providers practice within a relative narrow focus based on organ system or disease category.  Complementary medicine is also complex incorporating a huge breadth of perspectives and distinct philosophical precepts, along with a wide range of therapeutic rationales including modern science and ancient healing traditions.  The likelihood that one practitioner can master the breadth and depth of both conventional and complementary medicine is rare and reserved for a select few individuals.  The majority of practitioners with inclinations towards integrating their practice environment learn some things about a portion of the type of medicine in which they are not primarily trained.  Thus, they become incomplete amalgamations of conventional and complementary care.   Without a doubt, these integrative healthcare practitioners do practice more integratively.  However, it is also true that these providers have blind spots in their integrative practice.

The solution, in my opinion, is integrated healthcare.  Integrated healthcare recognizes the need for, and value of, bringing diverse practitioners together for the good of the patient.  Integrated healthcare may be comprised of integrative practitioners, and, is, in fact, benefitted by these expansive thinkers.  However, integrated practices arise from distinct and different practitioners who primarily practice within their discipline, and whom unite with other practitioners for the welfare of the patient.  Integrated medicine then offers a greater diversity of options and can potentially bring integrated/integrative healthcare to a deeper and broader level.

This distinction is important towards the future of healthcare.  I believe that the future of healthcare is integrated/integrative healthcare, henceforth referred to as integral healthcare.  I also assert that the most judicious way to achieve integral healthcare is via integrated practices.  I fully advocate for the training of integrative providers because these providers are better able to integrate with other provider types.  In addition, integrative practitioners practice some degree of integral medicine in their own practice. However, integrative healthcare practitioners do not comprise the end goal of integration.  Integrative healthcare practitioners are uniquely trained to move healthcare forward towards integral healthcare.  Through partnership among diverse practitioner types, united together by, and for, the care of the patient, the richness of integration in healthcare will become manifest.   The possibility for integral healthcare is real and rests upon our collective willingness to join together in a united quest for whole person health.   There is nothing about integrated or integrative healthcare that exists in isolation, silos  or disunity.  Integration is a chorus of voices – the harmonic voices of conventional and complementary practitioners.  Let us not forget each other in our efforts to transform healthcare.


References:

  1. “What is Complementary and Alternative Medicine (CAM)?”. National Center for Complementary and Alternative Medicine at the National Institutes of Health.
  2. http://www.drweil.com/drw/u/id/ART02054.  Accessed August 6, 2008.