Lise Alschuler, ND, FABNO examines the ingredients necessary to make a successful integrated practice work.
As anyone who as has been in a long term marriage or partnership knows, it is not enough to simply be in love. Successful long-term relationships require the will to sacrifice, compromise, and meet in the middle on contentious issues. Successful long-term relationships also require that people don’t just love each other, but that they like and respect each other too. I once asked my grandfather, who, at the time, had been married to my grandmother for 50 years, what he attributed the success of their marriage to. He replied, “She (my grandmother) lets me think I am right 50% of the time, and the other 50% of the time, I let her think that she is right.” We chuckled, and, I think there is genuine wisdom in this remark. And, lest you think that this will be a column about marriage instead of healthcare, I believe that what makes a successful marriage or partnership work are the same things that make a successful integrated practice work.
Let me break this down. At the very least, the ingredients to successful partnership (personal partnerships and business partnerships) include:
- Willingness to be in partnership
- Mutual regard including respect and trust
- Occasional steps outside of one’s own comfort zone and into the comfort zone of your partner
- Leaving the door open into the world of your perspectives and letting your partner walk in occasionally
- Willingness to alter one’s own view on an issue in order to adopt components of your partner’s view
- Letting your partner be right about 50% of the time
Assuming, that the motivation to integrate your practice is in place and the various provider types are also in place, adherence to these attitudes will set the stage for a long lasting relationship. While one’s personality and emotional intelligence are the seeds of developing these attitudes, repetitive practice is the fertilizer that will allow these attitudes to blossom in a healthy integrated practice. A few practical tips for each mind-set may be enough to start the growth.
Willingness to be in partnership
It may seem obvious, but this is a critical first question to ask. There are those practitioners who prefer to ‘go it alone’. That is fine, and they should not attempt to be part of an integrated practice. There are also those practitioners who practice in an environment that is founded upon the long-standing pillars of the Western medical system – hierarchy, vested special interests, and scarcity. This atmosphere is not conducive to integration. Integration, within this classic medical setting, will suffocate or live a bruised and battered life. Thus, it is critical that the integrative healthcare practitioner address the environment within which integration shall take place in order to allow it to flourish. Some of the essential ingredients for a successful partnership must be mirrored in the external environment of that partnership. Let’s elaborate on these key ingredients.
Mutual regard, Respect and Trust
In a medical setting, the foundation for mutual regard, respect and trust is the belief that the actions of another will more than likely, and primarily, benefit the patient. One way to establish this trust is to agree upon a mutual filter through which every protocol is screened. Utilizing the same filter will create mutual trust in all applied protocols – regardless of whether the final filtered product is familiar or not. One filter that will quickly serve this function is the filter of evidence. Although it is estimated that only 50% of conventional practice is evidence-based and 30-50% of complementary and integrative practice is evidence-based, nonetheless, applying an evidence-based methodology to all protocols and clinical interventions (inclusive of conventional and integrative practice) will create reliable and trustworthy integrated practice. Below is a simplified table of an example of an evidence filter:
Stepping Outside Your Comfort Zone
A key to a lasting and productive relationship between all provider types is a universal willingness to experiment with philosophies and practices that are unfamiliar. While an allopathic doctor may be unfamiliar with the concept of ‘liver chi stagnation’ as an assessment of their hypertensive patient, it behooves them to not just pay passing attention to this, but rather to inquire further. The explanation will certainly bring them outside of their comfortable and familiar territory of medical diagnosis and into a new perspective. The more often this new perspective is explored, the more familiar it will become. Conversations across disciplines will become increasingly comfortable and enjoyable. In lieu of this exploratory practice, what starts as puzzlement will soon turn into benign neglect, which, in turn, morphs into disregard and suspicion.
Opening the door into your world
Too many times, integrative practitioners make the assumption that because they work collaboratively with other provider types, their own philosophy and practice is understood and accepted. This is analogous to the silent mate who, over the years, becomes increasingly unfamiliar and distant – irrespective of whether s/he has changed in any substantial regard over that time period. Active invitation into your own practice will balance your own active exploration of the practices of your partners. Any good provider is constantly refining his/her art and it is important to share these refinements with your colleagues. This open sharing will feed the practice partnership with the mutual thrill of discovery and learning.
The willingness to change
A common lament about failed relationship begins with the phrase, “S/he wouldn’t change…” While it is true that we cannot require or control someone else’s changes and growth, we can commit ourselves to the practice of change. This is critical for the success of an integrated practice partnership. Integration, by definition, introduces different, often dramatically so, philosophies and practices. These differing world views will collide if their practitioners hold them rigidly. On the other hand, these world views will blend if their practitioners are flexible and open-minded. The willingness to change, in the context of an integrative practice partnership, is the willingness to adopt new practices that are more effective, less expensive, less harmful, more efficient, etc. This openness to changing one’s practice will begin to transform an integrated practice into an integrative practice – where each practitioner endorses a blend of interventions – some of which are learned from one’s partners.
Letting your partner be right 50% of the time
Even when you think that your interpretation or strategy is the right one, the willingness to accept and endorse the alternate strategy of your integrative practice partner will go a long way towards creating a happy partnership. Of course, the patient’s safety may never be compromised in the course of letting go of being right. Every other situation, however, represents the opportunity to share the leadership of the moment. Every moment of shared leadership reinforces the collaborative cord of the partnership. Collaborative partnerships, above all other partnerships, offer creative, resilient and broad-minded approaches to any and all challenges. A collaborative partnership stands the best chance of surviving in the face of adversity, transforming challenges into opportunities.
A strong and effective integrated practice partnership rests upon the pillars of open, trusting, collaborative relationships. The tenets outlined above can become each practitioner’s individual practice and can be institutionalized within the practice. Creating time for integrated grand rounds, case presentations, and case discussions is essential. Formalizing clinical treatment exchanges and/or shadowing a patient as they undergo evaluation and treatment from other providers creates the opportunities to learn. Developing and codifying an open environment ,where everyone’s ideas are considered, is essential. And, finally, a lasting partnership requires that integrated providers learn how to play together, not just work together.
Additional articles by this author:
- Integrated Medicine: It’s All About the Patient
- Strategies for Integrating Your Practice – Naturopathic Medicine and Integrated Healthcare
|To see Lise Alschuler, ND, FABNO in person, attend Breast Cancer: An Evidence-based Review of Naturopathic Supplement and Herbal Strategies, Update on Women’s Health Plenary Panel and National Policy and Integrative Practice: Building the Road at the 2009 Integrative Healthcare Symposium. Integrative Practitioner members get 15% off Symposium registration when they enter discount code 7470.|