For some patients, consulting non-MD providers may be a better option after PCPs fail to listen or address concerns or say nothing is wrong. Understand complementary healthcare services in your area to benefit your patients.
The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.
I hope you never doubt your doctor. I hope you never have a health problem that you can’t find a treatment to cure. I hope you never have to figure it out on your own after your doctor tells you he does not know how to help you or your child.
But if you do, I am writing this blog for you.
I frequently have patients report they are dissatisfied with their primary care provider’s care. They may think their PCPs fail to listen and address their concerns adequately, or they report their PCPs tell them nothing is wrong.
Sometimes I find nothing wrong. Sometimes I find pathology. It is not rare that I contact their PCPs reporting retinal hemorrhages or optic nerve edema or anything ending in -itis, only to be ignored by said PCP.
Previously from Dr. Schroeder-Swartz: Cosmetic dangers: Part 3-Keep patients informed, report cosmetic problems
I used to think it was because I was young and inexperienced. I became old(er) and experienced, then I thought it was because I was an optometrist (not a “real doctor”).
Then I had case after case of doctors not knowing what was wrong and not doing much about it.
I give them the benefit of the doubt, and I started referring around them. I also have learned that MDs are not the only option. For some patients, non-MD practitioners may hold the golden ticket to their health.
I am referring to “complementary and alternative medicine” (CAM) providers.
While these terms are often used interchangeably, they are not the same. The National Center for Complementary and Integrative Health (NCCIH) describes them as follows. If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.” If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.” These providers are more often complementary with Western medicine, but in my experience, MDs are not complementary in return.
The National Center for Complementary and Integrative Health (NCCIH) classifies different approaches into in these groups:1
• Natural products: dietary supplements and herbal remedies.
• Mind and body practices: meditation, prayer, relaxation and art therapies, as well as chiropractic and osteopathic manipulation, and massage. Human touch used to move or manipulate a specific part of your body is a common theme.
• Other complementary health approaches, such as Ayurvedic medicine, traditional Chinese medicine, homeopathy, and naturopathy.
Doctors, health food stores, and vitamin shops have been promoting and selling natural supplements for years. No legal or regulatory definition exists in the United States for standardization as it applies to dietary supplements,2 so caution should be used when making recommendations.
I am fortunate to have several compounding pharmacies in my area that offer seminars and private consultations for supplementation. In my experience, patients with autoimmune disease, thyroid problems, hormone imbalances, chronic fatigue, and diabetes are more open to seek a compounding pharmacist’s expertise.
These pharmacists are excellent resources for recommendations for probiotics to address inflammation, immunity, and GI distress, as well as education regarding prebiotic foods, omega-3 fatty acids, digestive enzymes and other nutrients. Some practitioners offer saliva testing for cortisol, estrogen and testosterone levels and make recommendations on results.
Mind and body practices
What follows is a summary of methods to help you should a patient report using an alternative method.
Chiropractors focus on the spine and how it relates to overall body function. Spinal manipulation appears to benefit those suffering from low-back pain, headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders.3
Osteopathic physicians see a patient as a person (rather than a specialized body area) and utilize a holistic approach to care. They are taught to use hands-on diagnosis and treatment through osteopathic manipulative medicine in addition to modern medical techniques.4 Unlike many MDs, DOs tend to think out of the box and be more open to alternative methods.
Feldenkrais therapy uses strategies to improve posture, flexibility, coordination, athletic and artistic ability, and to improve restricted movement, chronic pain and tension, as well as neurological, developmental, and psychological problems.5
Alexander techniques help you to identify and correct harmful habits from a lifetime of stress and learn to move more freely with the goal of being more comfortable in your own body. It may be beneficial for those with repetitive strain injury or carpal tunnel syndrome, back pain or stiff neck and shoulders, or performers or athletes who want to “reach their full potential.”6
Pilates and yoga are reflective relaxation techniques used to reduce stress and use the body weight to strengthen core muscles and promote wellness.
Rolfing Structural Integration involves aligning the body’s parts to create a smoothly functioning system by addressing the internal fascia. If the fascia is misaligned, re-establishment of balance by targeting the intra-fascial mechanoreceptors should trigger the nervous system to reduce tension of the related muscles and connective tissue.7
Ayurvedic medicine, as practiced in India, is one of the oldest systems of medicine.
Three ancient books known as the Great Trilogy were written in Sanskrit more than 2,000 years ago and are considered the main texts on Ayurvedic medicine-Caraka Samhita, Sushruta Samhita, and Astanga Hridaya.8
Key concepts of Ayurvedic medicine include connections among people, their health, and the universe; the body’s constitution, and life forces. Ayurvedic physicians prescribe individualized treatments based upon these concepts, including compounds of herbs or proprietary ingredients, diet, exercise, and lifestyle recommendations.
Other approaches include management of an invisible energy force that flows through your body. When this energy flow is blocked, broken, or unbalanced, the body may become sick. This energy force may be referred to as chi, prana, or life force. The goal of these therapies is to unblock or re-balance your energy force. Energy therapies include qigong, reiki, and healing touch.
Qigong is a system of coordinated body posture and movement, breathing techniques, and medication to promote health and spirituality.
Reiki is a Japanese technique for stress reduction, relaxation, and healing.9 Reiki means “spiritually guided life force energy.”
Unlike the yoga-like methods, healing touch is an energy therapy in which practitioners consciously use their hands “in a heart-centered and intentional way.” Physical and emotional stress reduces the energy, resulting in fatigue and a weakened immune system. Using massage, pressure is applied to manipulate muscles and restore balance via relaxation.10
Another alternative medicine is Total Body Modification. This method locates a body part that is stressed and corrects the problem to restore balance to the nervous system. Practitioners believe that under stress, neurons in the brain depolarize like a broken fuse, and the body part loses its connection with the brain.
Problems are identified using reflex points and muscle testing. Subsequently, areas of the body are stimulated to reconnect the “broken body part” to the brain to promote healing. They reportedly “reset the body’s computer.”
Interestingly, to be trained in this technique, you must already be a career health practitioner.11
Most of these methods focus on relaxation and overall wellness. While these can’t hurt anyone physically, they may be expensive. Most massage or exercise-based techniques are not covered by insurance, with chiropractor and osteopathic visits an exception.
For those patients looking for answers, spending time and money to consult non-MD practitioners may prove beneficial. Take the time to investigate compounding pharmacy and complementary healthcare services in your area to benefit your patients.
1. Mayo Clinic. Available at: https://www.mayoclinic.org/tests-procedures/complementary-alternative-medicine/about/pac-20393581. Accessed 6/20/18.
2. National Institutes of Health. Available at: https://ods.od.nih.gov/factsheets/DietarySupplements-HealthProfessional/. Accessed 10/30/17.
3. National Center for Complementary and Integrative Health. Available at: https://nccih.nih.gov/health/chiropractic/introduction.htm. Accessed 10/30/17.
4. American Association of Colleges of Osteopathic Medicine. Available at: http://www.aacom.org/become-a-doctor/about-om#infographic. Accessed 10/30/17.
5. The Feldendrais Institute. Available at: http://www.feldenkraisinstitute.com/about_feldenkrais/overview/?lid=nav_aboutfeld. Accessed 10/30/17.
6. Alexander Technique. Available at: https://www.alexandertechnique.com/at.htm. Accessed 10/30/17.
7. Rolf Institute of Structural Integration. Available at: https://www.rolf.org/. Accessed 10/30/17.
8. National Center for Complementary and Integrative Health. Available at: https://nccih.nih.gov/health/ayurveda/introduction.htm. Accessed 10/30/17.
9. Reiki.org. Available at: http://www.reiki.org/FAQ/WhatIsReiki.html. Accessed 10/30/17.
10. Healing Touch Program. Available at: https://healingtouchprogram.com/. Accessed 10/30/17.
11. Total Body Modification, Inc. Available at: https://www.tbmseminars.com/about_us. Accessed on 10/30/17.