Integrative Medicine's Pragmatic Mission

David Rakel, MD


J Participat Med. 2013;5 

In This Article

The Case

Ed is a 54-year-old construction worker who has had an exacerbation of his low back pain that has not responded well to physical therapy or to anti-inflammatory or pain medications. He has an interest in trying acupuncture since one of his buddies had a positive response.

Clinician A

Ed goes to a clinician whom he has never met. Due to limited time, the clinician quickly focuses on his pain and wants to try adding an antidepressant. He also refers him for an epidural steroid injection. When Ed says, "I was thinking about trying acupuncture," the clinician quickly states, "There is little evidence CAM therapies provide any benefit and I wouldn't waste your money."

Clinician B

Ed goes to see his primary care clinician whom he has known for years. They exchange stories about their kids after which the focus transitions to Ed's back pain. When the acupuncture idea arises, his clinician reports, "I have seen a few promising studies. I think it is worthwhile and the risk is very low." She then recommends an acupuncturist who has helped a couple of her other patients. Ed feels empowered that someone he trusts agrees with what he is interested in trying. He leaves hopeful.