Integrative Medicine's Pragmatic Mission

David Rakel, MD


J Participat Med. 2013;5 

In This Article

Who Is in Control?

If our clinical focus strives to create optimum health, we must understand the importance of giving patients a stronger sense of control in medical decision making. Primary care becomes much stronger when there is a continuous healing relationship with a provider who has broad insight about both disease and health. This requires that we shift some of the control from providers to individuals, their families and their communities. When health care in South-Central Alaska was transferred from the Indian Health Services to the people it served, they were asked what they wanted most from their health care delivery system. Their reply was an ongoing healing relationship with a community of clinicians that knows them well. Someone who "listens to them, takes time to explain things and who is able to effectively coordinate their overall care."[28] This health system formed with the goal of shifting control to the patient and providing both traditional and CAM services. This resulted in a 40% reduction in urgent care and emergency department utilization, a 50% reduction in specialist utilization and a 30% reduction in hospital days. Customer satisfaction surveys showed that 91% rated their overall care as "favorable."[29] We could add substantial value to health care delivery by recognizing the healing potential of these nonspecific variables that arise from relationship-centered care.