Patients' Wishes Matter at Harborview
Hospital Alternative Care Task Force Results
By Merrily Manthey, M.S.
A special task force on alternative health care at Harborview Hospital and Medical Center concluded "…it may be of greater importance to attend to whether our patients frequently desire that alternative approaches be made available .… it might be important to respect the patients' particular paradigm of illness. Although alternative interventions may not necessarily be endorsed by physicians, efforts to determine what interventions patients have attempted to try or are interested in trying is something that we recommend health care workers integrate more into their standard care."
After a request by the governing Board of Trustees, a task force of seven medical doctors and one Ph.D. psychologist began reviewing major modalities of alternative and complementary health care practices. Meetings were held from October 1995 through July 1996 during which time the task force familiarized itself with alternative medicine using a variety of sources. The National Institutes of Health report entitled "Alternative Medicine: Expanding Medical Horizons" (also known as the Chantilly report) was reviewed in its entirety. Selected sections of the syllabus from the Harvard Medical School Post-Graduate Course on Alternative Medicine were supplied to committee members.
Surveys were sent to all medical staff at Harborview, a patient survey was conducted, and employees were asked for input regarding the role of alternative medicine. In addition, the task force was asked to review which components of alternative medicine and health care have "demonstrable scientific evidence of efficacy at a level to warrant inclusion in specific patient care plans for discussion with patients."
The task force also examined a category of medical interventions that were at one time considered alternative but currently would best be regard as "mainstream allopathic medicine. Examples of such interventions might include lifestyle and diet changes for patients with hypertension and coronary heart disease. Another element is so evaluate how lifestyle and diet is contributing to the patient’s maladies. The tenant of naturopathy that advises practitioners to minimize caustic effects of treatments is also one which can be easily embodied by allopathic practitioners. It is conceivable that Harborview physicians can be advised to consider some of the beneficial tenants of alternative medicine and to integrate them into their practices when possible."
Treating the patient as a "whole person" was mentioned in the task force report as an important "non-specific effects of various treatment approaches which may be contributing to patient improvement." The report referred to the fact that alternative health care practitioners spend more time with their patients than do allopathic physicians.
The review indicated a number of alternative practices (as defined by the Chantilly report) are already available and in use at Harborview Medical Center. The groupings included mind-body interactions; alternative systems of practice; manual healing; diet and nutrition; bioelectromagnetics. These include hypnosis, relaxation training, art and music therapy, imagery, support groups, and prayer; acupuncture; massage therapy; nutritional counseling and trials of high dose Vitamin C (burn unit); and transcutaneous electrical nerve stimulation for pain.
Additions to the existing alternative practices were made for specific treatments and indications. For example, it was recommended that acupuncture be available for post-operative or cancer pain, when used as part of a total pain management program; and vitamin supplementation with moderate doses of Vitamin C and or Vitamin E for trauma and/or burn patients. Six other recommendations included other indications for acupuncture; the use of osteopathic or chiropractic manipulation; nutritional counselling, group education in lifestyle changes, and massage.
Physicians responding to the task force survey checked the "Should be made available" box for acupuncture, massage, relaxation techniques, biofeedback, hypnotherapy, diet/nutrition/lifestyle, yoga/meditation, and chiropractic.
More than half of Harborview patients indicated their use of alternative treatments.
The report concluded by establishing a recommended criteria for adding other therapies. The criteria included (1) there exists scientific evidence for efficacy, (2) the treatment is unlikely to be harmful, (3) the treatment can be incorporated into standard care plans, and (4) likelihood of significant patient demand.
To obtain a copy of the report, call or write Harborview Administration, telephone 206 731-3036, fax 206 731 8551, address: David Jaffe, CEO, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104
Harborview is owned by the Citizens of King County and serves as the only Level I Trauma Center in a four-state region. Harborview also operates over 50 outpatient clinics on or near the main campus, as well as numerous primary care clinics in outlying communities. The author of this summary is a member of the Board of Trustees appointed by the King County Executive and confirmed by the King County Council.