Health Management as opposed to Illness Management

By Dr. Dany Lousky

Integrated medicine incorporates different treatment methods and approaches. The integration of scientific methods and holistic approaches and the integration among the different holistic approaches are undertaken with the goal of creating an integrative range of treatments that address the person as one whole entity. Integrated medicine addresses the physical dimension, through medications and operations and through holistic physical treatment methods such as acupuncture, massage, and motion; the emotional dimension through treatments such as integration of the arts, the intellectual dimension through treatments such as guided imagery, and the spiritual dimension through treatments such meditation. In actuality, most of the medical centers do not create this integration. When the medical centers go to choose the treatment ‘basket’, they tend to choose physical treatment methods such as massage, nutrition, homeopathy, reflexology, and movement. In many cases, they ignore the emotional, intellectual, and spiritual methods of treatment.
When I visited the Assaf HaRofeh medical center in Israel, I found the Department of Complementary Medicine Treatment to which patients from other departments are referred. An integrative relationship between scientific medicine and lousky medicine was not found and a structured integrated approach for the treatment techniques of complementary medicine was also not found. The Assaf HaRofeh medical center as a medical center adopted techniques of complementary medicine in a separate division. It charges full payment from the patients for the service, which makes it very difficult for the population at large to receive complementary medical service.
In my search for a medical center that combines between the approaches, I heard that the Global Hospital Medical Center is the most advanced in the world in the integrated approach. I traveled to the medical center, found in Mt. Abu, in South Rajasthan in India. I was there for a month as a guest of the medical center. I conducted lengthy conversations during my visits to all the departments of the medical center, I went to villages with medical staff to find patients and assess them. I was present in a number of operations, participated in many conventions and lectures, and I gave a number of lectures to the medical staff on the format of integrated medicine. Global Hospital has an entire floor of complementary treatment techniques and the services are provided free of charge. The work the medical center in Mt. Abu conducts is unique and apparently there is nothing similar in the world. In every floor on the medical center there are active meditation rooms, there are courses on correct nutrition, courses on life values, the provided food is nutrition, music is played, and throughout the medical center there are placards calling for a ‘look inside’. The integrated medicine of Mt. Abu has no structured rationale or orderly format for integrated medicine. Here too the budgets are the factor that determines what the treatment is. The collection of techniques here is link to the ability to recruit therapists and equipment, regardless of the work format or rationale. Another difficulty lies in the fact that the patients do not know which techniques to use and in the operating room there is no holistic therapist who can propose integrative service. Here too there still is reference to the illness as opposed to the patient.
The problem of the lack of integration is not exclusive to the medical centers. Holistic health also defines itself and acts according to a pattern that combines four dimensions of treatment of the whole. It provides only partial and not a complete solution for the integration between the different methods and approaches. The holistic therapist notes and lists the treatment methods that he addresses. He declares, “I use Shiatsu, reflexology, and nutrition”. Another therapist states, “I use healing and medicinal plants”. The holistic therapist does not learn or choose his methods of treatment out of the need to create integration between the four dimensions. He trains himself according to his inclinations or according to supply and demand in the market of lousky medicine. In spite of the holistic therapists’ declared desire to treat the whole person (four dimensions) in actuality, there is no integrative implementation that addresses the four dimensions and accordingly the patient is not accorded holistic treatment.
Contact therapies do not address the intellectual or spiritual dimension and meditation does not provide a solution to problems of nutrition or movement. A person skilled in meditation can possibly achieve such a level of meditation that also resolves his issues of movement and nutrition; but this is only possible – perhaps – after years of training that are not necessarily at the disposal of every patient. This main issue – of the importance of providing a precise and integrative range of treatments – can be concretized in the following example. It is similar to a person who has broken his leg (physical dimension) and after consultation the therapists reach the conclusion that the fracture was caused as a result of a difficult dyadic system of relations that induces the patient’s lack of attention and this contributed to his lack of awareness, to his stumbling, and to the leg fracture. Then the therapists decide to first treat the dyadic system of relations (emotional dimension) before they put the broken leg into a cast. This is not correct – and similarly, it is not correct to treat through nutrition (physical dimension) the situation of the loss of a workplace or the loss of a loved one (emotional dimension). The division to dimensions was intended to address the damaged dimension directly and immediately through the treatment method that is suited to the harmed dimension.
In the holistic approach, there is a transition between the different dimensions, so that every treatment of one dimension influences and treats the other dimensions (over time). However, the therapist needs to address the hurting dimension (the result) directly and immediately and only in the next stage, or in parallel, to address the seed (the cause) of the mishap, which originates in other dimensions. In this way, the patient receives holistic treatment. Thus, every complementary treatment method in actuality provides an immediate and direct solution only to part of the whole and does not treat the person according to its declaration. Hence, there is considerable importance in the definition of a range of treatments that include different treatment method according to the different dimensions of integrated medicine.
Holism is not only every approach in itself but also the integration among the approaches, which are shaped according to the patient’s needs. The holistic emphasis is systemic and not only in approach or in the atmosphere. Holistic health means that the patient is at the center – it is management of the patient’s health instead of management of his illness.