Arizona Physician Fall 2023

FALL 2023

A P U B L I C AT I O N O F T H E M A R I C O PA C O U N T Y M E D I C A L S O C I E T Y

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Physicians across Arizona share their views on integrative medicine

Andrew Weil, MD, pioneer of integrative medicine, talks about how far the field has come

Medical Maverick

READY READY TO TO REJUVENATE REJUVENATE

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I did I did not not like like the the way way I was I was practicing practicing medicine—very medicine—very reflexively. reflexively.

I looked I looked forfor aa better better way way toto serve serve people people and and found found this this Fellowship.

Fellowship. it restored it restored mymy love love forfor clinical clinical medicine, medicine, and and I think I think this this is is the the best best way way toto practice practice medicine medicine and and take take care care ofof our our own own health health and and wellness. wellness.

Malathi Malathi Acharya, Acharya, MD MD Class Class ofof 2022 2022 Fall Fall

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Honestly, Honestly, I was I was broken, broken, and and Western Western Medicine Medicine couldn’t couldn’t fixfix me. me.

I was I was desperate desperate and and also also curious. curious.

ToTo say say that that the the Fellowship Fellowship was was life-changing life-changing is is anan understatement. understatement.

I am I am forever forever gratefu gratefu l. l.

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Gina Gina Serraiocco, Serraiocco, MD MD l l Class Class ofof 2018 2018 FalFal

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People People speak speak ofof aa holistic holistic approach, approach, but but most most have have nono training training oror dodo not not know know what what this this means. means.

The The Fellowship Fellowship gives gives you you direct direct experience experience toto achieve achieve this this goal goal in in your your practice practice and and your your personal personal lifestyle. lifestyle.

The The Fellowship Fellowship allowed allowed me me toto walk walk the the talk. talk.

““

Adalberto Adalberto Renteria, Renteria, MD MD Class Class ofof 2008 2008

Explore Explorethe theAndrew AndrewWeil WeilCenter Centerfor forIntegrative IntegrativeMedicine.

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CONTENTS VOLUME 5 • ISSUE 3

IN EVERY ISSUE 4 | From the MCMS Board 6

| From the Editor-in-Chief

7

| MCMS Partner Program

Edward Araujo

8

| Briefs

Creative Design

18 | What Arizona Docs are Saying

Editor-In-Chief John McElligott, MPH, CPH

Managing Editor

10

26 | Legal Corner

Cover & Featured Articles Photography

Tackling the Diseases of Our Time

28 | How To

Shad Marvasti, MD, MPH,

Ben Scolaro, scolarodesign.com

30 | Physician Spotlight

discusses integrative

Randi Karabin, KarabinCreative.com

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medicine.

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22

Maricopa County Medical Society Board Members

In Depth: HonorHealth Integrative Medicine Clinic

President Zaid Fadul, MD, FS, FAAFP

President-Elect Jane Lyons, MD

Treasurer Vishal Verma, MD, MBA

Secretary Ann Cheri Foxx-Leach, MD, D.ABA

Physicians share how

Past President

the integrative approach

Ricardo Correa, MD, EdD, FACP, FACE

Directors Kishlay Anand, MD, MS Jay Arora, MD, MBA Rahul S. Rishi, DO, FAAAAI, FACAAI Karyne Vinales, MD

Resident & Fellow Director

14 C O V E R S T O R Y

Andrew Weil, MD, founder of the integrative medicine movement, shares where the field is today and where it’s heading.

to medicine is helping their patients.

Deepika Razia, MD

Medical Student Director Sarah Carpinelli, OMS-IV

Digital & Social Media arizonaphysician.com ArizonaPhysician @AZPhysician @AZ_Physician

A R I ZO N A P H Y S I C I A N . C O M

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FROM THE MCMS BOARD

My Thoughts on Integrative Medicine

L

ast summer, I was enjoying a Mediterranean cruise when I was surprised by a very familiar face splashed on brochures announcing the wellness services available to passengers. The brochures touted the cruise’s Mindful Living Program created in collaboration with Dr. Andrew Weil, the very recognizable Arizona physician known as a trailblazer in the field of integrative medicine. My curiosity led me to take advantage of some of the program’s offerings. I participated in a yoga class at sunrise that successfully brought harmony to my mind and body for a great start to the day. This fond memory reminds me of the benefits of integrative approaches to medicine.

According to the National Center for Complementary and Integrative Health created by the National Institutes of Health, integrative health aims to coordinate conventional healthcare with complementary approaches to treat the whole patient rather than a disease or single organ system. Afterall, a patient’s medical condition does not exist in the vacuum of a single organ system. Nor does a patient’s body house only their physiologic and pathophysiologic reality. Integrative medicine is a method to address the physical, emotional, and spiritual concerns related to the patient’s condition and can provide profound and sustained wellness.

As a pain specialist, I have been a proponent of integrative approaches to the treatment of pain as an alternative to prescribing opioids. I encourage my patients to use the window of opportunity afforded them by conventional medical treatments to bring into focus lifestyle changes that will become the foundation for long-term health and pain relief. For example, I often provide radiofrequency ablations for the long-term relief of spinal arthritis pain. Most patients will have excellent pain relief for up to a year before needing a repeat procedure.

During that year of pain relief, I encourage 4

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my patients to address their nutrition, exercise regularly (often starting with physical therapy), practice stress reduction (such as deep breathing, yoga, meditation, prayer), and consider treatment alternatives (such as spinal manipulation, acupuncture, massage). I have found the most success in those patients who curate an arsenal of complementary techniques to buttress against exacerbations of pain rather than relying on pharmaceuticals.

Although I recommend many complementary therapies to my patients, the needs and preferences for each patient are unique. Therefore, the patient is often the arbiter of which complementary techniques they will continue and which they will not. I encourage every physician to consider which integrative practices could benefit their patients to support an active role in their own recoveries and ongoing wellness.

There is growing demand for integrative medicine and greater consumerism in the healthcare market. So, whether traditional physicians accept it or not, integrative medicine is here to stay. It is my opinion that physicians should take an active, if not leading, role in educating patients about complementary approaches that will augment the medical care being provided. Finally, integrative techniques empower patients to take an active role in their own recoveries and sustaining their wellness. This empowerment is the best medicine of all.

Ann Cheri Foxx, MD, D.ABA MCMS Board Secretary Dr. Ann Cheri Foxx is President/Owner of Nocio Pain Management, Anesthesiology and Consultancy. She graduated from the South Carolina School of Medicine in Charleston, where she also completed an internship in general surgery before pursuing a residency in anesthesiology at the University of Pennsylvania in Philadelphia. After years of practicing as an anesthesiologist in the peri-operative setting, Dr. Foxx went on to complete a fellowship in interventional pain management with a strong concentration in multidisciplinary approaches at Emory University in Atlanta, Georgia.

Interested in getting involved with MCMS? Reach me at mcms@mcmsonline.com

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FROM THE EDITOR-IN-CHIEF

N AT U R E I T S E L F I S T H E B E S T P H Y S I C I A N .”

—Hippocrates

F

or ages, we have known that being in nature is good for the mind, body, and soul. More recently, researchers have gathered evidence to link hiking and other outdoor activities to reduced depression, lowered blood pressure, improved immune function, and improved mood.

Regardless of causality or the strength of the connection, patients are demanding a more holistic view of their overall health. Mental health care is more mainstream.

More medical practices offer genetic testing and analysis.

Smartphone applications provide everything from medication to exercise routines to customized dietary plans.

Somewhere in the middle are physicians focused on helping patients to navigate traditional approaches to care with social, behavioral, and lifestyle determinants of health.

DR . A N DR E W W E I L The trailblazer of integrative medicine met with Edward Araujo, managing editor, at his home in Tucson. They discuss his original concept of integrative medicine, where it is today, and where Dr. Weil predicts the future will lead us. Dr. Weil discusses his vision of bringing together different approaches to caring for patients. Dr. Weil hopes, “we will shed the term integrative medicine, just calling it good medicine and fully incorporating it into the other forms of medicine.”

I N T E G R AT I V E M E DIC I N E We go in depth with the HonorHealth Integrative Medicine clinic. Drs. Melinda Atienza and Shalini Singh-Karnik, together with dietitian Denise Coventry, share how their approach is delivering results for patients and convincing more physicians to refer patients. Dr. Atienza says, “Almost anyone can benefit from an integrative medicine consultation because we focus on prevention by empowering our patients with evidence-based approaches to staying healthy and maintaining wellness throughout their lives.”

Shad Marvasti, MD, MPH, answers how integrative medicine can make headway for the chronic diseases of our time. He goes on to highlight the value of longer sessions with a physician, saying, “The average visit with a doctor is around 7 or 8 minutes. It’s like opening the floodgates and suddenly feeling relief to be able to share

your story and to be heard. A big piece of feedback I get is the initial visit is therapeutic.”

In our section What Arizona Docs Are Saying, 85% of respondents say that patient demand for alternative treatments has increased. One physician wrote, “In my opinion, traditional medicine is too focused on prescribing pharmaceuticals and not in finding the root causes of disease and approaching treatment from that direction.” Most respondents see integrative medicine as very valuable to the profession.

VA LUA BL E A R T IC L E S In Legal Corner, Molly Adrian, JD, Legal Risk Management Consultant at MICA, cautions physicians against “clearing” patients for surgery. Words matter, especially to a jury deciding a professional liability case.

She writes that MICA’s Risk Team fields calls from physicians who are asked to check a box and feel pressured to avoid any delays to a surgical procedure.

Amber Ratcliffe, Content Specialist at MedTrainer, details why your organization should avoid using YouTube for compliance training courses. She writes, “While YouTube has become a go-to resource for tutorials, entertainment, and educational content — all of which are indeed free — finding healthcare compliance training you can trust is a whole other ballgame.”

Check out the comments from Heidi Rula, MD, Integrative Oncology and Medical Director of the Supportive Care Services Department, Ironwood Cancer & Research Centers. She shares, “We bring in other tools to help patients navigate some of the challenges of their conventional cancer treatment. These tools allow them to take a more active role post diagnosis.”

Not an MCMS member? Visit mcmsonline.com/join or call us at (602) 252-2015.

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BRIEFS

NEWS AND NOTES FROM THE FIELD

7 Effective Strategies to Prevent Physician Burnout

EFFECTIVE TIME MANAGEMENT | Being efficient with your time can prevent feelings of being overwhelmed. Prioritizing tasks, delegating when necessary, setting realistic goals, and establishing a routine can help physicians manage their workload and help reduce stress and burnout.

Physicians play a vital role in society by caring for the sick, alleviating pain, and saving lives. However, the demanding nature of their profession can lead to a serious concern — burnout. Physician burnout can lead to long-term stress reactions which can include the following: emotional exhaustion, depersonalization, and the feeling of decreased personal achievement.

Here are 7 effective strategies to alleviate the endless stress that physicians endure.

SELF-CARE & WELL-BEING | Physicians should cultivate healthy habits like regular exercise, balanced nutrition, and adequate sleep. Spending time with loved ones, taking short breaks, and engaging in hobbies can contribute to overall well-being.

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PEER SUPPORT & COMMUNICATION | Having a supportive network among colleagues can bring a sense of community and reduce feelings of isolation.

Sharing experiences, concerns, advice, and having open communication with supervisors can lead to the implementation of supportive policies.

CONTINUING EDUCATION & SKILL DEVELOPMENT | Physicians should seek opportunities for professional growth, attend conferences, and engage in activities to stay motivated and enthusiastic about their careers.

Staying challenged can help prevent burnout.

WORK-LIFE BALANCE | Balancing work and personal life is essential. Set boundaries and schedule dedicated time for family, friends, and leisure activities can prevent blurring professional and personal time which can lead to burnout.

POSITIVE WORK ENVIRONMENT | Nurturing a positive work environment is crucial in preventing burnout. Healthcare organizations should prioritize physician well-being by offering resources like counseling services, workshops, and mentorship programs to support their mental and emotional help.

MINDFULNESS & STRESS REDUCTION | Meditation and deep breathing can help physicians manage stress and reduce the risk of burnout. This will help promote self-awareness and provide tools to handle challenging situations with a clear mind.

By implementing these strategies, physicians can mitigate the risk of burnout. In turn, this will ensure physicians remain healthy, engaged, and equipped to provide the best possible care to their patients.

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Tackling the Diseases of Our Time

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A Discussion with Dr. Shad Marvasti

e sat down with Shad Marvasti, MD, MPH, Director of Integrative Medicine at HonorHealth and

Associate Professor, University of Arizona College of Medicine Phoenix. Dr. Marvasti is also Founding Director of the Wellness, Integrative Medicine, and Nutrition Certificate of Distinction and the Culinary Medicine program at UACOMP. Dr. Marvasti brings a unique perspective to understanding the integrative approach to medicine. He draws on both his experiences in private practice and at the hospital setting.

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“We try to do more of a whole person, mind/body/ spirit approach in terms of getting a deeper history.”

ARIZONA PHYSICIAN: How would you describe

integrative medicine?

DR. MARVASTI: It's a whole person approach to health that includes all aspects of lifestyle and emphasizes the therapeutic relationship between the doctor and the patient. It’s evidence-based and uses all appropriate therapies that are safe and effective both on the conventional side as well as the complementary side.

So really, it's kind of the best of both worlds. Let's say you present with diabetes. I'm not only going to look at potential medications or medical tests. I'm also going to look at food prescriptions, exercise prescriptions, other lifestyle changes that you can do. We’ll examine your whole life as part of the care, which includes the social, behavioral, and lifestyle determinants of health. Integrative medicine is the place where you can really achieve wellness and get the tools that you need.

AP: Are patients or other physicians

AP: There is a lot that may go into visits with the

patient to get to root causes of illness. What are the range of services that your team offers?

DR. MARVASTI: An integrative medicine doctor will spend about one hour with you for that initial intake, and we have patients fill out a longer, more involved history. We ask about what's most meaningful and purposeful in your life. We ask details about your diet, sources of stress, how well and how much do you sleep, what your goals are in terms of your health. We try to do more of a whole person, mind body spirit approach in terms of getting a deeper history and then we review that with you and come up with a plan in terms of next steps. Then, we have 30-minute consultations as follow up with the physician. We also have a registered dietitian, a health coach, a massage therapist, an acupuncturist that also includes traditional Chinese medicine recommendations. These modalities blend to empower the patient with tools to make behavioral changes that are impactful. A primary care physician or a specialty physician may want you to do some lifestyle changes, but they don't have the time to go deeper. We have the bandwidth.

We have the interdisciplinary team to help patients with very practical next steps in terms of eating, exercise, mindset, improving sleep, and managing stress.

demanding this approach?

DR. MARVASTI: Many hospital health systems are now recognizing the role of employee wellness to prevent burnout and to improve healthcare worker well-being. Integrative medicine really connected well with that. They also did focus groups in the community where they found that there's a number of people asking for these types of services but not able to get it at their doctor's office. Patients are also not able to use some of their insurance for this care.

Having that accessibility, having that integrated into the healthcare system, came from a lot of different angles that aligned with HonorHealth and requests from patients and doctors.

Read more about our discussion on integrative medicine with Dr. Marvasti by visiting arizonaphysician.com/tackling-diseases

AP: Do patients want the longer sessions with

physicians and an interdisciplinary approach or do they want to rush through appointments?

Dr. Marvasti: The average visit with a doctor is around 7 or 8 minutes. It's like opening the floodgates and suddenly feeling relief to be able to share your story and to be heard. A big piece of feedback I get is the initial visit is therapeutic. Because you have a doctor who is willing to listen and talk to you about all these other aspects of your health that you know may not have been able to ever be examined because there was no time.

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AP: At what point do patients turn to

integrative medicine?

DR. MARVASTI: We see a wide range from young adults and late teens to elderly in their 70s and 80s. It could be a variety of things. It could be some with a chronic condition like diabetes or heart disease. Someone with chronic pain, someone with digestive issues or allergies, or questions about optimizing their health. Maybe they are an athletic type, but they want to take things to the next level.

AP: What are some of the strengths of

integrative medicine versus the more traditional approaches to medicine?

DR. MARVASTI: When you look at the diseases of our time, they account for seven out of every 10 deaths and 77% or more of all healthcare expenditures. These are conditions that don't happen quickly. A heart attack is the result of decades of chronic inflammation and narrowing of the arteries. There are many points where you can intervene through diet and lifestyle to prevent that from happening. A lot of what we do in conventional medicine, unfortunately, is very limited to either medication or some kind of procedure or surgery. And that's often when the disease has progressed to the point where you need more aggressive measures, and they don't come without side effects. When you can avoid those things or minimize those things or you can begin making effective lifestyle changes by using the science of behavior change, then we do a fair amount of deprescribing of medications. I think you reduce the burden of those approaches, and it can be much more cost effective when people start taking a proactive role in their health as opposed to waiting until disease sets in.

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AP: Are there one or two areas in which

you believe that integrative medicine needs to improve?

DR. MARVASTI: We need to improve the availability of integrative medicine within hospital health systems. I really feel like they have a central place to be able to address chronic diseases, as well as some of the medical mysteries and more complex conditions like chronic fatigue syndrome or irritable bowel syndrome. We want to be about health promotion and prevention and then really look at maximizing our lifestyle approaches as opposed to that being the last thing that we do. The other challenge is being able to get reimbursement by health insurance.

AP: Describe billing and how insurance

carriers respond.

DR. MARVASTI: You can either bill for time or you can bill for the complexity of a visit. I think we go back and forth in some instances. Billing for time makes a lot of sense, but then there's other cases where the medical complexity of the case fits better. We can get reimbursed for that extra time spent counseling and reviewing medications or charts. I think ours is really a hybrid model. Some services like acupuncture and dietitian and massage may not be covered.

We are working to use reduced rates compared to what's out there in the community or package services to make them more accessible.

AP: Are there innovative approaches you’re trying?

DR. MARVASTI: The cool thing about our approach is that we're trying to cater to all backgrounds, whether you're someone who's highly affluent and wants to optimize health or you’re someone who is food insecure. The other innovation is we do shared group visits. Food is Medicine is one group visit that we do mostly with AHCCCS patients who are food insecure. We partner with Desert Mission Food Bank to bring in fresh produce. We're also looking at innovations in resident education, as well as medical students. We’re going to pioneer group visits for diabetes with clinical pharmacy and our registered dietitian.

AP: There was a recent New York Times article that focused

on moral injury for physicians. Physicians want to see better outcomes for patients and have a more active role in shaping care. Do you see that integrative medicine is helping to close that gap?

DR. MARVASTI: Absolutely. We focus more on helping to empower the patient and teaming up with them to make these lifestyle changes and not just churning and burning through giving a medication and then moving on to the next. You feel more satisfied because you're making a meaningful connection with the patient.

You're seeing them make strides in their life. You get away from the pessimism of seeing a patient and predicting the repeat visitors because nothing's changing. It's better to do a deeper dive with motivational interviewing and see why they wanted to do this, like they wanted to be around for their grandchildren's graduation, and they found whatever was purposeful and meaningful in life and motivated them to change.

And then they come back with gratitude. That's a positive experience as a physician.

AP: Are you seeing the patients listening, adopting, and

making the changes?

DR. MARVASTI: For the most part, we do see that.

Obviously, trying to make changes is not easy. You gotta do the work when it comes to diet and lifestyle. Because people are coming to us for a consultation, they're motivated to listen and try to make those changes as opposed to when I was doing primary care, it would be a little bit of a mixed bag.

“It can be much more cost effective when people start taking a proactive role in their health as opposed to waiting until disease sets in.”

AP: What do you hear from other docs around the valley

about integrative medicine?

DR. MARVASTI: There's a range. Some are excited and want to know more. Others question what it is and believe medicine should just be medication or surgery.

We should work as part of an interprofessional team and there’s no question the physician is the quarterback. Patients respond to physicians. I use this analogy for my medical students. Regardless of the smoking cessation intervention, adding just one physician who says to the patient, “The best thing you can do for your health is to quit smoking and I highly recommend you quit smoking,” makes the intervention much more effective. To me, it shows the power of the physician to make an impact. I tell patients, “What you eat matters.

How you sleep matters. The relationships in your life matter. How you manage stress matters and let me tell you how to manage it.” ■

Meet Dr. Shad

Farshad Fani Marvasti, MD, graduated from the University of Arizona College of Medicine, Tucson, and completed the Stanford-O'Connor Family Medicine Residency at O'Connor Hospital in San Jose, CA. He has been practicing since 2010, first in private practice and now with HonorHealth and teaching students at the University of Arizona College of Medicine — Phoenix. You can reach him at doctorshad.com.

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Medical Maverick Andrew Weil, MD

After 50 years, Dr. Andrew Weil sees progress in the medical specialty he created.

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or a man who has been featured on national talk shows, written several books, and sports a beard as famous as ZZ Top, you may be surprised by how lowkey Dr. Andrew Weil behaves at home.

He quietly tends to his garden and herds two Rhodesian ridgebacks in and out of his Tucson sanctuary. Behind this gentle demeanor is a trailblazer who molded integrative medicine for over 50 years.

Today, integrative medicine practitioners focus on healing a patient’s mind, body, and spirit. That includes therapies such as meditation to round out the approach to well-being. Andrew Weil, MD, has dedicated his career to pushing the profession to support this approach to medicine. His journey seems validated, since both allopathic and osteopathic medicine incorporate aspects of integrative medicine and patients are demanding a more holistic approach to healing and staying healthy.

THROUGH THE EYES OF A NON-CONFORMIST After high school, young Andrew Weil received a scholarship from the American Association for the United Nations to live with families in India, Thailand, and Greece. While abroad, he gained an appreciation for the healing practices used by other cultures. More importantly, he understood how disconnected American medicine and science in the United States were from anything outside our borders.

Weil would go on to graduate from Harvard College with a degree in biology and stayed in Crimson to earn his medical degree in 1968. Dr. Weil completed an internship at Mount Zion Hospital in San Francisco and working for a year at the National Institute of Mental Health.

Disillusioned with the state of medicine, Dr. Weill decided to travel and write for a few years in the 1970s. Freelance work allowed him to earn a living and hone his communication skills. Travelling opened his mind to new ideas.

Dr. Weil says he wasn’t concerned about being accepted by his peers. He felt free to formulate his own concepts of a different approach to medicine.

This maverick spawned a burgeoning movement that is now an internationally recognized medical specialty that offers fellowship training and a board certification exam.

The culmination of Dr. Weil’s hard work was the founding of the Andrew Weil Center for Integrative Medicine (formerly Arizona Center of Integrative Medicine) in Tucson in 1994. The center is recognized for its educational programs, evidence-based clinical practices, and research in the field of integrative medicine which has helped influence public policy.

It offers residency and fellowship programs, which have graduated more than 2,000 fellows and trained doctors hailing from 50 US states and 27 countries.

LOOKING FOR SOMETHING DIFFERENT Many Americans, Dr. Weil says, “Don’t know that they pay three to four times the amount for prescribed medication than people do in Europe for the very same drugs!” The healthcare system in the United States is “dysfunctional,” Dr. Weil states. “We have worse health outcomes than any other developed country in the world. The WHO ranks the US 38th, which is on par with Serbia!” Dr. Weil questions the bang for the buck.

He says, “Any way you look at it, whether longevity or infant mortality. What’s wrong with that picture?

We’re spending more and more, and we have less and less to show for it.”

Dr. Weil believes the healthcare system needs to promote health and prevention of disease. By that he means more emphasis on helping patients manage diseases better by intervening in a patient’s lifestyle earlier. He wants patients to be empowered to make better choices in how they eat, how they exercise, and how they handle stress. In his view, conventional medicine doesn’t move the needle on lifestyle-related issues.

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On the Personal Side with Dr. Andrew Weil Q: If you could describe yourself

in one word, what would it be?

A: Curious Q: Do you have family? Pets?

A: 2 wonderful Rhodesian Ridgebacks: Juno (female age 9) and Kengo (male age 4) Q: Do you have a hidden talent

most people would not know about you?

A: I’m a good whistler Q: What career would you be doing

if you weren’t a physician?

A: Classical musician Q: What book are you reading right now,

or recently?

A: Cutting for Stone Q: What is your favorite movie?

A: Casablanca Q: What is your favorite food?

A: Excellent pizza Q: What is your favorite local restaurant?

A: True Food Kitchen Q: What is your favorite activity

outside of medicine?

A: Gardening

WHY INTEGRATIVE MEDICINE? Dr. Weil believes that patients come to integrative medicine because they’re tired of being overmedicated, overcharged for prescriptions, and never fully healed. He argues patients are prescribed pharmaceuticals that could be avoided if more time was given to understanding the patient. He questions the cost of prescriptions in the US and often doesn’t see the drugs as the value-added they are promised to deliver.

An integrative medicine patient can be someone with a complicated disease that conventional medicine has failed to heal. They could also be someone who wants preventive medical counseling and just wants to tweak their lifestyle to stay physically, mentally, and emotionally healthy. Most importantly, these patients are motivated and are active participants in their health.

The integrative approach requires more time.

A physician will spend at least an hour at the initial intake to take a deep dive into the patient’s history, current lifestyle, and goals. The medical team wants a more complete picture of the physical, mental, and emotional body. That means asking many questions.

Integrative physicians may use therapies like hypnosis, visualization, and guided biofeedback.

Dr. Weil believes for-profit entities have, “completely sabotaged the doctor-patient relationship.” He sees integrative medicine as helping to re-establish a more therapeutic doctorpatient relationship that will foster healing for patients. He also sees greater satisfaction among physicians who take this approach, helping to bring some joy back to practicing medicine.

SIBLING RIVALRY The rivalries between the allopathic, osteopathic, integrative, and naturopathic medicine are “only professional jealousy, and trying to exclude people rather than incorporating them,” states Dr. Weil.

Dr. Weil believes each of these different medical systems has strengths and weaknesses that can work in harmony to care for patients.

Allopathic medicine has been good at dealing with issues like trauma, critical or severe illnesses, and bacterial infections, but often fails to address chronic diseases. “Osteopathic medicine began entirely on the manipulation of the body,” says Dr. Weil. “Osteopathic manipulative therapy is one of

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Learn more on Dr. Weil's thoughts on integrative medicine at arizonaphysician.com/andrew-weil-md

the great healing techniques.” After surviving early persecution by the allopathic profession, osteopathic has become nearly identical to allopathic medicine.

Integrative medicine, he argues, has carved a niche for psychiatric, mental, and emotional illnesses, and does well in navigating chronic diseases. Naturopathic medicine has its roots in healing traditions that involve hydrotherapy and natural cures. Naturopaths, Dr. Weil states, “many times are better trained in nutrition and botanical medicine.” That leads to a better understanding of lifestyle medicine. Unlike allopathic, osteopathic, and integrative medicine, they lack patient resources, and few private insurance carriers will cover the naturopathic treatments.

THE FUTURE OF INTEGRATIVE MEDICINE After 50 years in trailblazing a medical movement, Dr. Andrew Weil knows that there is still work to do. One day soon, he hopes, “we will shed the term integrative medicine, just calling it good medicine and fully incorporating it into the other forms of medicine.”

The approach will become more mainstream, as more integrative fellows and board-certified physicians move into positions of influence and integrative medicine residency programs continue to flourish.

Dr. Weil sees our current healthcare system as heading off a cliff. A collapse, he believes, would force stakeholders to imagine how to create truly healthy outcomes and long-term effectiveness for patients. That could mean integrative and conventional treatments being seen as equals for patient care and investments to cut down on costs.

“We will shed the term integrative medicine, just calling it good medicine and fully incorporating it into the other forms of medicine.”

FINAL THOUGHTS In Arizona, being an unorthodox or independent-minded person, a maverick, holds much significance. That’s who Andrew Weil, MD, is through and through. He bucked the medical zeitgeist of the 1970s and 1980s, launching a different approach to medical care and training followers through the University of Arizona Andrew Weil Center for Integrative Medicine.

This movement has become a respected specialty that many physicians and hospitals are incorporating, and patients are demanding. ■

By Edward Araujo Managing Editor Arizona Physician earaujo@mcmsonline.com

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What

Arizona

DOCS are Saying

Which services are offered?

General Integrative Medicine Consults, Medical Oncology Integrative Medicine Consults, Massage (traditional and Reiki), Acupuncture (1 on 1 and group), Integrative Medical Fellowship for Hematology/Oncology fellows. —John Camoriano, MD, FACP Bioidentical hormones, thyroid disease, functional medicine, acupuncture, massage, nutrition services, clinical hypnosis.

—Melinda Atienza, DO

Does your practice, clinic, or hospital offer integrative medicine?

Yes 57%

No “services” but since the definition of integrative medicine is taking into account the “whole person including lifestyle,” a preventive-oriented practice emphasizing diet and lifestyle is integrative. I focus on lifestyle modification a lot with patients. However, since many things are often considered under the umbrella of “integrative,” it should be noted that only evidenced-based interventions are discussed at my office.

—Melanie Cloonan-Schulte, MD, FACP

No 36%

7% I Don’t Know

Lifestyle medicine - holistic approach to optimize the fitness, nutrition, hormones, mindset; medical acupuncture and some osteopathic manipulation where indicated.

—Tammy Penhollow, DO Medical Acupuncture. —Traci Pritchard, MD ENT. —Jeffrey Taffert, MD Medical Acupuncture. —Steven Burns, MD Integrative and Functional Medicine.

—Melinda Atienza, DO Osteopathic Manipulation, Massage, Full Med Spa Services, Hypnotherapy, Dietary Counseling and training, Exercise Counseling and training. —Adam Nally, DO

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Read more by visiting arizonaphysician.com/integrative-medicine

Please share your views on the differences between allopathic, osteopathic, integrative, and naturopathic medicine.

Ideally, they are mutually supportive approaches and philosophies that cover different aspects of a patient’s medical care and pursuit of health. Allopathic covers traditional scientific method, osteopathic covers the same plus manipulation, integrative pulls from many historical and natural, mind-body, nutritional and movement traditions and naturopathic leverages natural products and off label use of other drugs and supplements. —John Camoriano, MD, FACP

Has patient demand for alternative treatments increased?

No 15% Yes 85%

Naturopathic medicine uses non-evidence-based testing, treatments, and interventions. Integrative medicine can be done by both allopathic and osteopathic practitioners and uses evidence-based and scientifically accurate knowledge with a focus on the whole person, not a specific organ or disease state.

— Melanie Cloonan-Schulte, MD, FACP Differing philosophies on the approach to medicine.

—Michel Sucher, MD Integrative Medicine takes a more holistic and preventative approach to the patient than traditional allopathic medicine. In my opinion, traditional medicine is too focused on prescribing pharmaceuticals and not in finding the root causes of disease and approaching treatment from that direction.

—Ann Bullington, MD I don’t understand all the differences but am very hesitant without controlled trials about the risks and benefits of using different substances/herbs/vitamins.

I am also very skeptical of providers that directly sell and profit off their patients. —Jane Lyons, MD Both have roles: but not equal roles. In the truly sick patient, allopathic should dominate but not completely.

For wellness: naturopaths have the upper hand.

—Jeffrey Taffet, MD Continued on next page

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Continued from previous page They are blurring. Allopathic are either capitulating to corporate medicine or opening their minds to IM. DOs, NPs, NMDs, Chiropractor are striving to mimic Allopathic docs in many ways including whatever needs to be done for the reimbursement game. All these disciplines have a differentiated laudable root but are becoming homogenized. Some NMDs are perhaps more zealous about medical cannabis...but that too is just the revenue generation game that we all play.

Bottom line, all contribute wonderfully to healthcare, and I’ve personally utilized all for my healthcare needs.

—Traci Pritchard, MD No differences between allopathic and osteopathic medicine. Integrative is a vague term that has no real meaning. Naturopathy is quackery. —Steven Burns, MD Many patients have not seen improvement in their illnesses within allopathic care. They are seeking a different approach that does not involve more medications. —Melinda Atienza, DO Significant difference in approach to the whole body between allopathic and osteopathic medicine.

Osteopathic medicine naturally uses multiple integrative modalities. —Adam Nally, DO

What does the future hold for integrative medicine?

A merging with allopathic medicine such that they are both taught and practiced in a manner that leads to access for all patients in the future. —John Camoriano, MD, FACP Diet, exercise, and other lifestyle interventions will continue to have more focus and deservedly so, but the internet, alternative practitioners who are not evidence-based and other sources will compete for expertise and muddy the waters of what is actually helpful and what is the modern version of “snake oil.”

—Melanie Cloonan-Schulte, MD, FACP Very bright. Will continue to grow.

—Michel Sucher, MD If evidenced-based, and with young doctors, the future looks very good for this approach. —Stephen P. Herman, MD Promising. —Lydia Ehlenberger, MD This is what patients are looking for.

It needs to be the future of medicine.

—Melinda Atienza, DO It looks quite good. —Adam Nally, DO

On a scale of 0 to 10, indicate how valuable integrative medicine is to the profession.

Zero equals no value and 10 equals very valuable.

Average of

8.4

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It will probably continue to be a large market. I believe in the benefits of helping a patient’s entire life in addition to only their medical concerns, but there are many that want to profit from their patients and not use thoroughly tested treatments.

—Jane Lyons, MD Depends on reimbursement from the criminal cartel of insurance companies.

Most people can’t concierge docs.

—Jeffrey Taffet, MD In my ideal world, the things that can be proven with scientific testing, i.e., doubleblind trials, etc., will be retained and the rest will land on the ash-heap of history.

—Steven Burns, MD

Read more by visiting arizonaphysician.com /integrative-medicine

It will be mainstream. My concern is will it stay true to its original mission. —Traci Pritchard, MD The future may very well be exceptionally bright for an integrative approach to healing as we combine the knowledge of ages and go back to our roots of treating the person as a unique individual not a number and apply holistic approaches to cure (or put in western “remission”) the horrific chronic diseases that plague our societies - diabetes, cardiovascular disease, cancer, and neurodegenerative diseases. Lifestyle choices are at the root, and this requires a huge buy-in and commitment from the patient in a co-laboring approach to prevent progression and possibly reverse the processes. The future is prevention and the integrative approach of all of us working toward a healthier future for our patients and ourselves. —Tammy Penhollow, DO I believe many more patients will seek out integrative medicine in the future and we will need more physicians trained in this discipline. —Ann Bullington, MD

Learn more about the participating physicians John Camoriano, MD, FACP Mayo Clinic WEB | mayoclinic.org Melinda Atienza, DO HonorHealth WEB | honorhealth.com Melanie Cloonan-Schulte, MD, FACP WEB | drmcloonan-schulte.com Michel Sucher, MD Sucher Management, LTD Stephen P. Herman, MD Stephen P. Herman, MD, PLLC WEB | childadultforensics.com Lydia Ehlenberger, MD Mountain Park Health Center WEB | mountainparkhealth.org Tammy Penhollow, DO Precision Regenerative Medicine WEB | precisionmedprp.com Ann Bullington, MD (Retired) Jane Lyons, MD Banner Health WEB | bannerhealth.com Traci Pritchard, MD Jeffrey Taffet, MD Biltmore ENT WEB | biltmoreent.com Steven Burns, MD Southern Avenue Family Practice Adam Nally, DO Nally Family Practice WEB | docmuscles.com

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IN DEPTH

From left: Shad Marvasti, MD, MPH; Melinda Atienza, DO; Shalini Singh-Karnik, MD; Denise Coventry, MS, RD

A CONVERSATION WITH

HonorHealth Integrative Medicine Clinic

ARIZONA PHYSICIAN: Why did HonorHealth

launch an Integrative Medicine clinic?

W

e spoke with Melinda Atienza, DO; Shalini Singh-Karnik, MD; and Denise Coventry, MS, RD,

of the HonorHealth Integrative Medicine team regarding the growth of their clinic, connections within the network, and impacts on patients.

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DR. ATIENZA: At HonorHealth, our mission is to improve the health and well-being of those we serve. There are times when patients are dealing with chronic health issues that aren’t easily managed by conventional treatments and medication.

Integrative medicine gives us another path to provide relief to our patients through a combination of conventional medicine and alternative therapies. Through the vision and support of our leadership and the HonorHealth Foundation, the HonorHealth Integrative Medicine group is making a real difference for our patients.

Learn more about HonorHealth Integrative Medicine Clinic by visiting arizonaphysician.com/honorhealth-imc

“We are not looking to AP: Please describe a typical new patient.

Do they usually present with acute or chronic conditions?

DR. SINGH-KARNIK: Our new patients include someone who is seeking to optimize their health and has a desire to take an active role in staying well throughout their life. We also see individuals with chronic symptoms or diseases like diabetes or heart disease that want to explore ways they can prevent, treat or reverse their conditions with diet, lifestyle and complementary approaches. Some of them have tried everything else with limited results or they are experiencing serious side effects from the treatments prescribed and want to look for non-pharmacological approaches to addressing conditions like blood pressure or cholesterol. We dig deeper to find natural approaches and less invasive treatments whenever possible to blend traditional medicine with safe, evidence-based alternative medicine to reinforce the body’s innate ability to heal itself. We are not looking to eliminate traditional treatments but rather find a combination that works together to help our patients feel better. As a result, we do a fair amount of deprescribing medications as the patient makes lasting changes in their lifestyle and diet to control their medical conditions.

eliminate traditional treatments but rather find a combination that works together to help our patients feel better.”

—Shalini Singh-Karnik, MD

AP: What response have you received from patients

since opening the clinic?

DR. ATIENZA: Our patients are relieved after finding us. They feel heard and they have hope. They understand that our goal is working towards improving their overall health and wellness, while focusing on nutrition, exercise, sleep, and stress management. Integrative medicine treats the whole person, not just the symptoms or disease. We take into consideration all the factors that influence your health, it’s not just a pill for an ill. To be truly healthy, we must consider physical, emotional, mental, and spiritual well-being.

AP: Which services does your team

offer to patients?

MS. COVENTRY: We want you to live a long and healthy life and we help you achieve that goal by using an evidence-based, holistic approach to your care. Our team partners with you to improve your overall wellness and provide relief from chronic conditions.

We listen to your concerns and take a comprehensive look at all aspects of your life. Together, our team of doctors, dieticians, acupuncturists, health coaches and massage therapists will work together to provide you with a care plan that incorporates nutrition, behavioral health, acupuncture, massage, clinical hypnosis, tai chi, shared medical visits, yoga, and evidence-based supplements.

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IN DEPTH

“While this concept is relatively new, in the end, we are all trying to achieve the same thing which is helping our patients feel better.”

—Melinda Atienza, DO

we are hearing from more and more physicians who are looking for answers for their clients. Some still have reservations about integrative medicine, but just like with our patients, once we explain our philosophy and how we will work with them to help their patients, they are generally excited.

AP: On average, how much time do spend with

patients during the initial visit and follow-ups?

MS. COVENTRY: For our new patients, the initial visit will run one hour long, and each follow up visit is 30 minutes.

AP: Why does having more time with a patient

matter?

AP: What response have you received from

colleagues?

DR. ATIENZA: The response from our colleagues has been very good and as they learn more about what we are doing and see the results that we are producing, they are happy to refer their patients to us. While this concept is relatively new, in the end, we are all trying to achieve the same thing which is helping our patients feel better.

DR. SINGH-KARNIK: The additional time that we get to have with our patients allows us to ask more questions so that we can get a more complete understanding of where they are in their medical journey and how we can help. Integrative medicine is medicine made especially for our patients and every patient is different, so we focus our care on them and their needs.

AP: Why has patient demand for integrative

medicine increased?

AP: Describe the collaboration with other

physicians who refer patients to the team? Are there roadblocks?

DR. SINGH-KARNIK: As word of the work and results that we are achieving with our patients,

24 n A R I ZO N A P H Y S I C I A N M A G A Z I N E

DR. ATIENZA: I think that patient demand for integrative medicine has increased for a couple of reasons. More and more research is being done and published on the benefits of integrative medicine and one of those studies suggested that

Interested in having your medical practice/hospital showcased in Arizona Physician? Let us know at info@arizonaphysician.com

80% of chronic diseases can be addressed by lifestyle medicine which aims to change personal habits and behaviors to optimize health and prevent, treat, and even reverse chronic diseases. The other big driver is the fact that more and more patients are looking for a whole health approach which includes diet and lifestyle prescriptions instead of simply relying on medications or surgery to treat their medical issues.

AP: Have insurance carriers been covering

your services?

DR. SINGH-KARNIK: Most insurance payers cover the cost of visits with the physicians.

We continue to work with the insurance companies to show the benefits and results that we are seeing, which in the end provide the best care and outcomes for our patients.

AP: What does the future hold

for integrative medicine?

DR. ATIENZA: I think the future is great.

Almost anyone can benefit from an integrative medicine consultation because we focus on prevention by empowering our patients with evidence-based approaches to staying healthy and maintaining wellness throughout their lives. We continue to see more and more interest from healthcare professionals and the community who are looking for another option to help them live their best lives. ■

HONORHEALTH INTEGRATIVE MEDICINE CLINIC By the Numbers OPENED IN NOVEMBER OF 2011 1 CURRENT LOCATION 2nd location coming to the Osborn Medical campus in 2024

3 PHYSICIANS 1 REGISTERED DIETITIAN 1 LICENSED ACUPUNCTURIST 1 BEHAVIORAL HEALTH SPECIALIST 1 MASSAGE THERAPIST ADDITIONAL SERVICES: Tai Chi and Yoga classes, in-house lab with phlebotomist.

OTHER STAFF: two front desk staff, two medical assistants, practice manager

Connect with HonorHealth Integrative Medicine Clinic at xxxxxxxxxxxxxx.xxxxx

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LEGAL CORNER

Pre-operative Evaluation DON’T CALL IT A CLEARANCE

A

s a primary care physician or advanced health care professional (AHCP) treating patients for various health conditions, you will likely encounter requests to “clear”

patients for surgery. In this context, “clearance” means that the evaluating physician believes the patient is healthy enough to undergo surgery.

This terminology, however, can be misleading to all involved — the patient, the doctor or AHCP, the surgeon, and a potential jury deciding a professional liability case. It diminishes the true nature of what should be accomplished during a pre-operative evaluation.

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C OL L A B OR AT ION A N D C OM M U N IC AT ION Dr. Fred Pelzman, an internal medicine doctor, states in a 2022 opinion piece on pre-operative evaluations that “collaboration is key, and so often communication is the thing that makes this work…when communication and connection are lacking, collaborative patient care can suffer.” When a surgeon recognizes that a surgical candidate may have health factors that could pose a risk during surgery, or the patient’s health insurance plan requires a “clearance,” the surgeon will contact other members of the patient’s care team for a pre-operative evaluation.

MICA’s Risk Team fields calls from PCPs, AHCPs, and specialists who relay that they have been asked to simply check a box that says “cleared for surgery” or to write a simple statement to that effect. These physicians and AHCPs express discomfort with doing so since the picture of the patient’s health is often more complex than that, but also feel pressured to

move things along, especially when requiring a more in-depth evaluation could delay a procedure the patient so desperately wants or needs.

MICA recommends physicians and AHCPs discuss with the surgeon the need for more time for the PCP/AHCP, specialists, surgeon, and patient to engage in an appropriate risk/benefit analysis with consideration for the patient’s condition(s), the type of surgery, and the urgency of surgery. That process may include the following steps:  Call the surgeon to discuss the planned procedure.

W hat is the type and expected length of the procedure?  What kind of anesthesia will the patient need?  How long will the patient be confined to bed?  What type of rehabilitation is expected?  What is the anticipated recovery time?  What is the urgency of the procedure? 

 The evaluating practitioner should review the

patient’s medical records and complete a physical examination and diagnostic testing, and, if necessary, refer the patient to a specialist(s) for additional preoperative evaluation.  Upon completion of the pre-operative evaluation,

the care team should communicate about whether the patient is healthy enough to proceed with surgery and if there are any reasonable and prudent steps the health care team should take to potentially improve the patient’s surgical outcome.  The surgeon and anesthesiologist should each have

an informed consent discussion with the patient during which they share the risk/benefit analysis so that the patient may make a fully informed decision about whether to proceed and/or understands why the surgery may not be a good option at this time.

It may turn out that the patient is free of serious comorbidities and the surgical and anesthesia risks are low. A single phone call with the surgeon and documentation of your findings and thought process in those instances may suffice. In an emergency, with no time to complete these steps the surgeon and other members of the health care team should advise the patient or their representative of the risks of proceeding or waiting. In many cases, the patient will fall somewhere in between these two scenarios.

In that case, it is worthwhile to engage in a preoperative evaluation and to document your efforts to help the patient and the health care team proceed with a more complete picture of the patient’s health.

OP P OR T U N I T I E S T O I M P R O V E YOU R PAT I E N T S ’ H E A LT H Facing the reality of undergoing surgery and the recovery process along with discussions with health care practitioners surrounding how lifestyle choices have contributed to the need for surgery and/or to greater potential for adverse outcomes may be an impetus for change. This could be an opportune time to discuss the benefits of and strategies for things like smoking cessation, weight loss, diabetes control, blood pressure control, and other lifestyle factors the patient may be willing to re-examine. Doing so, and documenting that you’ve done so, also demonstrates your genuine concern for the patient’s wellbeing and long-term health status.

M A L P R AC T IC E R I S K As with all medical care, the evaluating practitioner(s) and surgeon face malpractice risk if an adverse event occurs during the procedure or recovery period. Ways to prevent malpractice allegations and fortify the defense of a malpractice lawsuit include the following: Completing an appropriate pre-operative evaluation for the patient’s condition, type of procedure, and urgency of the procedure. 

Engaging the patient in an informed consent process in which the surgeon and anesthesiologist explain the risks and benefits of, and alternatives to, the proposed procedure and type of anesthesia. 

Trying to help the patient set and maintain reasonable expectations by explaining the possible outcomes of the procedure and what recovery might look like in the short- and long-term. 

Documenting each patient encounter and all efforts to discover and mitigate potential risks of proceeding with surgery. 

“Clearing” a patient for surgery is a broad term that may later be used to imply the PCP, specialist, or AHCP evaluated and considered factors and findings outside their area of expertise.

Most PCPs, specialists, and AHCPs are instead “identifying and evaluating” patient’s medical problems and “recommending” interventions to address those problems within their scope of practice and in consideration of a surgery and/or anesthesia.

“Pre-operative” evaluations give the health care team the opportunity to help prepare patients for optimal outcomes. ■

Molly Adrian, JD Legal Risk Management Consultant, Risk Management Services at Mutual Insurance Company of Arizona (MICA) madrian@mica-insurance.com

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HOW TO

YOUTUBE: TO USE OR NOT TO USE

With all these considerations in mind, below are 13 reasons why using YouTube for compliance training is, in fact, a problem.

What’s the Problem with YouTube for Compliance Trainings?

It’s free!

I

n short, you get what you pay for. While YouTube has become a go-to resource for tutorials, entertainment, and educational content — all of which are indeed free — finding healthcare compliance training you can trust is a whole other ballgame.

Hira Rashid, Ph.D., Senior Learning Program Manager of MedTrainer, says training programs will continue to face increasing scrutiny from regulatory and accrediting agencies, requiring that courses be taken through approved providers, are interactive with multimedia, are ADA-WCAG compliant, and in some instances, must incorporate learning formats such as scenario-based learning. These specifications will also drive and impact the standards for Arizona healthcare professionals wanting to obtain or maintain licensure.

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1 | INACCURATE OR OUTDATED INFORMATION | YouTube is a user-generated platform, and the accuracy of content varies from one creator to the next. Healthcare compliance requires up-to-date and accurate information aligned with current regulations, which cannot be guaranteed on YouTube.

2 | LACK OF VERIFICATION | Unlike platforms that provide accredited courses, like MedTrainer, YouTube lacks a stringent verification process for content creators. This absence of vetting can result in unreliable or biased information being presented as fact — a big no-no in healthcare.

3 | NON-COMPLIANCE WITH REGULATIONS | Relying on YouTube for training makes it impossible to ensure adherence to compliance regulations, potentially leading to legal and ethical issues. Unwittingly sharing noncompliant YouTube videos as so-called training videos puts you, your staff, and facility at risk.

4 | PRIVACY CONCERNS | As a covered healthcare entity, you could breach HIPAA Privacy and Security rules, whether you intended to or not. For example, there’s protected health information (PHI) in the video you’ve instructed staff to watch. You are just as liable for the HIPAA violation as the random — sometimes anonymous — original content creator.

5 | LIMITED INTERACTIVITY | Effective compliance training increasingly requires interactive elements like quizzes, case studies, and discussions. YouTube’s one-way communication model doesn’t provide the necessary tools for robust interaction or evaluation.

6 | NO TRACKING OR REPORTING | While monitoring progress and assessing the effectiveness of training programs is crucial in healthcare compliance, there is absolutely no way to confirm whether a staff member actually watched a “training” video on YouTube. The platform lacks the tracking and reporting features necessary to measure trainees’ comprehension and progress. If a healthcare inspector asks you to prove who has taken certain courses, YouTube will leave you empty-handed.

7 | TIME CONSUMING | If you’re using YouTube for training, you’re not only spending time searching for a course, but also vetting the material by comparing its content to current regulatory standards and requirements, then perhaps sending emails to all staff with the video attached. A few email reminders later, you’re waiting on their reply that it’s been viewed (so you hope). If you’re really on top of things, you’ll also have to manually record who self-reported that they completed the training — perhaps on paper or an Excel spreadsheet.

That’s a whole lot of back-and-forth and time wasted.

8 | UNREGULATED COMMENTS AND TROLLS | YouTube’s comment sections are unregulated. This leaves the door open for your staff to be exposed to and distracted by spam, inappropriate links, commentary from disgruntled people that have nothing to do with your practice or training initiatives, uninformed opinions left by anyone, etc.

9 | VARIABLE VIDEO QUALITY | Video and sound quality on YouTube can fluctuate, affecting the trainees’ reception of essential details in training materials. Poor video quality can create disinterest and increase the likelihood that your staff will not watch it in full.

10 | DISTRACTIONS AND INTERRUPTIONS | YouTube’s algorithm often suggests unrelated or irrelevant content and frequent advertisement interruptions, leading to distractions during critical training sessions. These annoyances can hinder the learning process, resulting in poor knowledge retention and time wasted.

11 | VIDEOS DISAPPEAR | YouTube channels and their creators have the liberty of deleting videos anytime they wish for any reason. This means that if you or the staff need to reference the training video for a refresher or clarification on a particular point, it’s quite possible it will have been deleted. You’ll have to start from scratch searching for a new video and hope that the original video you sourced for training wasn’t deleted due to misinformation. Eek!

12 | DIVERSITY LIMITATIONS | It’s important that every training course, not just diversity-specific courses, reflects diversity and inclusion. The course content itself, whether it’s HIPAA, OSHA, or other, should convey inclusion via the way the training is delivered, the instructors, the images used in the training, the language, examples provided in the course, case studies, and more. YouTube’s training content on compliance is often outdated and not properly vetted for implicit biases.

13 | LACKS MULTI-FUNCTIONALITY | If you’re using YouTube for staff training, you’re missing out on other functionalities invaluable to maintaining compliance. Comprehensive tracking and reporting, automated staff reminders, status updates, certificates of completion, and onboarding paths with course curriculums auto assigned in bulk by role are just some of what YouTube does not offer. An all-in-one platform that covers all your compliance needs, from learning and documentation to credentialing, can save you a lot of time, money, and a few headaches.

IF NOT YOUTUBE, THEN WHAT?

So, while YouTube might seem like a convenient option for training on topics like HIPAA, OSHA best practices, workplace violence/sexual harassment, and so on, is it worth risking non-compliance and losing everything you’ve worked for?

Take the smarter route and join most healthcare organizations who use a quality learning management system for workplace education and compliance needs — one that is approved, unbiased, up to date, includes CE qualified courses, and meets the ever-evolving regulatory standards necessary to maintain a thriving practice. ■

By Amber Ratcliffe, MS, LPC, ATR-BC, RPT, Content Specialist, MedTrainer Amber.Ratcliffe@medtrainer.com

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PHYSICIAN SPOTLIGHT Heidi Rula, MD, of Ironwood Cancer & Research Centers on Integrative Medicine Q: How does integrative medicine apply to oncology?

A: I think it’s a great fit in that space of support, which is really what I do in integrative oncology. Cancer is something that creates a storm in somebody’s life. People who have cancer have incredible stress. From the stress around their work, their finances, their relationships to the fear of their mortality, huge stressors in which we help them navigate. Beyond stress, we work with patients on side effect management as many of our patients don’t want to just take another pill when they’re nauseated or if they can’t sleep. We bring in other tools to help them navigate some of the challenges of their conventional cancer treatment. These tools allow them to take a more active role post diagnosis. I think a lot of times when you get a cancer diagnosis, it’s a whirlwind, you feel like you’ve totally lost control of your ability to care for yourself. That’s where we step in, supporting patients in helping them understand areas in where they can take ownership of certain aspects of their care, which can be very empowering to them. We help patients build a foundation for care through optimal nutrition, sleep regulation, and helping them with digestive or nervous system issues. Finally, our team also helps restore health after some of the toxicities of their treatment may have caused some complications.

Q: What are the results that you’ve seen?

A: I hear from my patients over and over that it was just so important for them to get this level of support we provide. They don’t know how they would have gotten through their treatment without it. They feel like their side effects were less because we spend a lot of time on patient education by using an hour, hour, and a half by sitting with each patient and helping them understand how to manage their side effects.

By teaching them different ways to eat, supplements to take, and mind/body approaches, it builds a different mental outlook in patients. They begin to see that their therapy is something that’s healing their body versus adding toxins to the body. Ultimately, I think the big piece is where patients become empowered as they feel like they have the tools and education to get through some that’s incredibly challenging, like cancer.

30 n A R I ZO N A P H Y S I C I A N M A G A Z I N E

Q: What other complementary practitioners are

in your integrative oncology team?

A: Our team includes dietitians, social workers, acupuncturists, and even a department coordinator. This allows us to provide many classes. In our Chandler office, for example, we offer Reiki. In our other locations, we also offer yoga and Tai Chi. Q: Why does Ironwood offer integrative oncology

and other oncology practices don’t?

A: I think supportive care is a big challenge in cancer care. The economics are challenging.

Insurance doesn’t cover the cost of some programming that we run. So, this is kind of on Ironwood to identify as an important aspect of patient care. Even though financially, it may cost Ironwood more and not generate as much revenue, we do it because it provides the best care for the patient. Then, the word gets out that this is a place where you’re going to be supported as a whole person versus just delivering cancer care and not taking care of all the other aspects of your health. Patients are smart consumers. They seek out our elevated level of care. ■

HEIDI RULA, MD

Integrative Oncology and Medical Director of the Supportive Care Services Department Ironwood Cancer & Research Centers Heidi.Rula@ironwoodcrc.com

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