Integrative Medicine Transcript with Greta Kuphal
Host: Hello and welcome to Well Wisconsin Radio, a podcast discussing health and well-being topics with experts from all around the state of Wisconsin. I’m your host, Renee Fox and my guest today is Dr. Greta Kuphal. Dr. Kuphal is the medical director of the Integrative Health Program at UW Health. She earned her medical degree from the University of Wisconsin School of Medicine and Public Health, Madison and completed her residency at the UW Family Medicine Residency Program. She then went on to complete the 2 year academic integrative health fellowship in that same department. She is the inaugural director of the Osher Center for Integrative Health at the University of Wisconsin Madison. Dr. Kuphal, thank you for joining us today to talk about integrative medicine.
Guest: Thank you so much for having me. This is a topic I just love talking about and, and, and sharing with folks.
Host: I’m so excited to learn more and I’m sure our listeners are as well. Can you start by just describing the practice of integrative medicine and this approach to health care?
Guest: Yeah, uh, you know, that’s a really great question because it can get a little bit confusing. There are lots of different names for ways of approaching health that aren’t necessarily considered conventional. So, to start, when we think about names like alternative medicine, when we think of that phrase, we’re thinking about when an individual decides they don’t want to use conventional medicine and want to go a different route.
Complementary is a little bit more in the realm of, yes, I would like to use the benefits of conventional medicine, but would like to add some non-mainstream approaches. But then when we think about the phrase integrative, that indicates that we’re interested in bringing complementary and conventional medicines together in a very coordinated way that is often multimodal.
It’s not one pillar treatment, but a combination of those interventions and those interventions might be passive, meaning something that is just either we take or a treatment that is sort of done to us like acupuncture massage. And it might involve some active interventions, things like making lifestyle changes or learning meditation or other practices that involve effort and practice on the side of the individual.
When we think of integrative medicine, we also, I think it’s really important to recognize that many of the modalities that we use are coming from a lot of traditional healing practices, and that’s something that our field is needing to be sure to come to terms with, and how can we best learn from the wisdom of those healing traditions without appropriating or exploiting them, but still allowing our patients to benefit from the great healing potential.
And then well, you know, lastly, when we think about integrative medicine, we think about relationship centered care that seeks to really look at the entire person, mind, body, and spirit with the fundamental question of, you know, what really matters to you and what do you need your health for? And that sort of becomes our true north in terms of what direction are we going and what are the tools that we need to get there.
Host: Wonderful. I love the definitions and just how you describe that and I’m just really excited to gain more understanding as we get through this conversation too, but love this approach. So when you think of the different services that are included, if you were to go to the integrative health program at UW health, what are some of those types of services that would be part of that integrative plan?
Guest: So, you know, we’re one of the largest in the country and I’m so proud of the program that, my predecessors have built up over the last 20 years. You know, we have physicians and physician assistants that provide integrative health consults, much in the way of, you know, you’ve got a health concern, you might have to go to see a cardiologist where you can also go and see an integrative health professional to get input on how you might approach things that you would like to address. We have wellness consults as well, people that are interested in how can I optimize my health and what are the things that might be most impactful so that I can live a long and healthy life.
We also have, in addition to those one-on-one consults, we have group medical visits that use themes such as nutrition or movement or mindfulness or just sort of an intentional way of going through a broader approach to health in shared medical visits, which are a really lovely way to not only build community, but learn and really get more deeper into ways that we can foster our well-being. We also offer modalities such as acupuncture and massage, cupping, hypnosis, osteopathic manipulation therapy, health coaching, and health psychology, that are available in a couple of different locations within our organization. And I’m so very proud of our, I call it our grandmother program, and that’s our mindfulness program, which actually predated the integrative health program.
And they not only offer sort of the classic and standard mindfulness based stress reduction program curriculum, but have a wide variety of offerings for parents and children, for cancer patients, and a lot of other more specific populations. And then lastly, we have our fitness centers that offer a variety of options from one-on-one consultations with exercise physiologists, to classes for a general fitness and aerobics, some more specific classes for things such as like yoga and tai chi, and then for specific patient populations. So patients that might be at a high fall risk or have a history of Parkinson’s disease or, or stroke history, um, ways to safely and effectively move the body towards being safe as you’re sort of moving through your life.
Host: Impressive variety of services. Can you share some examples now of the types of services that might be combined together for someone’s specialized wellness plan, like based on a specific health condition or individual health goals?
Guest: Yeah. One of the things that we see a lot of in our consult clinic is pain. And when we think of pain, it’s so much more complicated than, you know, if you, if you hit your toe with a hammer, you know, that’s going to hurt and that’s pain, but when pain becomes chronic, it really changes a lot of the internal signaling within our bodies and with our neurologic system, and a lot of things can influence that. We might start by looking at number one, what is your relationship to the pain? How is it impacting your sense of well-being and what do you want to be able to do that the pain is impeding you from doing currently?
And to get at that, to start to overcome those barriers and move towards a place that is much more functional and meaningful for an individual, we might start with something like mindfulness. You know, can we further define the pain? Can we put borders on it? Can we understand what is worse? Can we understand what makes it better? We might review nutrition. We know that nutrition, the things that we take into our bodies can decrease or increase inflammation, which can impact our experience of pain.
There might be herbal supplements that might be helpful for decreasing inflammation and improving pain experience. And things like acupuncture and massage, right? In a very intentional and patient centered way, we might pick the things that a patient feels they’d like to start with and move from there.
You know, if we’re thinking of something more like sleep issues or, or stress management, you know, we need to think about for that individual, what makes the greatest impact on lowering stress? Is it exercise? Is it art? Is it that cup of tea that not only creates a ceremony around it, you know, having to stop, pause, heat water, hold something warm in your hand and nourish yourself.
But there also might be sort of a biological impact or a biochemical impact of chamomile or valerian root that we’re taking in as well. So finding out the combination of things that they have access to and might touch on a wide variety of areas of their own wellness rather than just sort of one symptom is the way we start to approach care.
Host: Oh, wonderful. You mentioned people who might be struggling with sleep or having chronic pain. Is this type of approach to healthcare designed for everyone or just people with some specific health conditions or at certain stages of life?
Guest: Our goal in integrative medicine is to, at some point, be able to drop the adjective integrative and just be really good medicine. Every one of us has a health goal, whether we realize it or not, you know, sometimes it is symptom management or making sure that we’re managing a disease appropriately.
But sometimes when we’re thinking about our health, we just want to remain as healthy and functional as we can for as long as we can, sort of decreasing that difference between lifespan and health span, right? We want to live as long as we can. So when we really look at way of viewing health and health management that’s not just focusing on pathology, you know, in what is conventional medicine, we’re really good at talking about pathogenesis pathos is, you know, disease and Genesis origins of with integrative health.
We’re looking at Salut agenesis, salutae meaning health and genesis origins of, so everybody can resonate with the desire to foster health and integrative health and wellness is primed to do that very well.
Host: How does having a treatment plan and the health benefits that patients are experiencing differ when you are combining both the conventional and alternative medicines versus just focusing on one approach?
Guest: So I think it’s really important to not ever demonize the benefits and the importance of conventional medicine. Sometimes people can be all in on integrative, they can be all in on conventional, but the truth is that both have so much to offer.
And, you know, when we think about, um, for instance, like a, a patient who has cancer, right? We really do want to make use of the incredible advances in oncology care, you know, radiation therapy, chemotherapy, surgeries. And oftentimes those things are delivered by patient, by providers who are truly passionate about saving lives and what a gift that is that we have.
But those modalities don’t always address the experience of the individual going through those treatments or all of the symptom management. And oftentimes patients are very interested in, you know, what else can I do? How can I participate in my own health and wellness? And so by combining the best of conventional medicine and the best of alternative or complementary therapies and really bringing them together, it’s much more, you know, dare I say salutogenic approach to care where we’re really looking towards fostering that wellness of an individual.
Host: I love that. So in terms of healthcare costs, what does this look like typically for patients?
Guest: You know, that’s an area that we need to look at a little bit more in this country in general. What we’re seeing in general is that there’s a trend towards going for a fee for service care where, you know, something is done and it has a cost and it’s paid for to more quality based care and outcome based care. So how can we manage a health challenge or someone’s health maintenance in a way that we’re looking at the outcome and not necessarily what’s brought in.
So that being said, there are some offerings that are covered by most insurances, you know, consults with physicians or advanced practice practitioners, group medical visits, health psychology, those things are generally covered by most insurances. What we’re seeing also is that more and more insurances are covering things like acupuncture, you know, some massage, especially as we are understanding things like pain more and that we can kind of look to the opioid crisis and knowing that just increasing doses of opioids, not only doesn’t manage pain well, but it causes harm.
So what are the other things that we can bring into a health plan for an individual? There are some health insurances that either get wellness benefits or incentives to use some things that are more like lifestyle interventions or are used to care for your health. And many health insurance plans will allow individuals to use like flex spending accounts for some of these modalities if they’re supported by a physician. There’s no doubt that some of these modalities and these supplements, et cetera, are going to be an out of pocket cost to patients.
And so as providers, we really need to make sure that when we have discussions with patients about these things that we’re recommending aspects of the plan that are accessible to the patients, and if they’re not either geographically or financially accessible, we’re going to have to problem solve that and say, you know, what else could we do? And what are the other ways that we can get to the point where we’re really stimulating that healing response within the people we’re serving?
Host: Wonderful. So are there risks associated with integrative health care that people who might be considering this approach should really think about?
Guest: So in deciding whether or not, you know, we want to recommend or if a patient wants to consider using a complimentary therapy. We use a mnemonic, we call it the echo mnemonic. And the E in echo stands for is it effective? Right. So how do we know it’s effective? Is there, are there studies based on it?
And that might be randomized control studies, um, or reviews. Um, there’s also, you know, evidence in traditional knowledge, how these things been used in traditional healing systems and also in your own body. Have you been doing something or taking something for an appropriate amount of time, a few months, and is it making a difference?
If it is, and it’s not causing harm, great, but you want to make sure that you’re paying attention. What was the intention of using this modality, and is it making an impact? So that’s the E. The C in the Echo Mnemonic is cost. Is it something that you can afford, right? And not threaten or negatively impact your ability to meet your other basic needs in life. Is it worth the investment? Is the impact worth the investment that you might be making?
The H in ECHO is harm. Is this something that could potentially cause harm? And so, you know, for instance, hypnosis may not be appropriate and may cause harm in someone who is having active psychosis. You know, high velocity manipulation in someone with osteoporosis could cause harm. You know, high dose medications or IV medications over prolonged periods of time that are not being closely monitored or, are indicated can cause harm. But the flip side of that is also, there can be a harm in not following a standard of care. So if you’re thinking about someone who has cancer and if they’re declining, but they want it treated, and they’re declining chemotherapy, surgery, or radiation therapy and wanting to do interventions that either don’t have evidence for it or very, very weak evidence there’s harm, right?
And time may be lost in avoiding that standard of care or sometimes cholesterol can be lowered and a person’s risk of heart disease many times actually can be lowered with lifestyle interventions, but there are situations in which a cholesterol medication can have a significant impact on lowering risk. So, two sides of that harm, you know, are we doing something that could cause harm? Are we avoiding something that is of more benefit? And then the O in the echo mnemonic is opinion, you know, is this something that the individual is open to. Do they feel it might work? We know that when someone really believes a medication or maybe in knowing that placebo may benefit their pain or depression, it makes an impact. Do they believe it? Does the physician believe that approach might work?
And then also an intervention needs to be in line with the values of the individual. So, I really felt like her anxiety and her sleep and her pain would have benefited from a mindfulness practice, but when I started to approach that, she felt it was in direct contrast with her spiritual beliefs. So it would have been completely inappropriate for me to go further with that recommendation. That’s the echo mnemonic that we kind of consider when we’re thinking about integrative modalities.
But some of the other things that I really sort of want patients to watch for, there’s a few red flags. You know, if you’re seeing someone that says conventional medicine wants to keep something from you, that’s a little bit of red flag. If you’re in an office and the products that are being sold are part of a pyramid scheme. Probably something to be cautious about if the provider is sure that a complicated case is completely explained by a single diagnosis, or if the diagnosis they treat or the modality that they use is the answer for everything, you know, something to be cautious about.
And then if the provider’s workflow requires there’s a lot of lab testing or imaging that’s done before they even talk with you, that’s something to watch out for. And then lastly, you know, are you not getting results? You know, like we talked about the efficacy before, if you’ve been working with someone for a while and nothing different is happening, maybe think about reconsidering a different approach.
Host: Yeah. Oh, really helpful. So if some of our listeners are interested in finding integrative medicine, medical care, anywhere across the state of Wisconsin, or they might be listening elsewhere out of state. So how can our audience, really make sure that they are seeing a legitimate provider when they’re seeking out this service?
Guest: Yeah. Well, I think if you start out by sort of knowing what credentials you are looking for and the credentials of the individual you’re working with. So if you’re looking for a physician or a, or an advanced practice practitioner, like a physician assistant or a nurse practitioner, are they, are they board certified in their primary specialty?
And then have they gone through a reputable fellowship or other training for the type of care that they are delivering? If they’re calling themselves a naturopath, you know, have they actually gone through a, a four-year naturopathic medical school? There’s a big difference in that.
Other things to sort of look for, are they affiliated with a strong academic medical center? Will you be getting evidence based or evidence informed treatment. Places you can look, the American Board of Integrative Medicine. If you go to their website, you can find a list of providers that are board certified in that specialty, though not all well trained providers are board certified.
The Andrew Weill Center for Integrative Medicine has a search function where you can find a trained integrative health practitioner, as does the website for the Institute for Functional Medicine. And then I don’t want folks to underestimate their own gut check. Like if it feels like somebody is just selling something to you, listen to that. If it doesn’t feel quite right or if you don’t fully trust or know the type of, or understand the type of care you’re delivering, listen to your own intuition on that as well.
Host: Great recommendations, and our listeners can find links to those resources in our show notes page for this episode. So are there integrative health programs that are located across the state of Wisconsin?
Guest: You know a number of health systems across the state will have some complementary and integrative health offerings and that is likely expanding all the time. People are very interested in this approach to care.
Host: That’s excellent. Are there any additional tips or resources that you think would be helpful for our listeners who are just wanting to learn more about this topic?
Guest: Yeah, so number one thing, when it comes to your health. You know, what you do is more often very much more potent than what you take. So take good care of yourselves. And if you’re looking for resources, the Osher Center for Integrative Health at UW Wisconsin has a website with a large number of handouts on various health concerns as well as practices and health information and links to our Grand Rounds presentations that are available and free to view.
The UW Health Mindfulness Program has a wide variety of both face to face and virtual offerings. Um, and that can be found on their website and then the UW Health Integrative Health Center website has links to all of our services as well.
Host: Wonderful. This is really great, helpful information. I’m sure our audience is really going to love and appreciate this as well. Thank you for your time today and for sharing this great information on integrative medicine.
Guest: Oh, you’re more than welcome and thank you so very much for having me on today.
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Resources to search for a trained practitioners:
- American Board of Integrative Medicine Note: You can search for board certified providers AND for board eligible fellowship programs—not all well trained providers will be board certified.
- Andrew Weil Center for Integrative Medicine
- The Institute for Functional Medicine
- Osher Center for Integrative Health at the University of Wisconsin-Madison Note: Includes links to handouts and grand rounds recordings
- UW Health Integrative Health
- UW Health Mindfulness Program