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Alexander Technique April 2014 MEDELLA, April 2014 VolumePage 1, 5Issue 3 MEDELLA CURE , HEALING POWER , H EALTH GW Center for Integrative Medicine 908 New Hampshire Avenue NW Washington D.C. 20037 Metro: Foggy Bottom Website: www.gwcim.com E-mail address: [email protected] Phone: 202-833-5055 Hours: 9 am to 5 pm Doctor of the future: INSIDE THIS ISSUE What do patients want? Doctor of the Future 1 A quote widely used on integrative medicine Alexander Technique 1 websites, with slight variations in wording, states: "The Relaxation for Insomnia 2 doctor of the future will give little medicine but will interest his patients in care of the human frame, diet, and in the cause and prevention of disease." Most websites attribute this saying to Thomas Edison, but some claim Albert Einstein said it. While it looks like doctors who understand that health and disease involve the true provenance isn't clear, it neatly sums up the the mind, body, and spirit and that health is philosophy of integrative medicine. determined in part by the context of patients’ lives. Patients value the relationship with their physician Consideration of this saying leads to the question: above all else, including service. What do patients really want from their medical providers? Are they seeking knowledge and compassion; treatment of their disease and symptoms; or an ongoing prevention, education, and health optimization program? Here is a look at several studies that have tried to answer this question. The Future of Family Medicine project, initiated in 2002 by the leadership of seven national family medicine organizations, defined family physicians as Please see Doctor on page 2 Alexander Technique: Better living through better posture As part of its monthly guest speaker series, in April the in turn helps them project their voices more GW Center for Integrative Medicine hosted Mary Naden, a powerfully. The technique fosters balance -- physical certified teacher of the Alexander Technique (AT). The and emotional. technique uses a unique mind-body re-education approach, teaching conscious processes to alter automatic “We are not called therapists, we are teachers,” postural coordination and ongoing muscular activity. Mary said. Originally a professional performer, Mary Music and theatre students learn AT as a tool to help completed three years of training at the Philadelphia them avoid injury and improve their performances. In and School for the Alexander Technique. During her 20 out of the theater, students of the Alexander Technique years of voice and movement teaching experience experience relief from back, joint and muscle pain. The she taught in the theatre departments of Duke Alexander Technique seeks to do more than relieve pain; Ellington School of the Arts and the University of it aims to change a person's relationship with their body. Maryland, Round House Theatre, Georgetown Law Students learn how to breathe more freely, which Center and American University. Please see Alexander on page 4 Page 2 MEDELLA, April 2014 Relaxation Fights Insomnia Millions of Americans suffer from long-term sleep response, which slows breathing, lowers blood pressure disorders, and insomnia is one of the most common and produces a feeling of calm and well-being. out of 80 sleep disorders. It affects about 20% of Americans, reducing quality of life, and resulting in lost In preliminary studies, mindfulness-based stress productivity and even early mortality. "Sleeping pills" reduction, a type of meditation, was as effective as are the most common remedy, but their effectiveness the prescription drug Lunesta in a small group of is limited, and side effects range from sleepwalking to people with insomnia. dependency. Music-assisted relaxation may be moderately beneficial in improving sleep quality in people with Sleep is a basic human need, like drinking and sleep problems. breathing, and is vital to good health and well-being. Preliminary studies in postmenopausal women and Lack of sleep slows thinking and reaction time, makes women with osteoarthritis suggest that yoga may people irritable, increases risk of injury, may decrease be helpful for insomnia. resistance to infection, contribute to obesity and increase the risk of heart disease. The National Center for Complementary and Alternative Medicine at the National Institutes of Health has compiled a list of mind and body practices that involve relaxation and have demonstrated effectiveness in treating chronic insomnia. Relaxation techniques include progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. Each of these techniques aims to help people who are sleep-deprived learn to Please see Insomnia on page 3 consciously produce the body's natural relaxation Continued from page 1: Doctor… Patients value a physician who listens, takes time to Restoring Health When Ill. Patients want to get explain things, and is able to effectively coordinate their better, to be returned to good health. The majority overall care. The other five basic criteria included: to be of patients primarily focus on relieving illness and in their insurance plan; to be in a convenient location; to symptoms rather than disease prevention. Evidence be able to schedule an appointment within a reasonable that does or does not support the use of treatments period of time; to have good communication skills; and based on large groups of people is of much less to have a reasonable amount of experience in practice. interest to patients than whether those treatments work in their specific case. A commentary in the Kindness. Patients want to be treated with Journal of American kindness, empathy, and respect for their privacy. Medical Association Hope and Certainty. Even if patients are in a health classified patient state for which cure is exceedingly unlikely, they priorities from high to want to have hope and be offered options that low. Among the might help. Patients are uncomfortable with selected high priorities: uncertainty about diagnoses and prognoses and often request tests to help alleviate those anxieties. Jan Steen, c. 1663 Please see Doctor on page 3 MEDELLA, April 2014 Page 3 Continued from page 2: Insomnia… Some practitioners who treat insomnia have Relaxation techniques before bedtime should be part of reported that hypnotherapy enhanced the a strategy to improve sleep habits that also includes effectiveness of cognitive behavioral therapy and lifestyle changes, such as maintaining a consistent sleep relaxation techniques in their patients. schedule; avoiding caffeine, alcohol, heavy meals, and A small 2012 study on massage therapy showed strenuous exercise too close to bedtime; and sleeping in promising results for insomnia in postmenopausal a quiet, cool, dark room. women. Sources: Various forms of relaxation are sometimes Gross CR, Kreitzer MJ, et al. Mindfulness-based stress reduction combined with components of cognitive- versus pharmacotherapy for chronic primary insomnia: a behavioral therapy such as sleep restriction randomized controlled clinical trial. Explore (NY). 2011 Mar- and stimulus control, with good results. Apr;7(2):76-87. NCCAM, http://nccam.nih.gov/health/sleep Continued from page 2: Doctor … Continuity, Choice, and Coordination. Patients want to oriented approach – to consider the entire person and not build a relationship with a health care professional or simply the symptoms. “Doctors need to consider team in whom they trust, and have that same person care alternatives to 'usual' medical practice as well as coordinate for them in the future. They want the members of their care with alternative healers” was one of the themes in health care team to communicate with each other to patient responses. coordinate their care. Patients reported they wanted doctors who would: Interestingly, when doctors become patients, they want Stay up-to-date in their medical knowledge and what patients want: that the provider consults with them view consumers as important sources and regarding care decisions. Expectations of doctors when repositories of valuable knowledge and information; they became patients were to establish a strong Take a preventive focus and help people understand relationship with a provider, which included and care for themselves to avoid unnecessary acknowledging the whole patient whose illness affects sickness and disability; work and other life aspects, incorporation of holistic Understand, acknowledge, and use health care which identifies personal risk factors, and complementary/alternative medicine as part of prevention and health promotion -- because doctors are caring for the “whole person;” and no better at accessing preventive health care than the Understand and acknowledge the limits and general population. boundaries of medicine in general and within their own clinical specialties. Patients in a British study want professionals who are interested and sympathetic, involve them in decisions, Since this study was completed, the number of integrative give them sufficient time and attention, and provide medicine clinics and providers, with unhurried consultations advice on health promotion and self-care. A systematic and team approaches to treating the whole person, has review of the literature on patients' priorities for general grown significantly. Has the future of medicine arrived? practice care, which examined 19 studies published between 1966 and 1995, found that the most important Sources: Future of Family Medicine Project Leadership Committee. The Future of Family factor was “humaneness,” which ranked highest in 86% of Medicine: A Collaborative Project of the Family Medicine Community. Ann Fam studies that included this aspect. Med. Mar 2004; 2(Suppl 1): s3–s32. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466763/#r38 Detsky AS. What patients really want from health care. JAMA. 2011 Dec More than 10 years ago, through focus groups conducted 14;306(22):2500-1. http://www.ncbi.nlm.nih.gov/pubmed/22166610 in 10 U.S. communities, researchers identified what, Kay M, Mitchell G, Clavarino A. What doctors want? A consultation method according to patients, the doctor of the future should when the patient is a doctor. Aust J Prim Health. 2010;16(1):52-9.
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