How would you design a new integrative Oncology Program, or else expand the scope of an existing one in your Medical Center? This is the final session in the present course on Integrative Oncology during which we will offer practical ways in which Integrative Oncology can be promoted within individual Cancer centers, as well as on a National and International level. We will return to some of the leading integrative medicine Practitioners, interviewed in earlier chapters in order to hear about their experience with creating an integrative medicine service within the Conventional Oncology setting. This should give you a better idea on how to proceed with establishing a similar program in your medical setting, or else improve one that currently exists. The first to be asked about his experience in setting up an integrative medicine service is Dr. Elad Schiff. Dr. Schiff describes the integrative service in his hospital setting. Listen carefully to how he describes the process of what he defines as selection, with the need to step in as well as where, to begin with what. We started seven years ago in this General Surgery Department. It was the pilot department for integrating complementary medicine in the hospital setting. We selected the surgery department because we knew that the needs of the patients are quite repetitive. So, patients are anxious before surgery, they're painful after surgery, they're nauseous after surgery, and they need a rehabilitation process after recuperate from the surgery. So, it was quite a clear understanding where we need to step in. We could educate the complementary medicine Practitioners on building protocols or to address these common symptoms in the hospital setting. Therefore, the general surgery department was seemed as the best place to begin with. One of the most important steps in establishing the new integrative program, within the conventional medical system, is to choose the setting where the integrative interventions will be able to most significantly impact supportive care. Dr. Schiff, found that the best place to start in his hospital was in the surgery department, especially in the perioperative setting. Although he's the head of an internal medicine department, Dr. Schiff 's relationship with the surgery stuff at his hospital enabled him to implement a productive collaborative venture which then expanded to additional settings in the hospital. Think about where you should start at your institution, where you can find colleagues who you may have worked with in the past, whether in a conventional or non conventional capacity, a department or clinic where you could provide much-needed supportive care with an effective and safe environment. In the next segment of this interview, Dr. Schiff talks about the importance of acknowledging the need to prepare both the conventional HCPs, physicians, nurses, and others, as well as the CIM practitioners. Well before opening the integrative medicine service, according to Dr. Schiff, at the initial stage of the integrative medicine service, it is more important to focus on being integrated and less on the doing integrative medicine. Integration into hospitals is very challenging because in the hospital setting, patients are in acute situation. They are in a very hectic, energetic, unhealthy situation, and it's a risky environments. So, really to bring complementary medicine practitioners,into the hospital is a risky endeavour. So, we had to prepare both the complementary medicine practitioners, and the departments themselves, the physicians, the nurses, the paramedical teams to prepare themselves for the integration. It was a long process, I would say, 1, 2 years to do that. Then we started the integrative service itself where we provide complementary medicine. We integrate complementary medicine into departments where the patients are, where the Physicians are, where the Nurses are, there, you will find also our Practitioners. First what we did, we assessed the needs of the conventional medical team. We talked with the nurses, we talked with the head Nurses, with Matrons, we talked with the Physicians and asked them where they see themselves providing a less than effective treatments, where they feel their hands tied. In those areas, we sought to see if we can provide better health. So for instance, pain management it's not a secret, isn't good in the hospital settings. Patients are very anxious before they go through procedures, through surgery. The conventional medicine is quite limited in the help they can provide patients. We assess those needs through conversations, with the conventional team and also with patients. After understanding where the limitations are of the conventional medicine, then we researched if complementary medicine can provide some benefits. In our interview with Prof. Moshe Frenkel, we heard about two integrative Oncology settings in which he was able to establish an Integrative Oncology Iervice. The first is a former medical director of the Integrative Medicine Service at the MD Anderson Cancer Center in Houston, Texas. The second is the current Director of an Integrative Oncology services, at the Mayo Medical Center in Israel. First of all, when you come to our Oncology Center, you have to learn the environment that you're working in. You don't come up with flags doing integrative medicine and this is what I'm going to do, you'd coming up with just to observe the specific center that you're going to be working in. Learn the people that are actually working there, and see how you can utilize a plan that is a win-win plan, that everybody can benefit from it. Coming up from outside with a very organized plan, to a new place is not always beneficial or going to be successful. So, the first thing is you have to learn the place. When I came to MD Anderson I told them that I want to learn four months. "I just want to learn. Don't expect me to open anything. I just want to learn the culture of the institution." When I came to Mayo, I sat down for four months and I didn't see even one patient. I just wanted to see what you're doing, what's the atmosphere in the actual institution, how it's moving. At the next stage of setting up the Integrative Oncology Program, Prof. Frenkel recommends that you know what type of treatments you're going to utilize. This refers not only to a list of specific complementary medicine modalities, but also to a process in which you can establish a professional training program, for the integrative medicine practitioners, so that they can think out of the box. The second part is you have to know what type of treatments you're going to utilize. I think there's a few things that are essential to have in Integrative oncology. One is something that relates to nutrition. Then the second part is complementary therapies. The minimum that you have is acupuncture and some kind of a body or a touch therapy that you can actually utilize. The third part is to have something that relates to the mind, the spirit. If you can combine all three in those practitioners, that is the best. Practitioners not always are coming with that kind of a feeling, they coming with, they have to do acupuncture, that they've to do reflexology. You have to change them a little bit and say, "You're an integrative practitioner that actually integrates a few modalities in the care that you provide to the patients." Integration is a complex process, especially when trying to bring complementary medicine professionals on board. Some of these practitioners may feel that becoming integrative requires them to become more medicalized with a risk of losing their professional identity. In the following interview, Sharon Kotzer, a non-medical professional, who works as an herbalists speaks openly about the benefits of an open-minded, dialogue taking place in the integrative setting with the participation of both sides of the medical spectrum. It's important for us, from people who come from herbal medicine, from traditional herbal medicine not to lose our way. It means, not to be came to scientific. We need to keep our tradition. Doesn't matter if Chinese, or Vedic, or Western, we need to hold to it because it's very real
