Franklin Perry, M.D., Ph.D.
Rainbow Medical Corporation
Pain Management & Internal Medicine
2175 Park Boulevard, Palo Alto, CA 94306
650-330-3688/Fax 650-330-3686
A PROPOSAL FOR A NEW “RAINBOW” (TAKE 2.3)
Introduction
With over two decades of experience working with chronic pain patients, I have concluded that patient outcomes may be improved significantly when treatment is provided by a multi-disciplinary team of professionals who have traditional and non-traditional training. A “whole person wellness” approach can reduce recovery time and dependency on pharmaceutical compounds and increase personal productivity.
We plan to recruit a team of individuals to develop and to implement a holistic, or integrative medicine, approach to the treatment of persons with chronic pain and related illnesses.
Despite widespread recognition of a crisis in the American healthcare system, what to do about the problem remains controversial. As costs rise inexorably, quality seems elusive. Our failure to adequately address chronic illness, particularly chronic pain, has been a major contributing factor. Every patient with chronic pain represents a failure of our current medical and healthcare system.
We are developing a plan to apply what we know about improving the health of those with chronic pain and to research the effectiveness of various approaches to the problems of the chronic pain population. Goals include reduced suffering, increased quality of life, and net savings in health care expenditures. My colleagues and I will develop a program of integrative medicine, combining allopathic medicine with “complementary and alternative” healthcare approaches, such as mindfulness practices, psychotherapy and other forms of counseling, chiropractic, body work, acupuncture, Chinese medicine, movement therapies, physical therapy, nutritional counseling, etc. Using a quality improvement model, we will also systematically evaluate the effectiveness of our work for our patients and clients to determine which approaches are most useful for which types of problems and persons.
We welcome the participation of interested individuals. We need ideas, energy, time, and, yes, money from like-minded individuals willing to help make a transformation of pain a reality.
Towards a Plan:
We know much of what is involved in achieving and maintaining optimal health. Furthermore, anyone can become healthier. Unfortunately, the approach of modern medicine has been an increasingly reductionist focus on disease and injury. Little in medical practice concerns health or what health might be. A useful conceptualization of health is “wholeness”. A person is a “whole person”, even with one or more body parts missing. I propose that helping persons to experience and to manifest their wholeness is in fact what healthcare should be.
The requirements for good health include optimal nutrition, bodily movement (aka exercise), adequate sleep, intimate and other social interactions, “spiritual” practices, “positive” attitudes, community involvement, stress management, avoidance of toxins and addictions, a healthy environment/ecosystem, and love (for self and others). Medical care when necessary for diagnosis and treatment of diseases and injuries and for prevention as well (e.g. immunizations, blood pressure & lipid monitoring, etc.) can make a significant contribution to health and healing, although a small one compared to that of behaviors and public health efforts.
Pain is part of the human condition. Nociception clearly has survival value; we have evolved nervous systems with elaborate nociceptive networks. Chronic pain, however, unlike the acute pain of tissue damage or threat of tissue damage, has no survival value. Chronic pain in fact can be viewed as a disease (or dis-ease) condition in its own right. Chronic pain may be conceptualized as a mis-perception of ongoing tissue damage, when the underlying condition has had more than enough time to heal. Still, time enough to heal does not necessarily mean that healing has occurred or been completed. Certain diseases such as rheumatoid arthritis, for example, involve on-going or recurrent episodes of inflammation and damage to tissues. Nevertheless, I propose that any person, no matter how persistent and/or severe their pain, can be healthier, that is to say, more aware of their wholeness and healing.
How can we do this? On one level, as noted previously, we know many of the factors, behaviors mostly, that are needed for optimum health. Consistently performing these behaviors, however, or helping others to consistently perform these behaviors, remains problematic. For example, by now, certainly every American teenager and adult knows that smoking tobacco is harmful to health, but many begin to smoke every year, and many more smoke tobacco habitually in the U.S., despite multiple techniques and tools for smoking cessation. A similar situation prevails with regard to many other seemingly intractable health problems, such as obesity, heart disease, cancer, substance abuse/addiction, and the so-called psychosomatic illnesses (e.g. fibromyalgia, migraines, etc.). Nevertheless, we have managed to identify some approaches that can help change harmful behaviors or habits into healthful behaviors and habits. Unfortunately, even the best practices cannot help if they are not available, and many who could benefit from these practices do not get them, due to ignorance, financial barriers (including the expectation that health insurance should pay), and insufficient motivation.
One key to success, I believe, is the approach called mindfulness. Experience and data suggest that people with chronic pain (and other chronic illnesses) who learn and practice mindfulness (e.g. MBSR, Mindfulness-Based Stress Reduction) can achieve an “orthogonal rotation” in their perceptions and come to “own” and to manage their health problems, a process that includes reduction of suffering and improvement in overall self-care and quality of life (see Jon Kabat-Zinn, Coming to Our Senses).
We can set up a healthcare system that actually promotes health and wellness. Typically, chronic pain cannot be completely eliminated. As a subjective phenomenon, pain cannot be measured with much validity. Many have proposed that the aim of treatment of chronic pain ought to be increased functionality. While this view has merit, as function can be to some degree measured objectively, patients are interested in more than improved function; they want relief from pain and suffering. Moreover, we all want the maximum possible quality of life (QOL), another difficult-to-measure concept. We will seek out the best available measures of QOL and use them as a major part of our assessment. We may in fact have to modify available measures or even to create new ones.
Considerable evidence indicates that the most successful treatments for persons with chronic pain involve the “multidisciplinary” approach. Multidisciplinary pain clinics tend to be expensive. Third party payers often want to pick-and-choose among the recommended treatments. Chronic pain is a multifactorial problem, however, and the most successful approaches therefore address the problem from multiple perspectives, e.g. analgesia (via medications, acupuncture, heat and/or cold, nerve blocks, hypnosis, etc.), cognitive behavioral psychotherapy (to address the emotional, attitudinal, motivational, etc. aspects), physical therapy/rehabilitation, stress management, chiropractics, exercise, etc. The model commonly used in multidisciplinary pain clinics includes a comprehensive assessment by a team of providers with different areas of expertise and subsequent development by that team of a treatment plan to be carried out by some or all of that team, as well as others to be determined by the needs of the patient. In our holistic or wellness model, ourteam will include “complementary and alternative” practitioners, therapists, counselors, nutritionists, etc., as well as allopathic physicians, and our treatment plans will include preventive efforts, patient education, “energy” practices, mindfulness, movement training & practice, counseling/psychotherapy, and others as deemed necessary.
Some questions to be addressed:
1. How will this be funded? I am uncertain of the best model, but obvious options include total self-pay (a “cash practice”), acceptance of PPO-type health insurance, acceptance of Medicare, Workers’ Compensation, other governmental (e.g. grant) support, or some mix of the above.
2. We can begin this in Rainbow Medical’s current facility (2175 Park Boulevard, Palo Alto). Later we may need a larger facility that can more readily accommodate more providers and more patients.
3. Do we need investors? If so, how can we find and approach them?
4. Should we affiliate with a large institution? We might approach PAMF and/or Sequoia Hospital, for instance, with proposals. This is a bridge we may consider crossing after we have demonstrated success with our treatment approach.
5. What can we learn from others who are doing somewhat similar projects? Examples include the Osher Center at UCSF, the local “functional restoration programs” (e.g. SPARC, HELP, and BAPW), the Queen of the Valley Wellness Center (Napa), Dr. Brauer’s practice in Palo Alto, Kaiser, Scripps Center for Integrative Medicine in San Diego, etc.