Fort Bliss: leading the way for integrative medicine in the military.
Subject: Integrative medicine (Forecasts and trends)
Medicine, Military (Forecasts and trends)
Acupuncture (Methods)
Pain (Care and treatment)
Pain (Methods)
Author: Peterson, Jan
Pub Date: 03/22/2012
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2012 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Spring, 2012 Source Volume: 15 Source Issue: 1
Topic: Event Code: 010 Forecasts, trends, outlooks Computer Subject: Market trend/market analysis
Geographic: Geographic Scope: United States Geographic Name: Fort Bliss, Texas Geographic Code: 1USA United States
Accession Number: 282741114
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Col. Richard Petri, MD, was still a young resident in rotation in the Philippines when he was struck by an awareness of the possibilities of integrative medicine.

"My first exposure, I was actually the patient," recalled Petri, who was suffering from lower back pain. A Vietnamese doctor performed acupuncture to alleviate the pain. "It seemed to help a little bit in my acute pain. I had to put that in the back of my head that there were other treatments for conditions."

Petri earned his medical degree from Georgetown School of Medicine and completed his residency in physical medicine and rehabilitation from Walter Reed National Military Medical Center. With such training, he was well educated in conventional Western medicine. But that early lesson in complementary medicine stuck with him and today, 20 years later, Petri is at the forefront of complementary medicine.

In 2003, Petri was named director of the Department of Defense's first Center for Integrative and Alternative Medicine Center, at Fort Bliss, Texas.

"We started modestly with three modalities and gradually added additional modalities over time," Petri said. "We set the tone, at the least, that integrative medicine can be tried as medical treatment options."

When it opened its doors, the center offered only acupuncture, chiropractic services, and monochromatic near-infrared energy technology, which is used to speed healing of broken bones and wounds. Over the years, the center expanded to offer its patients mind-body medicine, Reiki massage, and biofeedback.

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It now has on staff two physiatrists, a chiropractor, nursing assistant, military medic, chiropractic assistant, medical support assistant, and a research director. Petri's staff serves an average of 50 patients per day in the acupuncture clinic, 30 patients in the chiropractic clinic, and 12 to 15 patients per day in the pain/physical medicine and rehabilitation clinic.

Petri said that, as with any change, integrating complementary medicine into the military healthcare system wasn't without challenges.

"For many reasons, change is met with skepticism and disbelief. Alternative medicine has at times been viewed as voodoo medicine with the science of colon cleansing and psychic surgery." "Like many changes over the course of time, change comes because of necessity. Over the past year, multiple negative press stories have highlighted the single-dimensional approach of our health-care system. This has had a positive impact for the exploration into the role of holistic philosophy of integrative medicine as a multidimensional approach," Petri said.

In fact, since the center opened at Fort Bliss, the use of integrated medicine has spread widely through the U.S. military. Petri said that a recent survey of 12 major military medical treatment facilities showed that 92 percent of them now offer integrative medicine.

Petri offers two points that may be behind this growth. First, complementary medicine is not that far afield from traditional Western medicine.

"Integrative medicine is not alternative medicine. That is, IM utilizes modalities with some known evidence for safety and efficacy with the typical Western medicine treatments ... Integrative medicine ... is the balance of both conventional and alternative medical practices," he said.

Second, the success of complementary medicine is measurable.

"Quantitative successes include decreased medication requirements and pain levels. Qualitative successes include increased function, decreased stress and anxiety, and improved quality of life," Petri said. "However, the most satisfying successes are the witnessing of patients' sense of control over their condition from a state of hopelessness. The patients begin to feel that they don't have to suffer because they have a chronic condition."

It's that last element that Petri finds particularly exciting.

"What I really like about patient-centered care is that we are placing the patient as the team leader, but more important than that, we are asking the patient to now be responsible for their condition and take ownership of their condition," he said.

"It changes the model from passive to active; it asks the patient to be responsible for their health."

Petri offers the example of a patient with diabetes: "They eat improper food, but when they're engaged in integrative medicine, they tend to take a more responsive role toward keeping their health."

But while Petri's example cites diabetes, he points out that integrative medicine's role in pain management is increasingly in demand because of the rising number of injured soldiers returning home.

"This is a challenging time within the military medical system due to the ongoing military conflicts. Never in the history of the United States have we had troops engaged in conflicts for such a prolonged period of time. Additionally, our technology has saved more lives than in other conflicts. More warriors are returning with significant injuries," he said. "Therefore, we have been challenged to excel in health care delivery. Integrative medicine ... expands our available tool kit of treatment options for the best possible outcomes for our wounded warriors."

Petri said he is working on an acupuncture training program to take acupuncture to the trenches, allowing soldiers to get the care they need where and when they need it. "The training is a three-tiered approach in which physicians, mid-level providers, and medic soldiers are trained in acupuncture approaches. The goal is to bring acupuncture to the soldier as far forward as possible. Another initiative is the training of soldiers in mind-body techniques (meditation, visualization, relaxation) which can be used in everyday life, on and off the battlefield," he said.

That training program is only one of the many integrative medicine changes planned for military health care providers.

"Fort Bliss in conjunction with William Beaumont Army Medical Center is undertaking a comprehensive holistic project of prevention and wellness known as Wellness Fusion Campus," Petri said. "The concept is one of empowerment of the person to be responsible for their own health and healing through the physical, emotional, social, family, and spiritual dimensions. Again, IM is an important component of the program."

Petri said the WBAMC is also developing new programs of integrative medicine for the Department of Defense for the treatment of traumatic brain injuries, combat stress-related issues, and pain.

A long-term goal is to develop an Institute in Integrative Health and Healing, a Defense Center of Excellence in Integrative Medicine focused on patient care, education, and research.

"I think the future for integrative medicine is very promising. Western medicine is defined as those modalities that are generally accepted as standard practice. As we prove the value of integrative medicine modalities through research and patient care, integrative medicine modalities will become western treatments," Petri said.

The possibilities excite Petri as much today as when he was a resident in the Philippines.

"I just think it's a great time to be in medicine. I kind of equate it to when they discovered penicillin or when they found the germs and they understood that there were microbes. I think we're in a new era of medicine," he said.

"For me personally, I haven't even started yet. We've got a lot of work to do. This is just the beginning."
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