Case Conferences on Integrative Medicine – a New Tool to Improve Patient-Centred Care in Medicine

Abstract

Complementary and alternative medicine (CAM) is frequently used with patients in industrialised countries. Although the high demand for CAM and the number of CAM practitioners clearly show that CAM is very popular, there is a considerable lack of discourse and cooperation between those physicians who practise complementary medicine, those physicians who practise conventional medicine, and physicians who practise different forms of complementary medicine [1]. Moreover, there is often little or no communication between patients and their conventional physicians regarding CAM use [2]. Therefore, it is important to increase transparency and enhance communication in order to facilitate the best possible patient-oriented health care. In view of this aim the ‘Dialogue Forum on Pluralism in Medicine’ has introduced in 2006 a new tool for the communication between practitioners of complementary medicine and practitioners of conventional medicine, the case conference on integrative medicine (IM) [3]. The ‘Dialogue Forum on Pluralism in Medicine’ was founded in Germany in 2000, with the objective of initiating a structured dialogue between representatives of different therapeutic approaches, and of contributing to a patient-suitable and effective IM [4]. Since 2006, 8 case conferences have been held. The aims of the case conferences are to facilitate the dialogue between conventional and CAM physicians and to discuss the potential of IM approaches with regard to specific patient cases. The term ‘case conference’ was chosen in analogy to clinical conferences in hospitals in which medical cases are presented and discussed in detail. The case conference consists of a panel of physicians who are well-trained experts in either conventional medicine, CAM, or both, and chaired by one or two experts. Further participants admitted to the conference are physicians or individuals interested in the case and in discussing the findings with the experts. The length of each conference depends on the number of experts of conventional medicine and CAM (at least 1 expert of conventional medicine and 2 CAM experts are required) and ranges from 90 to 180 min (fig. 1). After a short introducing lecture on the background, concept, and aim of the case conference, the expert panel is asked to develop integrative medical diagnoses and therapeutic strategies taking as a starting point the particular patient case. The first case conferences held were about chronic disorders. In 3 cases a real patient was presented at the conference, which apparently stimulated the discussion of the case. In order to facilitate their participation in the conference, the members of the expert panel had received details on the case 2–4 weeks in advance in order to prepare their statements. After these statements, experts and audience can take the opportunity to ask the patient or the presenter for details regarding the patient’s presenting history and symptoms. After presentation of the patient’s case, possible diagnostic procedures and treatment options from conventional medicine and from different fields of CAM (e.g. naturopathy, homeopathy, anthroposophic medicine, acupuncture) are presented, each for 10 min. After a short break, the experts draft dialogue possibilities between their respective field of complementary or conventional medicine in another 10-min statement. Afterwards, experts and audience are invited to discuss common grounds and limitations of the presented treatment options as well as future treatment strategies. The first case conference was held in December 2006 [3]. The cases of 2 patients with chronic pain diseases, one with fibromyalgia and the other with irritable bowel syndrome, were presented resulting in an interesting and constructive interchange of treatment options and discussions on how to treat these patients with IM. Initially, the discussion on definitions and boundaries between conventional and complementary treatment strategies had been fruitless and without results. However, when the focus turned to the patient and their complexity as an individual, the different points of view were brought closer together and the diversity of perspectives was perceived as a valuable resource for promoting individualisation in medical treatment. To continue this discourse further case conferences in IM were recommended. So far, a series of 6 case conferences have followed this groundbreaking conference all focusing on patients suffering from chronic diseases. The first international case conference took place in November 2009 at the ‘2nd European Congress of Integrative Medicine’ in Berlin, Germany. An experienced panel of experts of both conventional medicine and CAM developed integrative medical diagnoses and therapeutic strategies for a patient case with chronic