Quite a few people ask me what I do, and when I tell them that I am a Family and Preventive Medicine Physician who helps people use preventive and integrative therapies to improve the health of my patients, they often say, “Awesome, that sounds great! But what is the difference between the two?” Please read along, as I explain the differences AND similarities of the professions, and how they are intimately connected and are ultimately used to promote health and prevent disease.
Primary Care is a well-known medical discipline, so I won’t spend too much time on it. But, in a nutshell, primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the “undifferentiated” patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis. Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g., office, inpatient, critical care, long-term care, home care, day care, etc.).
Preventive Medicine focuses on the health of individuals, communities, and defined populations. Its goal is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death. The purview of preventive medicine has traditionally been described to encompass primary, secondary, and tertiary prevention. The community is our patient, and we can go about diagnosing and treating the community using much the same thought processes as we do in treating individuals.Preventive medicine can be practiced by governmental agencies, primary care physicians and the individual himself.
Preventive medicine specialists are licensed medical doctors (MD) or doctors of osteopathy (DO), who possess core competencies in biostatistics, epidemiology, environmental and occupational medicine, planning and evaluation of health services, management of health care organizations, research into causes of disease and injury in population groups, and the practice of prevention in clinical medicine. They apply knowledge and skills gained from the medical, social, economic, and behavioral sciences.
Integrative Medicine may be described as orienting the health care process to create a seamless engagement by patients and caregivers of the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health throughout the life span. It is healing-oriented medicine taking into account of the areas of mind, body, and spirit. Integrative medicine combines the discipline of modern science with the wisdom of ancient healing. It emphasizes a holistic, patient-focused approach to health care and wellness, and treating the whole person rather than, for example, one organ system. It aims for well-coordinated care between different providers and institutions.
For people living with chronic or life-threatening illness, it can transform the physical, emotional, and spiritual dimensions of their lives. Integrative medicine may also be valuable to those who are not ill but wish to increase self-healing, and help prevent health-related problems.
In treating disease, we assess the patient using the conventional medical assessment including labs, diagnostic studies, and history and physical exam. Patient are integrated with medical treatment to help alleviate stress, reduce pain and anxiety, manage symptoms, and promote a feeling of wellness.
Why is all of this important?
The overlap between preventive medicine and integrative medicine can be viewed at the levels of prevention as stated above. As behavioral and lifestyle choices account for the majority of premature death in the U.S., targeting these areas can potentially provide the greatest benefit. For example, healthy behavior, notably diet and physical activity, and stress improvement, and can be linked to primary prevention. For secondary prevention, screening rates and utilization of preventive services for chronic diseases, such as, cardiovascular disease, diabetes, and certain cancers, can be improved. For tertiary prevention, integrative healthcare approaches for chronic disease can improve functionality, reduce illness, improve quality of life, and directly influence disease processes. For example, nutritional supplements such as fish oil and mind–body techniques have been used to treat Type 2 diabetes. An anti-inflammatory diet, nutritional supplements, and manual therapies, such as acupuncture, have shown promise in the management of rheumatoid arthritis.
The last two decades have shown an increasing use of integrative therapies, including complementary and alternative medicine (CAM). CAM includes therapies such as dietary supplements, acupuncture, special diets; manipulative therapies (massage, chiropractic); meditation; and other mind-body therapies, among others. We, as physicians, must meet our patients where they are. It is important to realize that our patients want to be healthy and will seek alternative ways to promote health if conventional medicine is unable to provide all of the answers. We must familiarize ourselves with current CAM therapies, and be able to have informed discussions with our patients when creating a healthcare plan that is both beneficial and sustainable for the patient.
The links between primary care, preventive medicine, and integrative medicine are now woven together so tightly, that it is almost impossible to practice one without the other. For those that are aware of this evolution in medicine will benefit patients the most; for those that are not aware of this will find themselves playing catch-up, as the healthcare terrain is everchanging.
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