Transcription of Dr. Elizabeth Strawbridge for the show Summer Wellness, #97
Lisa: As listeners of our show know, I am a big fan of integrative medicine and in fact I’ve practiced integrative medicine myself and on acupuncture and traditional Chinese medicine on nutrition counseling, lifestyle work with my patients for many years so it is a great privilege to be able to spend time with another physician who actually trained in the same program that I did at Maine Medical Center and the Maine Medical Center Family Medicine Department who is out doing integrative medicine but in slightly different way.
Today I have with me Dr. Liz Strawbridge who offers integrative medicine and acupuncture consults right here at Maine Medical Center in Portland. Thank you for being with me today.
Liz: Thank you so much for having me in the show.
Lisa: Liz, you went further beyond the family medicine training and you actually done an integrative medicine fellowship also here at Maine Medical Center. Tell me what that was like.
Liz: It was actually a huge breath of fresh air. It felt like coming home. Throughout my entire medical training, I always felt like it was a little bit too cold and impersonal. As the mystery of health and healing was removed, I mean that’s the goal of our medical training is pure objectivity so anything that was left to the unknown was not very important. To me I found that to be the most entrusting and exciting and creative part of health and life is that necessary and so going back in studying integrative medicine which really just means incorporating all sorts of different healing modalities and cultural ways of healing into our perspective has really I think fulfilled what I was looking for when I went into medicine in the first place.
Lisa: Listeners of our show have heard our interviews with Dr. Craig Schneider who’s the director of the Integrative Medicine Program and also Dr. Steven Donnelley and how they’ve created their own integrative medicine approaches. Yours is slightly different in that yours is inpatient versus outpatient and inpatient means in the hospital. What types of things can you offer people in the hospital that you might not be able to do in the outpatient setting?
Liz: There are a few things. In the inpatient setting people are usually in the higher stage of acuity so their illnesses are … they’re suffering a little bit more strongly with their illnesses or came in for something like a heart attack for the first time so people I think are both more vulnerable and possibly open to alternative ways of healing and also I think they’re more motivated to change because they have likely undergone some strong attack to their health. They are in a place where they’re ready for new ideas, ready for dietary and lifestyle changes where they might not be ready to take that step just in the outpatient setting.
I found that working on the inpatient wards has been really rewarding especially doing some of the alternative techniques like acupuncture, hypnotherapy, guided imagery, breathing techniques. People really respond well and sometimes more powerfully than I’d felt like they responded when I was doing outpatient medicine.
The other thing that has been really wonderful being in the hospital is broadening the perspective of other practitioners whether it’s physicians, nurses. The whole culture of the hospital has been very open and welcoming but also really had been curious because a lot of them have not been exposed to integrative medicine and so I think in some respect, it’s been very educational for our health care community in general. In the outpatient setting, most people who seek out integrative medicine are already on the path to wellness in some respect so when people are surprise to see me walking around in the inpatient setting, I feel like I’m spreading the word.
Lisa: When I was resident at Maine Medical Center, they were offering osteopathic consultations with Dr. Bryan Beck and I understand there’s been another osteopathic physician who’s joined him and they were also starting to offer Reiki which is not exactly healing touch, but there is an energetic component to it. There was a little bit of an entrée for you. Was there any problem at all getting the people in the administration or within the family medicine department who embrace the type of work that you wanted to offer in the hospital?
Liz: I was really lucky because I’ve been practicing in the outpatient setting amongst other family doctors. I was able to gain their trust earlier on and I think having been a resident in the family medicine program and know a lot of the doctors at Maine Med especially Ann Skelton who was very helpful in getting me credentialed to work in the hospital. I was lucky from that perspective and I don’t know if I had been in another community or tried to do this in another community where I didn’t know a lot of the local physicians if this would have been a possibility.
I’m very lucky for that and certainly Dr. Beck has paved the way. He has been doing this for several years and started off with very few patients and now he has a list that he can barely get done by 6pm at night, so he’s really paved the way and has gotten the attention of a lot of doctors that there are other ways of treating pain and many common problems that we often reach our pharmaceuticals.
Lisa: Looking at the curriculum of the integrative medicine program at the University of Arizona which is the program that Maine Medical Center is affiliated with, it is very evidence-based. Some people have had concerns about things that are “unproven” but the reality is more and more of this is proven. We’re taking what has been known in some way anecdotally for a long time and now getting the research to back it up.
Liz: Yeah exactly and some things that aren’t proven, there’s a very low risk profile so Dr. Wyle in the University of Arizona, they’re prospecting and I agree with it is if there’s the potential for great benefit and there’s a very low or minimal or zero risk but there isn’t a randomized control study about it, then because of the low risk then I would say it’s worth a trial for the patient and that there’s a possibility that it might be helpful, but certainly I try to fit into the mold of evidence-based integrative medicine.
When I see patients in the inpatient setting, in my notes I usually document references of studies that have been done or just stay there, aren’t any studies on this but there are very little chances harm being done so that patients and other physicians who read my notes are aware of the data that’s out there.
I think I believe wholeheartedly in evidence-based medicine but it does has some shortcomings because nobody is out there really funding the studies that need to be done so it’s hard to try to bridge the two worlds, but I do see that a little bit as my role given the western medicine training. I think we have to keep within the realm of comfort of western medicine trained physicians in order to have them gain our trust that perhaps there are other modalities out there that could be helpful.
Lisa: What types of problems do you find that you’re most effective with in the inpatient setting?
Liz: It’s interesting I have the… things seem to come in waves. I remember this happened even as a medical student or resident that all of a sudden we get a ton of patients with pneumonia or stroke and you just see things in clusters. Currently, I’ve been doing a lot of work with pediatric oncology patients. There’s so much that can be done in the alternative world for them including a lot of mind-body therapies. I do accupressure with tuning forks so for kids who are needle-averse or anybody who doesn’t want needles or acupuncture, I use acupressure points and use sound healing with tuning forks on the points and that’s actually very relaxing.
I do a lot of diet and nutrition counseling as well as exercise and mind-body works such as yoga. What I try to do is create a whole treatment plan for patients so that when they leave the hospital, they have a document that goes through all these different modalities and give them an outline of a diet or plan for an exercise program as well as if I recommend yoga or tai-chi, I’ll give them a contact information websites that I would recommend for them to see or if it’s self-hypnosis or guided imagery I will again connect them with resources so that they can continue the strategies that we begin in the hospital and continue them as a whole lifestyle change when they leave.
Really as I’m saying I’d see a gamut of things and for awhile I was seeing a lot of cystic fibrosis patients, irritable bowel, inflammatory bowel, migraines, insomnia, fibromyalgia, post operative pain, nausea and vomiting associated with chemo so it run pretty much any diagnoses that’s amenable to integrative techniques but those are the ones that I’ve seen the most. I think the other practitioners in the hospital really think of when they think of me it’s often in the context of how to control their patient’s pain so that’s probably being the number one reason for consultation.
Lisa: You’re about a year into this I think?
Liz: About seven months.
Lisa: Seven months into it?
Liz: Yeah.
Lisa: It’s always hard the first year, some would say even harder the first five years. What are some of the lessons that you learned from doing this very different thing that most doctors wouldn’t even think that they have the training to do?
Liz: One thing that has been so important is just facing a lot of my fears. I think it’s really hard to be the fish swimming in the wrong direction in the hospital, so I’ve spent a lot of time really trying to back up what I preach. Like I said I always reference studies and I’m really trying to fit into the world of the physicians and that’s been a little bit challenging for me and I’ve had to gather a little bit of courage when I recommend an herb and I feel like I have to explain it and also ensure that it won’t interact with any other medicines and show the data and really trying hold up my torch so that it withstand the questions and skepticism of some other physicians.
The second thing I think that’s been really important is they could tell you make it and we did … and part of the integrative medicine training we did something called laughing yoga where you just start laughing and you’re faking laughing and then before you know it you’re hysterically laughing for real. Some of the things I had studied a lot of the guided imagery and hypnosis but when you’re starting no matter what you’re starting, you want to come across as an expert. Now, I’ve been doing this for several years and I feel like I am very comfortable but in the beginning I have to pretend a little bit. I have to pretend a little bit and I think I’m now hysterically laughing for real but it was hard in the beginning to really feel like an expert.
I think every doctor goes through that in any shape anyway. You sort of have the impostor syndrome. The people expect you, they call you doctor all of a sudden you’re a medical student one day a doctor the next and what happened except when I sleep. I think that’s a common theme in medical practice in general, but certainly it felt little bit more powerful now that I’m doing something very different in a very mainstream world.
Lisa: I encourage people to go to your website healmaine.com and find out more about the integrative medicine and acupuncture consults that you’re offering at Maine Medical Center. We’ve been speaking with Dr. Elizabeth Strawbridge. Thank you for coming in and thank you for the work you’re doing.
Liz: Thank you so much.