Case Study: How To Optimize Your Practice With Integrative Medicine Protocols
Contributed and reviewed by Dr. Andrew Krause, ND, Ashley Koff, RD, and Dr. Robert Silverman, DC, MS, CNS, CCN, CSCS, CKTP, CES, CIISN, DACBN, DCBCN, HKC, FAKTR
One of the distinguishing characteristics of integrative medicine is a focus on the individual. Integrative practitioners denounce the one-size-fits-all model of medicine, and patients are drawn to a more personalized approach. Fearing that their medicine will become a form of “green allopathy” or “cookbook medicine,” some integrative clinicians may even shun the use of protocols. (1)
While a focus on the individual is an unwavering principle of integrative medicine, it also presents challenges. Beginning with a blank slate and building a unique treatment plan for each patient can be incredibly time-consuming, and tracking down accurate and reliable information about integrative therapies can be an overwhelming task. In addition, the practice of integrative medicine, in an effort to become more mainstream, must adopt an evidence-based approach to therapies which should always serve as the foundation for protocol creation.
Practitioner insight
In thinking back to his early days in clinical practice, Dr. Andrew Krause, ND, says, “I was doing loads of research on my own about which diets, supplements, and lifestyle practices were best for each patient. Many topics required exhaustive research because they were not broadly or completely studied.”
Practitioners research diets, supplements, and lifestyle changes to create an integrative approach to any condition.
Practitioner insight
Dietitian, Ashley Koff, RD, recalls similar struggles. “Before I used protocols, I was always writing out the same stuff or going back to old notes, copying, and then editing.”
Most new practitioners rely on a combination of their own research, information from supplement companies, and the experience of trusted peers. The process of developing treatment plans from scratch is inefficient and doesn’t deliver consistent results.
As medical research advances—and practitioners feel intense demands on their time and energy—it’s increasingly difficult to deliver well-researched treatment plans that are customized for each patient. More than ever, integrative clinicians need reliable tools to provide high-quality and effective patient care.
Practitioner insight
One of the tools that many practitioners have turned to is evidence-based integrative medicine protocols. According to Dr. Robert Silverman, DC, MS, CNS, CCN, CSCS, CKTP, CES, CIISN, DACBN, DCBCN, HKC, FAKTR, “Protocols are a great starting point for patient care. The ability to utilize, personalize, and individualize their implementation has enabled me to obtain better clinical outcomes.”
Instead of viewing protocols as contradictory to the ideals of integrative medicine, maybe it’s time to see them as an indispensable tool for delivering personalized patient care.
What are evidence-based integrative medicine protocols?
The concept of protocol-based care is ill-defined but not complicated. (2) The term “protocol” is often used interchangeably with practice guidelines or pathways. Protocols provide structure and a plan when approaching a patient case. Practitioners are expected to rely on protocols as guidance and to use clinical judgment to customize each plan.
Whereas protocols are common in the conventional medical setting, they are less frequently used by integrative practitioners. An evidence-based integrative medicine protocol is unique because it includes suggestions for the use of complementary therapies, such as nutrition and movement, in addition to vitamins, herbs, and other nutritional supplements.
Evidence-based integrative medicine protocols rely on a review of current research as well as input from authoritative practitioners. Depending on the organization that publishes the protocol, recommendations must meet specific criteria for the strength of evidence. This means the hard work of compiling research-backed and clinically relevant information has been done for you, the practitioner.
Evidence-based protocols are not intended to dictate treatments, but rather to serve as a launchpad for patient care. They provide a foundation from which practitioners can then personalize treatment plans—based on allergies, preferences, and the unique biochemistry of each patient.
3 benefits of evidence-based integrative medicine protocols
Evidence-based protocols can be indispensable to running an efficient and successful integrative medical practice. For practitioners who are new to practice, protocols provide reliable advice and a strong foundation for treatment plans. For practitioners with years of experience, protocols provide updated guidance on the most current therapies. Consider the following three benefits of evidence-based protocols in practice.
1. Protocols create clarity
Developing a treatment plan for each individual patient without a roadmap to follow can lead to an inefficient visit and a patient not sure about the next steps. During a visit, a lot of information is shared and discussed. It is the goal of the provider to leave each patient interaction with a well-developed and clear path for health improvement. By utilizing protocols within a practice, the provider can deliver a focused plan to share with both the patient and their staff that encompasses each particular aspect of the patient’s journey.
Evidence-based protocols provide a foundation to stand on when delivering patient care. Beginning with a protocol, you can then fine-tune the details for each patient.
Practitioner insight
“Protocols are a starting point,” says Koff, “from which I can personalize a recommendation.”
Greater focus and clarity frees up mental energy for better decision-making. Your staff will learn what to expect, and your patients will sense that you are consistent and clear. That means, most importantly, that patients receive better care.
2. Protocols save time
Researching patient cases can place a significant burden on a clinician’s time. New practitioners might spend hours outside of patient visits, preparing thoughtful and well-researched treatment plans. These hours are not reimbursed and increase overhead expenses. Over time, a lack of efficient systems is unsustainable.
Practitioner insight
Evidence-based protocols can play a key role in optimizing the efficiency of patient care. Dr. Krause says, “the time savings comes from not having to do continual research on the same thing every subsequent time.”
Personalizing an existing protocol inherently takes less time than devising each treatment plan from ground zero. Patients receive more efficient care, practitioners have more time for patients, and the stage is set for practice sustainability and growth.
3. Protocols build trust
When patients ask for a recommendation, the last thing they want is for their practitioner to flounder or stumble over words. Without a plan, you may lack the confidence to answer without hesitation. To earn the trust of your patients, they need to sense that you are competent and confident. Part of that comes from having a plan.
Well-researched protocols ensure practitioner confidence when recommending patient wellness plans.
Evidence-based protocols could be part of what builds your confidence and earns trust from your patients. A vetted protocol allows you to make recommendations with authority and achieve more predictable results.
Practitioner insight
Dr. Silverman says, “Protocols allow me to record a starting point for care and, ultimately, document outcomes.” As a result, patients should experience better care and develop further trust for integrative medicine.
Evidence-based integrative medicine protocols in practice
In contrast to the notion that the use of protocols might depersonalize medicine, many integrative practitioners are relying on protocols to deliver individualized and personalized patient care.
Practitioner insight
“I often rely on evidence-based protocols as a starting point for research on a health condition I haven’t treated before,” says Dr. Krause. “They help me understand broad research on a topic without having to read countless individual research papers.”
If you are new to using evidence-based integrative medicine protocols in practice, consider following these three steps:
1. Identify reliable sources for protocols
Practitioners can source protocols from government databases, journals, professional organizations, supplement companies, or expert practitioners in their field of expertise. (3) Not all of these protocols are considered to be evidence-based, but all of them can provide helpful guidance and a plan. High-quality protocols will combine information from both research and clinical experience. The recommendations are often supported by scientific studies, and the protocols reviewed by a panel of clinicians.
2. Personalize protocols to each patient
Protocols are not a substitute for clinical experience and judgment. Some patients will only need part of one protocol, whereas others will need a combination of multiple protocols. Every time a protocol is used, it should be personalized to the patient.
3. Refine protocols to make them your own
Many practitioners take published protocols and modify them over time based on their clinical experience. If you see great success with a particular intervention, for example, you can add it to an existing protocol. You will likely find that your art of medicine shines through, and you end up making protocols your own.
Evidence-based protocols for practice success
Evidence-based protocols may seem contradictory to integrative medicine’s focus on the individual. Despite this paradox, many clinicians are utilizing protocols as a tool to deliver highly personalized patient care.
Practitioner insight
“I use protocols as a starting point, like a baseline, in my practice,” says Dr. Silverman. “As I’ve stated earlier, I personalize and make the protocol the patients’ own to allow the patients to reach their genetic potential.”
Protocols can improve efficiency, effectiveness, and patient success.
Practitioner insight
“Anything that makes me more efficient and that helps provide a combo of evidence and practice-based insights,” says Koff, “makes me a better practitioner.”
The bottom line
Maybe you need more clarity and focus in your practice. Maybe you need to save time. Maybe you want more confidence to build trust with your patients. Evidence-based protocols can do all of these things—and improve patient care. Integrative medicine protocols may be the key to unlocking the potential for your practice success.
