High-tech, high-touch: reconciling technology and integrative medicine.

V is medicatrix naturae. Latin, from Greek, originally attributed to Hippocrates, translated as “the healing power of nature.” One of the core principles of the integrative medicine philosophy. We value nature and natural healing. We strive for homeostasis, for balance. We laud the healing powers of our planet and lament the erosion of her natural resources. Ecologically sustainable medicine—buzz words we use to champion the necessary greening of medicine— recognizes not only the impact of the environment on health but the impact of the practice of healthcare on the environment. We cheer recently published research documenting the positive effects of green spaces on human health. We strive to be models of health for our patients, adopting yoga or meditation or other practices designed to simplify our lives and harness the power of the mind-body connection for optimal healing. Yet we live and practice in an increasingly technology-driven society. E-mail and texting are default methods of communication, and our patients request that we “friend” them on Facebook and follow health advice delivered in brief 140-character bursts on Twitter. In fact, in a 2008 survey conducted by the Commonwealth Fund, nearly 90% of respondents indicated that they wanted their physicians to communicate electronically. Patients want high-tech doctors. But they also want more face-to-face time, more personal connections. The onslaught of high-tech has been blamed for rising disconnection and depersonalization in our communities. We worry about the impact on children’s minds and about the very nature of human interaction. In the increasingly complex world we inhabit, how do we reconcile our high-touch values with our high-tech realities? Communication, I believe, is the key shared value. Integrative Medicine promotes healing relationships and open communication as cornerstones of our philosophy. Indeed, as defined in 2004 by the Consortium of Academic Health Centers for Integrative Medicine, integrative medicine “is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.” It is notable that this statement emphasizes the importance of the relationship in healing. Regardless of the modalities a practitioner employs— drugs or herbs, surgery or acupuncture needles—it is the very nature of the connection between practitioner and patient that begins to define integrative medical care. It is the foundation of our work. In fact, we have research to support this common-sense contention. In a landmark 1987 study published in the British Medical Journal, Dr KB Thomas reported on his experiences with 200 patients in general practice. All patients presented with physical symptoms (eg, cough, sore throat, abdominal pain, headache) but demonstrated “no abnormal physical signs” and no definitive diagnosis could be made at that time. Patients were divided into two main groups: half were given a “positive” consultation (given a firm diagnosis and told confidently that they would be better in a few days) and half were given a “negative” consultation (told that it was uncertain was what wrong). In both groups, half were offered treatment (a placebo) and half were offered no specific treatment. When asked how they felt, two weeks after consultation, a significantly greater percentage of those given a positive consultation reported feeling better than those given a negative consultation (64% vs. 39%, P ! .01). Whether or not patients received prescribed treatment made no difference. The outcomes were predominantly predicated on communication between doctor and patient. Connection is crucial, therefore, to the practice of integrative medicine. Many of our tried-and-true healing remedies emphasize the power of human contact. In the most ancient, basic, and perhaps most poorly understood (from a conventional, scientific perspective) modalities, this involves touch. Hands-on therapies such as osteopathy, chiropractic, and massage are just a few of the many practices that rely on human touch for healing. The power of touch is tremendous. Even those practices that involve energy fields (eg, acupuncture, reiki) incorporate person-to-person contact as a core element. Sadly, this element of healthcare practice—the “touch” in healing touch—has become more and more removed from modern medical care. Practitioners and patients alike mourn the loss of face-to-face communication time. This is the mechanism by which, historically, we have established healing relationships. Especially in primary care, relationships that develop through 1:1 time spent together over many years are crucial to both patient and practitioner satisfaction. The previously cited Commonwealth Fund report points out that “our fragmented system rewards