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4. v 69 The American Acupuncturist 21 A Roundtable Discussion Mainstream Medicine and Integrative Patient Care: Who Gets to Choose? care to deal with the emotional aspects and psychological aspects of chronic pain. That was one reason why we thought bringing in a psychologist would be a good idea. The other reason was that we do some other procedures that require psychological evaluation, such as more invasive procedures that I hope you never need, but one of them, for example, is a spinal cord stimulator. As part of the treatment requirements, that was one example. So that's the second reason. The third reason was that many of us dealing with pain on a daily basis decided to certify in pain management as a subspecialty to ensure that we were not neglecting most of our patients' needs. We realized that to deal with a patient's pain would require access to the patient's psychological and emotional well-being. The healthcare system being so big and with those of us at the Spine Center being somewhat isolated, these circumstances in themselves created some barriers to having the center that we wish we had. Then there is the increase in demand nationally on physician productivity. Unless we had a dedicated pain center with funding, not necessarily insurance-based funding, it became difficult to acquire adequate resources to support this more comprehensive treatment. We professionals did not feel that it could be sustainable. And it is very unfortunate that I can't provide my patients with access to clinicians like our former pain psycholo- gist. I can tell you I was a very frequent user of his services for a lot of my patients. I was very satisfied with his services, and so I kept referring to him. I think having lost him, we lost some of that comprehensive approach. We have to rely more on outside consultations and use that communication element, whether a simple tap on the shoulder or a daily dialogue about our patients. But even that is a bit of a romantic view of medicine in general, because physicians are all so busy now that we risk losing that communication. You can still see better communication among healthcare providers in some other centers at Emory. That's where I think acupuncture has a better role. We do maintain affiliation with an outside private group that does acupuncture. ST: Are they working in your building? JGC: Until recently they were in the building. They're in the adjacent building now so they work nearby and we have access to refer patients to them. ST: Is that something you do frequently? JGC: In a way, it's mutually inspired with patients. We have bro- chures that promote acupuncture services for them. I don't neces- sarily mention that first when I'm still in the middle of work-up or diagnosis. I usually let my patients in the early phase inquire about that and we talk about that as an option. Most of my patients want to hear from the allopathic side, is it okay? Am I in danger doing this? Once we see that we can give our blessing for something as benign as acupuncture treatment, and it's within a group of people that have met the professional criteria to be affiliated with you, we have the peace of mind to move ahead. I should mention that probably I refer more patients to acupunc- ture in the end stages when all of my services have been explored. Why? Because it involves a cost to the patient, and to date, not all insurance companies are willing to provide coverage for that. I'm very careful not to recommend something that is out-of-pocket for my patients whenever possible. ST: That is unusually thoughtful in my experience. And when you do suggest acupuncture, are you able to follow up with the acupuncturist and see how that treatment is going? Have you had patients who have had good results from acupuncture come back to you? JGC: Yes, I have. Considering that it's so benign, my threshold to recommend it is low for that reason. Once again, we don't have all the answers so I have to remain open to that and other alternative treatments, such as physical therapy. With the acupuncturists that we have, we have local collaborative work. They do have access. They have contacted me after work. Sometimes they talk to me but it's not very clinically oriented. I don't think they have any access to medical records because of the privacy restrictions that any hospital like mine has. We don't have the full communication that I wish we had to answer your question correctly. You can probably see that better in a private setting. Private practitioners have a lot more flexibility than we do in a hospital setting. ST: I think this is a good time to bring in Dr. Wei Huang since she does practice in one of the clinical areas in the Emory University Healthcare system that we are talking about. How long have you been practicing, Dr. Huang, and how did you get involved in the kind of integrative clinic you have at Emory University and the Atlanta Veterans Administration Medical Center (VAMC)? WH: I had acupuncture training after medical school. I saw patients really benefiting from acupuncture and I wanted to learn about it, so I took a six-month course to get myself more familiar- ized with the techniques. I didn't really think too much of it, except as more of a curiosity than anything else. Then during the process, when I was doing my residency program, I had 2 attending physicians who were performing acupuncture. We had a very good complementary alternative medicine (CAM) rotation as well during my residency training. I was very lucky to be able to see different CAM modalities being practiced clinically and how patients benefit from them. As soon as I started practicing at Emory, I was into acupuncture. Initially I used it not as in the sense of an integrative approach, but rather if patients wanted acupuncture, I would try it. Later I felt that acupuncture has its pros, especially when it's integrated with conventional medical treatments, it does much better. Then I started doing more of an integrative approach, integrative meaning that I assess a patient for all his or her issues that could be hindering healing or functional recovery and then target selected treatments towards those areas. Those areas could be a person's physical health, I applaud the doctor for the immediate response and treating me at such a reasonable cost. CVS has almost double the amount of clinic locations than than Walgreen, yet, its rival has outpaced MinuteClinics revenue growth. 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