Hypertension-prone Barry Taylor wishes he could spend more time at the doctor’s office, even though he has been going about three days per week for more than a year.
Taylor relishes the experience, like the sound of water trickling down the glass wall of the doctor’s waiting room. An emergency room doctor had recommended he seek out Duke Integrative Medicine after treating him for an episode of hypertension and hearing Taylor’s thoughts on alternative medicine. Taylor attends weekly group meditation sessions, which are followed by lunch gatherings out on a garden patio.
“I went into the foyer and immediately had this feeling like I was home,” Taylor recalled of his first visit a year and a half ago. “It’s what I was looking for a whole long time, and I didn’t know it existed.”
Tucked away in the forest of the Duke Center for Living Campus near the intersection of Erwin Road and Cameron Boulevard, the Duke IM complex serves the mission of the Duke University Health System with a holistic blend of conventional and alternative medicine. Services and treatment programs range from massage therapy to nutrition counseling to stress management classes, as Duke IM integrates medical techniques from different sources.
“I was expecting like a seven-story Duke Medicine high-rise,” Taylor said of his first visit to the center in February 2010.
Taylor, who spent five years in Japan, said Duke IM’s philosophy of medicine is reminiscent of Eastern holistic methods, which allows patients to pay doctors based on how healthy they are.
Dr. Victor Dzau, chancellor for health affairs and president and chief executive officer of DUHS, said integrative medicine improves medical services by looking at the whole of an individual, rather than focusing on the treatment of isolated symptoms or conditions.
“The most important thing is they get the evidence that certain things work and give the patient more than the traditional treatment,” he said. “What we’d like to see in the long run is that every patient is treated this way.”
The facility opened Nov. 2006, with examination rooms, yoga studios, acupuncture and massage therapy facilities and a labyrinth. Duke IM also features a library constructed of warm wooden beams and glass, facing a thick line of trees receding past the curve of the Duke IM building.
The theory of integrative medicine can sometimes confuse prospective patients with its unique definition.
“Integrative medicine combines conventional medicine with evidence-based modalities from non-Western traditions,” Duke IM Director of Communications Isabel Geffner said. “We practice Western medicine here in the U.S. That doesn’t mean that’s what they do in India or China or Japan or many places around the world where there are lots of really healthy people.”
Evidence-based, alternative medicine
This approach provides the benefits of advanced medical technology along with research-tested complementary and alternative techniques, Geffner said.
“It’s chest X-rays and acupuncture, it’s throat cultures and massage, it’s EKGs and nutrition consultations,” she said. “Traditional conventional Western research... demonstrates [that integrative medicine] can have a beneficial effect on a condition and or a patient.”
Duke IM subscribes to a philosophy of patient-centered proactive care, arguing that the most effective lifestyle changes are those driven by the individual, Geffner said.
“We all view that the individual is the single most important part of the healing equation and that the individual’s capacity to be self-aware is the most powerful single factor in their health, happiness and healing,” said Dr. Jeff Brantley, director of the mindfulness-based stress reduction program at Duke IM.
To focus on the individual, Duke IM check-ups can last up to 80 minutes.
The concept for Duke IM was conceived under the chancellorship of Dr. Ralph Snyderman, who served as DUHS chancellor from 1989 to 2004. In 2000, Dr. Tracy Gaudet, former director of Duke IM, returned from studying with integrative medicine pioneer Dr. Andrew Weil—the founder and program director at the Arizona Center for Integrative Medicine—to lead the practice at Duke, Geffner said.
The plans for the center eventually drew the attention of DUHS Board of Visitors member Christy Mack. Mack is the wife of Board of Trustees emeriti John Mack.
Mack led fundraising for the Duke IM building to be built and contributed a $10 million donation from her foundation in 2004. Her donation—and close work with Gaudet—led to the construction of the integrative medicine building and its opening Nov. 2006.
‘Subtle but intentional’
In its very design, the Duke IM deviates from traditional medicine.
Glimpses of nature appear in every room. Picture windows look out on lush Carolina forest, inner courtyards bustle with gardens of native plants. Dry streambeds of North Carolina river stones weave across the hallways, pass through the walls and continue through the garden. The “subtle but intentional” color scheme reflects the four seasons, Geffner said.
“We consider our lives as just a natural extension of nature—we are conceived, were born, we live and we die,” Geffner said. “That life-cycle happens around us all the time, [so here] we have regular reminders of that with ongoing vistas of nature to remind us what goes in comes out, what goes out comes in.”
The Duke IM building was the first medical building in North Carolina to achieve LEED-certified status. The building also won a Design Award from the American Institute of Architects. The structure and its design assert the facility’s medical purpose with functional healing tools.
“Our notion is that when you go to see the doctor, you should be in a place that makes you feel relaxed and happy and maybe even healthy,” Geffner said. “You often walk into a doctor’s office, and you don’t like the way it smells, you don’t want to touch anything—it’s like icky. Our invitation is come here and enliven your senses.”
Expanding access
Duke IM’s off-campus location and fee-for-service model may contribute to its relative obscurity among the Duke community, Geffner said.
Taylor said he believes a closer, more overt relationship with Duke Medicine could expand Duke IM’s image.
“If there’s anything that could be improved it would be the communication between Duke IM and conventional Duke Medicine,” Taylor said.
Cost is the currently the primary barrier to access to the Duke IM, Dr. Adam Perlman said, who joined the Duke IM as executive director in early September.
A yearly gold membership costs $2,995—offering full use of the facility and a personalized health plan—and a basic initial 50-minute doctor visit can cost $265, according to the Duke IM website.
Due to the relative novelty of integrative medicine, most insurance companies do not cover it, so much of the cost must come out of pocket, Perlman said. He plans on exploring insurance coverage options to make the facilities more available.
“We are definitely interested and are actively looking to engage with the community,” Perlman said, adding that he plans to focus on expanding Duke IM’s patient base and promoting the integrative philosophy within the whole of DUHS.
In the meantime, some offerings are affordable. Regular yoga classes and mindfulness-based stress reduction classes cost $10, and Duke IM offers a 15 percent discount for students, Geffner said.
“A lot of people would be scared off by the financial thing, but you don’t have to sign up to benefit,” Taylor said. “You can come into Jeff’s class for 10 bucks.”
Perlman added that he plans to promote greater awareness of Duke IM’s services among the student body and is meeting with leaders of Counseling and Psychological Services to discuss plans for integration.
“Maybe during exam periods, we [could] go and run classes on the campus... two, three classes per day going on during exams as a way to help the student body deal with the stress of exam time,” Perlman said.
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