10 Ways to PRIMA™ Care
Over the past decade, veterinary medicine has followed its human counterpart down the path of a predominantly bimodal approach of prescribing either drugs or surgery. In veterinary practice, of course, we have another approach — namely, euthanasia. Clients elect to euthanize their animals when they are either pushed to the limit financially or emotionally, or when they have been told by their veterinarian that “there’s nothing else we can do.”
However, ending the life of an animal takes its toll on veterinarians, especially when more could have been done, if only the client or doctor had known. Sticking to the drugs-and-surgery model as presented in veterinary school may work for veterinary practitioners that just want to stay in their lane, get their paycheck, and remain within a limited paradigm.
The truth is that what veterinary students learn in school is far from complete. Faculty teach what they know and are rarely challenged by students to defend their recommendations or to present a full spectrum of treatment options that includes integrative medicine. Some may feel threatened by less invasive methodologies that they perceive could threaten their standing within their institution.
No wonder veterinarians feel burned out, depressed, and even suicidal, realizing that the medications or surgeries they were told to recommend run the risk of additional problems for the patient, more expense for the client, and possibly another avoidable euthanasia on their calendar.
Most veterinarians and even new graduates entering the profession have much more to learn about best practices to restore health and hasten recovery from injury and disease. This is why integrative medicine has largely grown up around veterinary schools and is now gradually gaining a foothold within more forward-thinking faculty’s lesson plans.
At CuraCore® VET, we have pioneered and promoted science-based integrative medicine since 1998. That is the year our founder and CEO, Narda G. Robinson, DO, DVM, MS, FAAMA joined the teaching ranks at the Colorado State University College of Veterinary Medicine and Biomedical Sciences. Since that time and still today, CSU students have had the opportunity to learn from Dr. Robinson and faculty colleagues that she has educated in medical acupuncture and related techniques. Research in acupuncture and cannabis remains ongoing at CSU, and veterinary students and practitioners from around the world enroll in the Medical Acupuncture for Veterinarians program, which Dr. Robinson founded, also at CSU.
Now, over twenty years later, Dr. Robinson seeks to fill the gaps in veterinary education through the PRIMA™ certification pathway. “PRIMA” stands for the “Pain, Rehabilitation, Integrative Medicine Advantage.” Pain medicine, rehabilitation, and integrative medical approaches can change vets’ lives and save pets’ lives by moving past the limitations of the drugs-and-surgery mindset. Each of these methodologies deserves a rightful place on the front line of patient care. And, until now, each of these methodologies has been relegated to the position of an “after thought.” Recommended after surgery has failed and the patient can no longer walk or stand correctly and internal organs are no longer functioning correctly. Thought of as the “one last hope” prior to euthanasia, after draining the animal’s recovery potential and the client’s emotional and financial resources on risk-filled medical or surgical maneuvers.
Surely, pharmaceuticals and surgery play an important role in modern medicine, but they should be considered in conjunction with or after PRIMA™, allowing for an integrated approach to engage the patient’s innate healing mechanisms and overcome disease more quickly.
And – guess what. Veterinarians that entered the profession and “idealistically” thought that they could help animals and thereby bring joy to the client and family are finding their dreams can come true. There is room for them in this profession and they were right to stand up for least invasive approaches that can be delivered in a fear-free, supportive environment. And when veterinarians feel bonded to their clients and patients and when they return to their own animals and family at the end of the day, they do so feeling uplifted because their soul has been nourished. They have made a positive difference in this world. Day after day after day.
This is the future of medicine. This is PRIMA™.
These are our Five Fundamental Principles.
1. Restore Medicine’s Art and Soul.
Today, modern medical practice seems to have lost its soulful touch in search of ever more sophisticated technological achievements.1 While this may work for some, it’s left others lost, burned out, and wondering where and whether they still have a place in the profession.
As one physician wrote,
“Corporate medicine no longer offered me the opportunity or obligation to appropriately deal with my patients’ emotions or their spiritual values. So,…I changed the direction of my path. It was a 2-year process – a fellowship that allowed me to integrate traditional clinical medicine with the evidence-based healing therapies from around the world…Adding fellowship training in integrative medicine is only one of several ways physicians can restore their artful brand of medicine and transform. Those among us who yearn to be a healing presence for patients and long for the joy of medicine will seize the opportunity and step off the treadmill. Unless physicians take the opportunity to alter the character of their medical practice, this transformation from shift worker to physician-healer will never occur, and the caring, healing touch of the physician’s hand will continue to disappear. Physicians who see themselves as artists will forge their own destinies and settle for nothing less.”
2. Ask Questions. Listen Intently.
“A thorough history can lead to the right diagnoses about 75% of the time.”
“Skilled history taking is reported to be declining among medical trainees…Technology appears to have supplanted clinical skills overall and, as more advances take place in
the biomedical industry, this dominance is further increasing…It is important for educators to show learners the importance of history taking in solving diagnostic dilemmas and simultaneously to stem the tide of needless investigations to combat the ever-rising healthcare costs.”2
When was the last time that you were told to spend more time with a client in order to derive a more comprehensive history? When was the last time that you methodically explored a list of differentials, for example, for a dog’s hindlimb lameness? Have you noticed that it has become all too easy, too mindless, and possibly too financially self-serving to run needless radiographs and lab work instead of spending more time sufficiently exploring the patient’s history with the client?
PRIMA™ practice is different. As a patient and client advocate, PRIMA™ providers invest in bond-centered care that builds trust and fosters feelings of safety and belonging within the practice network. Clients and staff become part of the clinic’s ecosystem, with everyone participating in supporting an atmosphere conducive to healing and recovery.
Is this type of practice idealistic? You bet. Is it realistic, as well? Absolutely. Perhaps not in a mechanized, high-pressure, high-volume corporate veterinary operation, but that’s where we have a choice. Fortunately, most of us can choose where and how we want to live. We can uphold the highest standards of medicine while, at the same time, live well and find meaning.
3. Revive a Lost Art – the Physical Examination
Performing a hands-on physical examination is more than nostalgic – it’s central to practicing good medicine, arriving at accurate diagnoses, and reducing medical errors. Despite this, physical exam skills have been deteriorating steadily.3 Factors responsible for this downturn include increasing reliance on technology, reduced time allotted to doctor-patient interactions, and lack of confidence in physical exam skills.
“Poor physical examination skills are a threat to patient safety as the probability of diagnostic errors and oversights is increased. Moreover, unnecessary investigations themselves are potentially harmful. In an era where there is growing concern of over-utilization of health care resources and expense, poor physical examination skills lead to more injudicious referrals and patient mismanagement, leading to added costs.”4
We educate our PRIMA™ providers in myofascial palpation and movement evaluation in order to endow them with proficiency in diagnosing the source, location, and nature of dysfunction, disability, and pain in their patients. Until these methods of patient assessment are taught to every veterinary student and practicing veterinarian, we consider the revival of interest and proficiency in hands-on evaluations to be a central theme of our certification program.
4. Recognize Integrative Medicine as First-Line Considerations
We educate our PRIMA™ providers in myofascial palpation and movement evaluation in order to endow them with proficiency in diagnosing the source, location, and nature of dysfunction, disability, and pain in their patients. The future of veterinary medicine, which we call “Vet Med 2.0,” will be reshaped by the discussion and robust inclusion of pain medicine, rehabilitation, and integrative care at the outset of the veterinarian-client-patient relationship. In so doing, the most effective and least invasive interventions will be implemented whenever possible.
5. Create Bond-Centered Practices around Patient-Centered Care
In the words of Sir William Osler, widely considered to be the father of modern medicine,
“The good physician treats the disease; The great physician treats the patient who has the disease.”
The patient comes first. The patient is the cornerstone of clinical veterinary medicine. Patient-centered care has gained a foothold in human medicine and is building a following among those at the forefront of veterinary healthcare. We permeate PRIMA™ instruction and certification programs with the following dimensions of patient-centered care:
- Communicate information about the patient’s diagnosis, clinical status, progress, and prognosis to the client.
- Coordinate clinical care and support services within the hospital and at home.
- Provide pro-active PRIMA™ care throughout the hospital stay and in at-home after care, as desired by the client and indicated by patient status.
- Invite conversation with the client regarding the client’s or other family members’ fear and anxiety about the health of the patient, the impact of the patient’s illness on the family, and open discussions about projected costs of ongoing care.
- Recognize the healing nature of supporting the family’s bondedness to the patient.
- Encourage visitation by one or more close family members during a hospital stay in order to maintain and strengthen the human-animal bond.
- Provide information about physical and clinical support resources after discharge.
- Instruct clients about preventive measures to maintain health and avoid disease.
Here are our Five Pillars of PRIMA™ Practice and
How They Move Medicine beyond the Limited Bimodal Drugs-and-Surgery Motif
6. Medical Acupuncture
Dr. Robinson was the first to introduce medical acupuncture to veterinary medicine when she opened her first continuing education program at CSU in 1998. She has remained active in the human medical acupuncture community and was among the first group of physicians to earn board certification in the field and fellowship status within the American Academy of Medical Acupuncture. As founder and CEO of CuraCore® VET, she maintains a leadership role, having inspired academicians and private practitioners around the globe to pursue a purely scientific approach to integrative medical care, including medical acupuncture.
We teach medical acupuncture as the contemporary approach to neuromodulation and connective tissue normalization. We base our teaching on current research into anatomy, physiology and pathology, consistent with the principles of evidence-based medicine. We recognize the value of medical acupuncture as a scientific, clinically meaningful, and cost-effective healthcare option. Its diversity of restorative benefits is increasingly acknowledged by federal agencies and insurers in human medicine, highlighted as a reliable and strongly positive alternative to prescription opioids.
The wide acceptance and substantial scientific backing of medical acupuncture has earned this modality a central focus of PRIMA™ certification.
Photomedicine is a form of treatment that applies light in the form of therapeutic laser or light-emitting diodes to the surface of the body. In contrast to high-power lasers designed to cut or destroy tissue, photomedicine is used to relieve pain, lessen inflammation, and regenerate tissue. Its mechanisms of action, termed “photobiomodulation,” resonates closely with the ways in which medical acupuncture works, but has distinct advantages of directly activating cellular physiology. As such, PRIMA™ practitioners often utilize both treatments within a session. Like acupuncture, photomedicine is safe and well-tolerated by patients when performed by a well-educated, science-based provider.
8. Medical Massage
Medical massage constitutes a wide range of soft tissue manual therapy techniques, chosen specifically to address a patient’s diagnosis as it becomes incorporated into the individual’s treatment plan. As with medical acupuncture and photomedicine, medical massage normalizes nerve function and reduces painful myofascial restriction. However, in contrast to needling or photonic delivery, medical massage uses touch as the vehicle for promoting proper physical function and physiologic restoration. Medical massage’s versatility, acceptability by patients, and array of treatment techniques, make it a welcome adjunct to care for an extensive list of species and veterinary medical conditions.
9. Botanical Medicine
Herbal medicine presents new vistas but also new challenges as we consider its inclusion into veterinary medical care, especially as first-line agents. We teach botanical medicine as a pharmacologic approach and urge our course participants to regard herbal treatment as they would any medication that has positive and negative clinical effects, a potential for interactions with other chemicals in the body, and a need for quality control and consistency. In contrast to medications, however, the unknown pharmacokinetics and pharmacodynamics of most botanical products require caution and vigilance. No myths or metaphors, no moving chi or eliminating wind suffices for modern medical care. And, certainly no secret ingredients.
10. Integrative Rehabilitation
The field of canine rehabilitation has grown considerably over the past ten years, even to the point of becoming a boarded specialty. However, we at CuraCore® VET are set to write the next chapter of rehabilitation by incorporating deeper insights into structural and functional relationships based on core tenets of osteopathic medicine and physical therapy. Moving beyond an exercise and modality approach to the intrinsic neural and myofascial networks that drive the system, CuraCore® VET and PRIMA™ practitioners incorporate integrative rehabilitation into everyday practice as part of mobilizing innate healing mechanisms as much as moving the body. We dive deeply into signaling processes from the brain to the periphery and back again and have become the “fine dining” alternative to “fast food” types of instruction that offer certification but skimp on substance.
1 Mambu J. Commentary: Restoring the art of Medicine. Am J Med. 2017; 130(12):1340-1341. Accessed on 09-04-19
2 Ramani S. Promoting the art of history taking. Medical Teacher. 2004;26(6): 374-376.
3 Asif T, Mohiuddin A, Hasan B, et al. Importance of thorough physical examination: a lost art. Cureus. 2017;9(5):e1212.
4 Asif T, Mohiuddin A, Hasan B, et al. Importance of thorough physical examination: a lost art. Cureus. 2017;9(5):e1212.
Let’s be honest. If you’ve reached this last paragraph, it just might be that you are seeking to recharge your spirit, redirect your career, or rethink your decision to pursue veterinary medicine unless something changes, and in a big way. If you’ve had it “up to here” with your current boss, job, and life, know that another path awaits. Give us a call at 970-818-0851 or send us an email at firstname.lastname@example.org. We’re eager to learn more about you.