In this interview, Austin-based obstetrician and gynecologist Shawn Tassone, MD talks about how he transitioned his practice from traditional “heal with steel” to an integrative focus. Tassone, who is currently completing in his PhD in mind-body medicine, offers advice on how to include integrative care in a traditional insurance-model practice and how to shift patient care to active wellness.
Kimberly Lord Stewart: Your medical training and early practice years look like a fairly traditional path in obstetrics and gynecology. What was the catalyst to explore integrative medicine?
Shawn Tassone, MD: If I look back, I kind of came through that meat grinder of medical school and residency, where we used to say ‘heal with steel’ and other monikers that today sound pretty brutal. In 2001, a couple of months after 9-11, my mother was in hospice because she had ovarian cancer. I sat there watching her body go through the rigors of death. I watched her stop breathing. I didn’t have anyone to call or talk to because I am an only child and my parents were divorced.
I remember thinking there is this body that I know is my mother, but it’s not her. I had this strange disconnect between the fact that this was my mother, and being a physician where everything is body oriented. The person that is my mother didn’t just stop being what made her who she was. I realized we are more than just our bodies – some traditions would call it the soul.
A year later I was in Sedona, AZ. While my wife was getting a massage, I read Andrew Weil’s book, Optimum Health. The book fascinated me because it talked about spirituality and health. I was blown away by it. I finished reading it while I sat there. In the back of the book, there was a note that said, if you are interested in integrative medicine and you are a physician, come to this website. So I literally signed up while I was waiting for my wife. That started my two-year fellowship three months later at University of Arizona.
KLS: How did you begin integrating integrative medicine into your practice?
ST: I took the fellowship in 2005 and finished in 2007. You have to make a decision. I had to decide if I was going to continue to stay in traditional practice and continue to take insurance or go to a cash-based model. I already had my practice, so I decided to stay in that traditional model and take insurance. And as an OB/GYN, women are using a lot of supplements in menopause, peri-menopause and pregnancy, probably more than in men’s health.
So when I got out of the fellowship, I joke that I started integrating integrative medicine into my practice. The first thing I did was change my exam rooms and waiting areas, so I had things on my walls that would remind me of key points. For instance, in one room I had a painting of the chakras, the healing centers in the body, which reminded me that as I was talking to patients to think outside of the traditional forms of medicine. Obviously, if you need antibiotics, you need antibiotics, but in those instances where other treatment may be effective it is important to consider other options.
For instance, I had a patient with severe pelvic pain with a quick onset. I couldn’t find any reason for it. The chakra chart was right behind her – I looked at the pelvic and the root chakra – out of the blue I asked her, “How are you personal relationships?” This isn’t a typical doctor-patient question. She started crying and said. ‘My husband is having an affair.’ I explained to her that you could get pelvic pain from stress, just like you would from a migraine. I sent her to therapy to see what could be done about relieving some of her stress
This was a new path for me because I was planning to operate on her. I am not suggesting that all pelvic pain is non-surgical, but this training got me thinking that there are other ways to treat patients. That is how I began, and now I have developed my own regimens of supplements that I might recommend to someone with insomnia or menopausal symptoms, for instance.
KLS: Within your field of women’s health, do you find that you are educating the patients about integrative care, or do they request it based on your reputation?
ST: It’s interesting because there are so many different levels. I think in Austin the patients are a little more advanced. The patients come here in varying stages. For instance, today I am doing a hysterectomy on a patient who is on Medicaid, so she doesn’t use a lot of alternative medicine. One of the things we talked about for the surgery today is for her to give me her uterus, I don’t want to take it from her. Guided imagery is free and I don’t think she would perceive that as an integrative therapy. But then I have patients who come in with a trash bag full of supplements, but they might not know why or be using a good pharmaceutical brand. They can be little savvier, so I might educate them on how to read a label and what works better for say menopause.
KLS: What are the challenges to transitioning toward an integrative care model?
TS: The number one challenge is your colleagues. I am in a group with 10 other doctors and they don’t know what integrative care is. Some might think of it as quackery, or whatever you want to call it, and others might use acupuncture themselves, but they don’t realize it’s alternative medicine. Most of them may take some sort of supplement, like fish oil, but they don’t really know why they are taking it.
I am doing a PhD on mind-body medicine at Saybrook University. My colleagues in Tucson, AZ would ask me, ‘I can’t believe you are getting your PhD, what’s it in?’ I had two answers. When I said mind-body medicine, I would get this puzzling look like, what’s that? So, I started saying philosophy, which is the truth because mind-body medicine is in the philosophy department. And colleagues said, “Wow that’s really neat.’ It depends on how you word it.
My friend Larry Dossey says it’s the beef stroganoff principal; do you call it stroganoff or beef with noodles? You have to know the audience. For my colleagues, philosophy made sense to them. Then I would say, ‘I am kind of focusing on alternative ways of healing.’ For instance, I went to visit John of God in Brazil to learn about herbs, and I am learning about acupuncture. And, they would say that’s really neat. But if I threw mind-body medicine at them, I could see them glaze over.
Then there is jumping off the cliff of a cash-based model. It’s scary. You have to jump in with both feet – you can’t put one foot in the cash model and one foot in the insurance model. It’s very hard because patients may fall off. It’s a big risk to run your own practice. I have to say that in all the integrative teaching they don’t teach you the business model. There are a lot of successful people out there and some of it is based on location. ‘Am I going to succeed, there is a big fear factor.’
KLS: As you say, mind-body medicine is an uncomfortable space for many doctors because of the raw emotion it can evoke. As paradigms move from illness to health, how can physicians take into account the power of the mind as a tool for wellness?
ST: We’ve moved past that psychosocial behavioral model from 20 years ago and have come to a place where we recognize, for instance, that stress can lead to headaches. Many don’t understand it is an example of mind-body medicine. We are still somewhat cartesian in that we separate the mind from the body. We are body doctors. We are not mind doctors. We are not psychiatrists.
I think what happens is when we look at illness versus health; it’s the same thing. We look at it in a split sense and there isn’t a continuum. The body is either sick or the body is well. Right now we have a passive patient and an active doctor. The doctor controls everything and the patient just sits there and says, OK.
With patients moving toward health, what you are seeing is a shift towards self-care.
Now the patient is the active person and the physician has to be willing to be the passenger. I often say to patients, ‘you are walking through the forest, my job is to help you pick the best path.’ Or, I use the analogy that we are at a bowling alley with kiddy bumpers. I am the bumpers to keep you moving within the lane. That is hard for doctors because they don’t like being passive. That is what we have to learn to do.
In closing, I learned this with my mother. As a son, I had to learn to let go. And her doctors didn’t know what to do because they want to be active. But when there isn’t anything more for them to do, they are lost.
The big questions we need to ask are, ‘What are you doing?’ and, ‘What do you want to do?’ That is the health part. When patients go home, they have to keep dealing with whatever the issue is. We aren’t going to be there. We need to teach patients how to do both self-care and prevention.
Watch Dr. Tassone’s webinar On-Demand. He will share how YOU can integrate active patient care and integrative wellness into your practice.
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About Shawn Tassone, MD PhD(c)
Shawn Tassone, MD PhD(c) is a double boarded physician in Obstetrics and Gynecology and the American Board of Integrative Medicine. He is a practicing OBGYN, author, speaker, and patient advocate. Dr. Tassone is the author of two books Spiritual Pregnancy: Develop, Nurture & Embrace the Journey to Motherhood (Llewellyn Publications, 2014) and Hands Off My Belly! The Pregnant Women’s Guide to Surviving, Myths, Mothers, and Moods (Prometheus, 2009). He has written and published extensively on topics of spirituality in medical care and he is an advocate for whole foods to heal the human body. He is an instructor in integrative medicine at Arizona State University and he has been on the faculty at the University of Arizona and the University of Oklahoma Health Sciences Center teaching residents and medical students. His belief is that the human body was made to heal itself and that the medical model should involve more patient-centered care with an active patient and a passive healer. He has written for Psychology Today and was the content editor for About.com Women’s Health page.