Practicing right medicine in the context of integral health care involves more than considering the nature of the medical problem when choosing a treatment. In fact, the success of treatment is dependent upon the ability of the person being treated and the health care practitioner to collaborate together to create a treatment plan that addresses the individuals needs on all levels -- physically, mentally, emotionally, spiritually, culturally, socially, economically, politically. This is because no therapy will work if the person being treated does not want the treatment for any reason. So, for example, if someone is a vegetarian, then medications from animal sources would not be considered right medicine for that person, while they might be perfect for a meat-eater.

Another example would be the attempted use of a synthetic drug when the person is politically committed to living a purely green lifestyle. Likewise, a homeopathic remedy would be inappropriate for someone who believes that energy medicine is pure quackery! And an expensive medication be inappropriate for someone who was unemployed and uninsured, yet a viable option for someone whose health insurance would cover the cost. Practicing right medicine involves not only understanding different therapeutic options, it also involves learning how to understand people in all their diversity and complexity.

See also therapeutic ladder for some of the considerations made by your HeartSong physician in the practice of right medicine.

What does it mean to move "up" the therapeutic ladder?

It is important to recognize that you were born with the innate capacity self-regulate and self-heal. We live in a constantly changing environment and our bodies and minds are designed to change and adjust to the changes that arise from day to day, season to season, year to year. Most disease processes begin with slight dysregulations in physiological function that result from the body and/or mind trying to adjust to a change in surrounding circumstances. If a person has life habits that are health-promoting, the body and mind easily adjust and restore normal function. Most of these shifts in function, beginning with a dysregulation and ending with a normalization, go unnoticed by the person affected.

If the life habits of the person do not promote self-healing, and the organism is repeatedly disturbed, what began as a small imbalance may progress into a more severe dysfunction and the person will start to experience discomfort (symptoms). If this is ignored, or mistreated, or compounded with unhealthy behaviors, the dysregulation continues to escalate, sometimes to a point where there has been enough damage (pathology) that the organism is unable to return to normal function on its own.

In many natural approaches to medicine, the individual does not wait until he or she is feeling unwell to see the doctor. Instead, the natural physician is consulted to provide guidance as to how to live a lifestyle that is health-promoting. In some medical traditions, such as Ayurveda and traditional Chinese medicine, there are diagnostic techniques, such as pulse-reading and tongue diagnosis, that can be used by the clinician to identify and imbalance long before the person experiences any symptoms.

Primary care at HeartSong encourages you to live in a way that supports the mind and body to function optimally so that imbalances are self-corrected by the body and mind without any medical assistance. When medical care is required, the "therapeutic ladder" concept is a tool to use to identify appropriate therapies for your health condition, beginning with those that are least disruptive to your current functionality and ending with those that are most invasive, i.e. moving "up" the ladder from least disturbing to most perturbing.

THE THERAPEUTIC LADDER From bottom to top

Rung 1: Lifestyle

Interventions that are lowest on the therapeutic ladder are those that don't require any treatment or medicine from a physician. They involve, quite simply, changes in lifestyle to reduce unnecessary disturbance and promote wellness, such as getting adequate sleep, exercising an appropriate amount and in a way that strengthens without stressing the body, dressing in a way that is appropriate for the season, eating foods that nourish the body and mind, avoiding stimulating and mind-altering substances such as caffeine, tobacco, alcohol, drugs, and thinking thoughts that promote feelings of well-being.

Rung 2: Energy medicine

When imbalances arise despite a health-promotive lifestyle, then energetic medicines, such as homeopathy, acupuncture, marma, and polarity therapy, are the next rung of the therapeutic ladder, since they are the least invasive and don't involve the digestion of particular substances.

Rung 3: Physical Medicine

When lifestyle and energy medicine are insufficient to restore balance, physical techniques can also be used. Chiropractics, craniosacral therapy, hydrotherapy (water therapy), physical therapy are some examples of physical medical techniques that can help the body restore equilibrium.

Rung 4: Food as Medicine

When energy alone is not enough, then specialized diets are the next rung. Depending upon the nature of the imbalance, food alone is often enough to help the system return to balance.

Rung 5: Herbal Medicine

When food, together with lifestyle and energy medicine are insufficient to allow the body to self-restore normal function, herbs are the next step. Herbs have evolved alongside people throughout our history. They are complex entities, with a distinct identity and vital force that speaks to our bodies through a myriad of physiological and energetic mechanisms simultaneously. Like food, they are whole, not fragmented.

Rung 6: Orthomolecular nutrition

When lifestyle, energy, food, and herbs are not sufficient to allow the body and mind to restore function fully, targeted nutrition with specific nutrients, extracted from plant and food sources as much as possible, are the next step.

Rung 7: Modern pharmacology

Modern pharmacology uses drugs that have been derived from natural and synthetic sources. Obviously, those that come from natural sources will be more easy for the body to use to help normalize function since they will be recognizable to it. Within this rung, therefore, there are two levels of intervention: Drugs derived from natural substances are lower on the therapeutic ladder (less invasive) than drugs that are created from the synthesis of chemical agents which are not derived from natural sources.

Rung 8: Surgery

When lifestyle, energy medicine, physical medicine, food, herbs, isolated nutrients (used alone or in combination with one another and/or herbs and/or food derivatives), and modern pharmacology are unable to allow the body or mind to self-heal and restore optimal physiological function, surgery is the last rung, and most invasive rung, of the ladder.

USING THE LADDER TO PRACTICE RIGHT MEDICINE

It is important to remember that using a therapy from a particular rung of the therapeutic ladder does not preclude using therapies from other rungs, especially ones below the one where treatment is focused at a given time. This is because the lower the rung, the more health-promoting, as opposed to disease-treating, a therapy is. This means that, in addition to treating a particular condition, they will also be promoting health in general.

Integral medicine recognizes that the complexity of the mind-body-emotion-spirit holism reflects the complexity of the world, and the world has given us a multitude of different medical traditions and therapies. Each medical therapy is of potential value, if used in the right way, for the right person, and at the right time, for the practice right medicine.

Integral medicine is not about excluding one type of treatment for another; it is about including everything that might be of use to optimize health and healing. The therapeutic ladder metaphor gives us a way to navigate the complexity of therapeutic decision-making and make thoughtful choices about which interventions to use and when to use them. It helps us visualize how to practice right medicine.

For a complete list of the current formulary, go to the following pdf link on the State of Vermont's website: Naturopathic Physician Formulary Approved 12/11/2009.  HeartSong physicians will only prescribe items on this list. If your physician believes that you need a drug that is not on this list, you will be referred to a specialist who can prescribe the recommended medication.

Allergy

Allergists specialize in the diagnosis and treatment of allergies, usually food and environmental allergies. They do not usually diagnose and treat allergies that are caused by medications prescribed to you by a physician. The physician who prescribes the offending medicine will treat you if you have a reaction to a medication.

HeartSong refers people to the following allergists:

1. Dr. Robert Fagelson, Brattleboro, Vermont
2. Dr. Nathaniel Hare, Cheshire Medical Center, Keene, New Hampshire

Audiology

Audiologists specialize in measuring hearing loss and diagnosing different sources of hearing loss. They fit hearing aids when necessary.

HeartSong refers people to the Austine School for the Deaf in Brattleboro Vermont when they need an assessment for hearing loss.

Cardiology

Cardiologists specialize specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the heart and the blood vessels which transport blood to and from the heart.

HeartSong refers people to the following cardiologists:

1. Dr. Mark Burke, Brattleboro Memorial Hospital, Brattleboro, Vermont
2. Dr. Alan Opsahl, Cheshire Medical Center, Keene, New Hampshire

Chiropractics

Chiropractors focus on disorders of the musculoskeletal system and the nervous system, and the effects that disorders in these systems have on general health.

HeartSong refers people to the following chiropractors:

1. Dr. Steve Gruber, Gruber Chiropractics, Brattleboro, Vermont
2. Dr. Lisa Nash, Saxton's River, Vermont
3. Dr. Elizabeth Gillepsie, Woodcock Clinic, Guilford, Vermont

Dentistry

Dentists specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the mouth, especially the teeth and gums.

HeartSong refers people to the following dentists:

1. Dr. Mark Breiner, The Breiner Whole Body Health Centre, Trumball/Fairfield, Connecticut
2. Dr. Tom Heydinger, Dental Health, Brattleboro, Vermont
3. Dr. David Neumeister, Dental Health, Brattleboro, Vermont

Dermatology

Dermatologists specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the skin.

HeartSong refers people to the following dermatologists:

1. Dr. Jorge Crespo, Chesterfield, New Hampshire
2. Dr. Rebecca Jones, Brattleboro, Vermont
3. Dr. George Lovett, Cheshire Medical Center, Keene, New Hampshire

Endocrinology

Endocrinologists specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the endocrine system -- the system of glands and its secretions (hormones) that influence all levels of physiological function.

HeartSong refers people to the following endocrinologists:

1. Dr. Margaret Ferry, Bratleboro Memorial Hospital, Brattleboro, Vermont
2. Dr. Lara Levin, Cheshire Medical Center, Keene, New Hampshire
3. Dr. Judith McBean, Brattleboro Obstetric and Gynecology, Brattleboro, Vermont

Gastroenterology

Gastroenterologists specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the digestive tract, including the stomach, the liver, pancreas, and the small and large intestines.

HeartSong refers people to the following gastroenterologist:

1. Dr. Otto Trinkl, Cheshire Medical Center, Keene, New Hampshire. Dr. Trinkl is also a member of HeartSong's Advisory Board.
2. Dr. Jeffrey Potash, Brattleboro Memorial Hospital, Brattleboro, VT

Gynecology & Obstetrics

Gynecologists focus on female reproduction, including pregnancy care, birth and delivery (surgical and nonsurgical), as well as in the diagnosis and medical and surgical treatment of diseases and disorders of female reproductive organs (uterus, ovaries, fallopian tubes) as well as vaginal diseases and disorders. Obstetricians specialize in the care of women during pregnancy, childbirth, and after delivery.

HeartSong refers people to the following gynecologists:

1. Dr. Cheri Brodhurst, Windham OB-GYN, Brattleboro, Vermont
2. Dr. Artie Carasquillo, Windham OB-GYN, Brattleboro, Vermont
3. Dr. Evelyn Fleming (gynecological oncology), Dartmouth-Hitchcock, Lebanon, New Hampshire
4. Dr. Judith McBean, Brattleboro Obstetric and Gynecology, Brattleboro, Vermont

Midwifery

Midwives specialize in prenatal care, birth and delivery of infants.

HeartSong refers people to the following midwife:

1. Ms. Lois Trezise, Four Seasons Midwifery, Brattleboro, Vermont.

Nurse practitioner

Nurse practitioners function in a variety of different roles in the health care system, under the supervision of a medical doctor. Most often, they act as primary care providers. They can prescribe all pharmaceutical drugs, and can perform minor surgery.

HeartSong refers people to the following nurse practitioner for certain services which HeartSong physicians do not provide: minor surgery, pediatric immunizations, certain prescription medications.

1. Mr. Richard Fletcher, Putney Family Healthcare, Brattleboro Memorial Hospital, Putney, Vermont

Neurology

Neurologists specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the nervous system.

HeartSong refers people to the following neurologist:

1. Dr. Theodore Ruel, Cheshire Medical Center, Keene, New Hampshire
2. Dr. Edward Orrechio, Brattleboro Memorial Hospital, Brattleboro, Vermont

Oncology

Oncologists specialize in the diagnosis and medical and surgical treatment of all forms of cancer.

HeartSong refers people to the following oncologists:

1. Dr. Joseph Rosen, Surgeon, Brattleboro Memorial Hospital, Brattleboro, Vermont
2. Dr. Evelyn Fleming (gynecologic oncology), Dartmouth-Hitchcock, Lebanon, New Hampshire
3. Dr. Joseph Paydarfar (heck and neck), Dartmouth-Hitchcock, Lebanon, New Hampshire

Optometry and Ophthamology

Optometrists and ophthamologists are licensed to provide primary eye care services, including the diagnosis and treatment of eye diseases and vision care, including the fitting of corrective lens. Ophthamologists train as medical doctors (MD) and perform eye surgery. Otometrists have a degree in optometry (OD) and do not perform surgery.

HeartSong refers people to the following optometrists and ophthalmologists:

1. Dr. John Duff (OD), Brattleboro, Vermont
2. Dr. Joseph Santry (OD), Brattleboro, Vermont
3. Dr. Dale Pollack MD, ophthomology, Cheshire Medical Center, Keene, New Hampshire
4. Dr. Basilio Kalpakian, Cheshire Medical Center, Vermont
5. Dr. Rosalind Stevens, Dartmouth-Hitchcock, Lebanon, New Hampshire

Orthopedics

Orthopedists specialize in the diagnosis and medical and surgical treatment of bone injuries, diseases, and disorders.

HeartSong refers people to the following orthopedists:

1. Dr. Elizabeth McLarney, Brattleboro Memorial Hospital, Brattleboro, Vermont
2. Dr. Johnathan Thatcher, Brattleboro Memorial Hospital, Brattleboro, Vermont
3. Dr. Heather Shafer, Cheshire Medical Center, Keene, New Hampshire
4. Dr. John Chard, Brattleboro, Vermont
5. Dr. William Vranos, Brattleboro Memorial Hospital, Brattleboro, Vermont

Otolaryngology

Otolaryngologists is the oldest area of specialization in medicine in the United States. They specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck. They are often referred to as ear, nose, and throat (ENT) doctors.

HeartSong refers people to the following

1. Dr. Donald Wilson, Cheshire Medical Center, Keene, New Hampshire
2. Dr. Paul Righi, Cheshire Medical Center, Keene, New Hampshire

Physical therapy

Physical therapists are licensed professionals who diagnose and treat people who have medical problems or other health-related conditions, illnesses, or injuries that limit their abilities to move and perform functional activities.

HeartSong refers people to the following physical therapists and physical therapy practices:

1. Ms. Catherine Audette, Putney, Vermont
2. Brattleboro Memorial Hospital, Physical Therapy Department
3. Brattleboro Physical Therapy, Brattleboro, Vermont
4. Ms. Debbie Feiner, Williamsville, Vermont
5. Maple Valley Physical Therapy, Brattleboro, Vermont

Podiatry

Podiatrists specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the feet.

HeartSong refers people to the following podiatrist:

1. Dr. Anna Ruelle, Cheshire Medical Center, Keene, New Hampshire
2. Dr. David Liebow, Brattleboro Memorial Hospital, Brattleboro, Vermont

Prosthetics

Prostheticians specialize in the evaluation, fabrication and custom fitting of artificial limbs, orthopedic braces, and orthodics.

HeartSong refers people to the following prosthetician:

1. Dr. Phil Kramer, Brattleboro Orthodics, Brattleboro, Vermont

Pulmonology

Pulmonologists specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the respiratory tract.

HeartSong refers people to the following pulmonologist:

1. Dr. Kashif Hussain, Cheshire Medical Center, Keene, New Hampshire

Psychiatry

Psychiatrists specialize in the diagnosis and medical treatment of diseases and disorders of the mind.

HeartSong refers people to the following psychiatrists:

1. Dr. Sabah Salam, Salam Psychiatric Services, Brattleboro, Vermont
2. Dr. Lewis Mehl-Madrona, Matrix Health Systems & Coyote Institute, Brattleboro, Vermont

Sports Medicine

Sports medicine physicians specialize in the diagnosis and medical treatment of sports injuries.

HeartSong refers people to the following sports medicine physicians:

1. Dr. Brett Hynnenin, Brattleboro Memorial Hospital, Brattleboro, Vermont
2. Dr. Elizabeth McLarney, Brattleboro Memorial Hospital, Brattleboro, Vermont
3. Dr. Heather Shafer, Cheshire Medical Center, Keene, New Hampshire

Surgery

Surgeons perform surgery to investigate and/or treat diseases or injuries, or to help improve bodily function or appearance.

HeartSong refers people to the following surgeons:

1. Dr. John Bookwalter, Brattleboro, Vermont
2. Dr. Gregory Gadowski, Brattleboro, Vermont
3. Dr. Thomas Lewis, Brattleboro, Vermont
4. Dr. Joseph Rosen, Brattleboro, Vermont

Urology

Urologists specialize in the diagnosis and medical and surgical treatment of diseases and disorders of the genitourinary system. They also diagnose and medically and surgically treat diseases and disorders of male reproductive organs (penis, scrotum, testes, epididymides).

HeartSong refers people to the following urologist:

1. Dr. Craig Rinder, Brattleboro Memorial Hospital, Brattleboro, Vermont