Go to the list: Top Docs ’08

From the stethoscope draped around his neck to the distinguished touch of gray at his temples, Dr. Charles Elder, a specialist in internal medicine at Kaiser Permanente, looks like he just walked off the set of ER. Standing before a whiteboard in a conference room on Kaiser’s Interstate campus, felt-tip marker in hand, the handsome 46-year-old physician sports a natty tie, a high, square forehead and a sparkle in his eye.

With an MD from Boston University’s Medical School, Elder is perfectly comfortable discussing platelets and neuropeptides. Right now, however, he is delivering a lecture about vata, pitta, and kapha, the three doshas (or humors) of the ancient Indian system of ayurvedic medicine. His audience this morning: a small group of Kaiser patients, all women, who have been referred to this clinic by their primary care physicians for various ailments.

Elder invites discussion about one of the precepts of ayurvedic medicine regarding diet and digestion: that the main meal of the day take place around midday.

“Why is this?” he asks.

“Because proteins take 12 hours to digest?” suggests one patient.

“Uh, okay, that’s a good answer,” Elder replies. “What I was going to say is that according to the principles of ayurvedic medicine, when the sun is highest, that is the most auspicious hour for digestion.”

The patients nod, scribbling in their notebooks. Later, Elder suggests that they avoid drinking cold water.

“Is that because water dilutes the enzymes in the digestive tract?” the same patient inquires.

“Um, we would say it douses the fire of digestion,” Elder replies assuredly.

Despite the occasional look of befuddlement on the faces of his listeners, Elder sees no paradox in appealing to concepts thought to have developed in the Indus Valley some 5,000 years ago. “It comes down to what works,” he says. “If the patient has pneumococcal pneumonia, you’re going to give them penicillin. But if they have fibromyalgia, or irritable bowel syndrome, the conventional paradigm just doesn’t have good explanations. And for some chronic conditions, conventional medicine is not as effective as the naturalistic approach.”

Thanks to its unusual structure as both a medical system and an insurance company, Kaiser has been especially open to the integration of alternative care—so long as the patient wants it, the doctor deems it medically necessary and the patient’s member group has purchased a rider to cover the additional costs (see “Footing the Bill,” at right). At Kaiser, approximately 180 patients are treated in the alternative medicine clinic in an average month, typically for chronic conditions such as menopause, pain, irritable bowel syndrome, high blood pressure, fatigue, heart disease and digestive issues. According to Elder, internal data shows that patients who visit the clinic not only get better, but also visit their primary clinicians less often.