This Paths to Practice interview is
with Dr. Annie Budhathoki, DAOM, LAc, doctor of acupuncture and
Oriental medicine, and licensed acupuncturist at the Linda B. and Robert B. Wiggins
Wellness and Integrative Health Center, Huntsman Cancer Hospital and Clinics,
the University of Utah, Salt Lake City, Utah.
Background
video interview minute 0 - 5
Her clinical specialty is treating cancer-related side
effects. She helps patients maintain wellness and longevity after a cancer
diagnosis. Dr. Budhathoki is a research investigator on the use of acupuncture
in the oncology setting. Her areas of interest include oncology, integrative medicine,
pain management, geriatrics, and neurological disorders.
Since 2012, she has worked full time as an integrative
oncology clinician at Huntsman Cancer Institute in Salt Lake City, Utah. Dr.
Budhathoki spends about 10% of her time in teaching and outreach. She
is adjunct faculty for the University of Utah where she teaches in the
medical school’s integrative medicine program.
 |
| Dr. Annie Budhathoki |
Dr. Annie Budhathoki’s Path to Hospital-Based Practice
See minutes 07:55—14:00 for the related section of the
video interview
Dr. Budhathoki attended Pacific College of Oriental
Medicine (PCOM) San Diego where she obtained her master’s degree in acupuncture
and oriental medicine. Then, she studied healthy aging and longevity at Yo
San University
in Los Angeles, CA, where she received her doctorate degree in the field.
In November 2009 she opened a private practice in Salt
Lake City, Utah, where she enjoyed working as part of a patient’s healthcare
team. She started work at Huntsman Cancer Institute pro re nata (PRN),
in the summer of 2012 and by October 2012 she was a full-time employee there.
A Doctoral Degree in Healthy Aging & Longevity:
Everything at Huntsman is a Longevity Prescription
minute 16:00
Megan: So, you said your doctorate was in
healthy aging and longevity. What are some things you love about
your work at Huntsman?
Annie: So, getting that doctoral degree in healthy aging
and longevity my goal was to marry the ancient concepts of longevity with life
after cancer and with cancer. So that our patients can get the very
best results they have possible. I see everything in our hospital as a
longevity prescription. So, our entire goal as a hospital is
about patient care and about allowing a patient to get those best days as long
as possible to be increasing their quality of life...to be with family, to be
doing what they want to do, to be enjoying their days.
And that’s really empowering to me to be able to take
these ancient pieces…, integrate [them] into what Huntsman is doing at large
with treating cancer and giving patients these really amazing and sustainable
results.
And that gives me goosebumps because I think patients
feel that when they come to Huntsman, we are focused on them and their
priorities of quality of life and improving their life for as long as possible.
At Huntsman, we treat patients and caregivers.
What is your favorite thing to do in hospital practice?
Annie: Working with patients at the wellness center. The
Wellness Center helps patients regain their own power. The patients can work on
themselves while the oncology teams work on their cancer.
Acupuncture helps these patients with their stress and
improves their sleep. Acupuncture is empowering for them during a difficult
time. We reach the patients where they are. Often offering them hope in a
unique way.
The Linda B. & Robert B. Wiggins Wellness and
Integrative Health Center at Huntsman Cancer Institute
Dr. Pamela Hansen began the Wellness Center in 2005
with the “power exercise” program. This grassroots program out of an auxiliary bathroomped
patients with exercise and movement while they were undergoing cancer
treatment. This wellness center is one of the few wellness centers inside
an academic cancer hospital. It has grown to include over 36-39 programs
depending upon the season. And, the Wellness Center publishes a quarterly
catalog for patients, caregivers, and staff.
In 2005-2007 the wellness center program was very small.
Just an afternoon session, once a week. And it had a big waiting
list. So, in 2012, they decided to bring acupuncture on full time.
This year, the wellness program has 4 acupuncturists and
9 massage therapists. The Wellness Center’s clinical services are available
from 7AM to 7PM most days Monday through Friday. In the wellness center,
acupuncture and massage have a daily treatment average of 20-25 patients per
day for each program. Last year, in 2018 the whole wellness center
saw over 25,000 patients in our more than three dozen programs. [minute 13
of the video interview]
The Wellness Center is an outpatient acupuncture practice
inside the cancer hospital. The acupuncturists treat the side
effects and symptoms of cancer and cancer treatment [such as] neuropathy, pain,
nausea, insomnia, and hot flashes. Dr. Annie Budhathoki also does
inpatient acupuncture for hospitalized oncology patients.
Wellness Center Funding and Revenue Streams
Annie: The Wellness and Integrative Health Center at
Huntsman Cancer Hospital is a budgeted program supported and directed by our
patient-centered administration. Most of our programs are low-cost to no-cost; programs
with a fee are generally reduced costs similar to a copay. Acupuncture is a
fee-for-service program and the cost to the patients, caregivers, and staff is
$40. Additionally, Huntsman has a financial assistance program that supports
persons living on a low income and our wellness center offers a sliding scale
within this program. Currently, very few of the insurance providers in the
state of Utah cover acupuncture, so we don’t have insurance billing set-up for
our acupuncture services.
The Wellness Center is a Place Where Patients Regain
Their Power
minute 22
Annie: You know, the Wellness Center [is amazing; ] we
have all this programming. At Huntsman, we have a supportive oncology
team. Dr. Anna Beck is the director of supportive oncology; when she
came to Huntsman [she reshaped] the models for integrative medicine.
This wellness center is a place where people are
empowered to take charge of their health while going through cancer treatment
and beyond into survivorship.
As providers, we have the opportunity to support people
affected by cancer to overcome various health and wellness obstacles. We ensure
each person feels empowered to improve and maintain their individual health
despite their cancer diagnosis or former health status. When championing the
best care of each specific symptom, we work together as an integrative team
supporting the goals and betterment of each patient. Often this includes
referring them into various programs that also support their needs, knowing
that this is how they can continue to regain their power.
In the Wellness Center, we are supporting the basic
health needs and daily quality of life issues which affects a person’s ability
to function. We manage symptoms like nausea, fatigue or sleep while
their physicians are working on the cellular level to attack their cancer or on
a surgical level to get things taken care of.
[In oncology the side effects of chemotherapy, radiation,
surgery can be disempowering] for a patient because medicine takes over. And
rightfully so in many cases so that those specific diseases can’t become
chronic illnesses or can be cured if you will. But in wellness and
integrative health and especially acupuncture and massage, fitness,
nutrition—this is where patients really get a chance to shine on their own; to
regain their power.
 |
| Dr. Annie Budhathoki |
Advice for those of you working in integrative
oncology
Annie: As you practice in a hospital setting, keep that
in mind: how do the patients remain empowered with their own health care
as they go through that?
The Inpatient Acupuncture Program at Huntsman Cancer
Institute
Annie: We started the inpatient acupuncture
program with an Imagine Perfect Care grant from the University of
Utah. The inpatient acupuncture program began in September 2018.
We started that program on the oncology floor, working with symptoms
like nausea or constipation or ir-retractable vomiting. [Any]
symptoms that would keep a patient in the hospital and extend their stays and
prevent them from going home. [Eventually the program] moved into the surgical
ward and into other parts of the hospital. But the initial work was
symptom-based, treating any issues that would keep a patient in the hospital
too long.
What is the goal of integrating acupuncturists at
Huntsman?
Megan: So, you’re using acupuncture as a
complement to ongoing care to help people have shorter inpatient stays?
Annie: Our goal, long-term is to show the
efficacy of acupuncture in an inpatient oncology clinic in a hospital and to
show feasibility as far as reducing costs.
We believe acupuncture is a cost-saving measure for the
hospital overall. Whether that’s a reduction of opioid use, whether
that’s reduced hospital stays, or reducing re-admission rates; that’s really
our goal.
Integrating Clinical Outcome Measures Seamlessly in a
Clinical Research Environment
Megan: Are you doing ongoing research studies
related to either of these programs?
Annie: So, Huntsman is a research
institution. [Research is] a foundational force of Huntsman alongside
our clinical care. Research is really embedded throughout the hospital. In the
wellness and integrative health center, we have a number of research projects.
[Related to] the acupuncture program we currently have a
mindfulness acupuncture research study with
Dr. Eric Garland who [is] a
leading mindfulness researcher.
We also have a chemotherapy-induced peripheral neuropathy
(CIPN) study. Which employs an fMRI to [measure] the implications of
acupuncture on CIPN. And we have an inpatient acupuncture research
study in the works.
Teaching and Outreach with Medical Students at the
University of Utah
minutes 6-8 and minutes 25-26 of the video interview
Annie: The University of Utah has a very strong collaborative
approach to medicine. Recently, Dr. Amy Locke created and developed
an integrative medicine pathway. Prior to that, we had an
integrative medicine elective for our medical students. I teach in both [the
elective and the pathway].
What is the University’s Integrative Medicine Elective?
Annie: It’s an elective for medical students to [shadow]
integrative medicine practitioners and [observe] integrative medicine in
action. So, they come and spend about 1-2 weeks with us here in the
wellness center [where they follow me] in the acupuncture clinic and [other]
practitioners in their clinical work.
What is the Integrative Medicine Pathway?
Annie: In the integrative medicine pathway, we [have
several learning structures]. We do panel discussions about integrative
medicine. We’re developing a modalities class. There are
different ways in which we work together to educate medical students. [The
vision is] to develop their [knowledge base on integrative health] and [improve
their ability and confidence] in referring to integrative medicine and
utilizing it in their future [healthcare workplaces].
minute 25:50
Megan: So, as an instructor in the medical
school and as a clinical observation site you are shaping the future of healthcare
integration and help the physicians be informed and feel comfortable referring
to different integrative medicine services.
Annie: I really love that. I think, you know, spending a
day with a student, a medical student is very powerful. A whole day together in
an acupuncture clinic where they can ask all the questions they have in the
world. And they can try the needle and they can explore the ideas on how to
find an acupuncturist; “what could I use it for in my specialty?”. For me, that
also gives me goosebumps for the future. Because I think that being a template
or a first impression on acupuncture for their field is very rewarding.
Advice for future and current hospital acupuncturists
minute 14:10
Megan: What do you see as the biggest work-related
challenge or learning experience for acupuncturists?
Biomedicine Communication, Conventional Medicine
Literacy, and Practicing Research Literacy
Annie: “I think when it comes to work-related challenges,
I think that our education [programs] as a whole need to do a better job at the
literacy of speaking with elite oncologists, amazing world-class surgeons,
nursing staff, and then, of course, patients.”
Annie recommends you learn and practice research
literacy, study your hospital-based specialtyhether it is oncology or OB/GYN.
When you do this, you are better prepared to be “at the table [and] present our
profession in the very best way possible”. The key factor in good communication
with someone is language. Integrate both the practices and languages of TCM and
Western medicine to “create a synthesized dialog that medical professionals can
understand.”
Annie: “Many of the ancient tools we were given are
amazing. But [you need to] bring those to the table and translate [their
usefulness] in a way that makes sense for the medical professions at large and
ultimately [how these tools] benefit the patient [by giving] them the very best
results in their care.”
minute 18:00
Dr. Annie Budhathoki’s Advice for Students and
Professors of Acupuncture Education Programs
The educators at acupuncture programs could do better at
informing students about research literacy and how it relates to growing the
acupuncture practice field. The language of research is essential to know and
hone for communication with your hospital practice team, your physician
advocates/physician champions, and your hospital administrators. Dr.
Budhathoki’s doctorate degree, she says, helped her build and grow research in
the field.
Take time, on a regular basis, to read the research in your
field and related fields and discuss it with your colleagues.
Advice for the Student: Know Your Dream; Allow Your
Dream to Grow & Expand
Annie: “Allow [your] dream to be as big as
possible. Thread every piece of [new] information you have into that
dream as you learn. So, as you attain that dream and those pieces
come together, your dream then expands. And then, once you get that dream job,
you [then] see all the professors, all of the people… that guided you
and mentored you. And, like in my case now I am guiding and
mentoring. And so, the dream expands.”
Dr. Budhathoki’s advice for the New Hospital
Practitioner
Hone your patient care skills. “Sharpen your diamond”,
Dr. Budhathoki says. “Become a masterful practitioner” in your facility, for
your specialty, for your patients. Ways to hone your skills may include:
completing a doctoral degree, practicing your research literacy skills, and
reading acupuncture books written by physicians to better understand their
perspective.
Patient Care First
minute 19:50
On Gloving During Clinical Care: “Always Wear
Gloves”
Dr. Budhathoki wants all her hospital-based practice
colleagues, especially those working with immune-compromised patients to think
about where the microbes are. Keep infectious disease at the forefront of your
mind. Hand washing is extra important with immune-compromised patients.
Annie: Keep the patient in the forefront of your mind.
Think about what is best for them and the risks involved. Align the safety of
the patient with meeting their needs for symptom/condition. Keep the patient is
as safe as possible. Always wear gloves. Hospital gloves are very thin and
there are some good tricks to getting them to fit you well. Once you get used
to them, it will not interfere with your palpation skills.
I never want to bring what I have from my life into a
patient’s internal environment. So, as a protection for myself and as a
protection for the patient, gloving is my number one [priority in my hospital
practice environment]. Get to know your infectious disease
nurse. Get to know your infectious disease
team. [Contemplate] where things live and how they live on you and
others so you are not putting a patient at risk any time, ever, including
yourself.
Collaborate & Connect with your Champion
minute 21:20
Dr. Budhathoki believes the collaborative connection to
colleagues in the workplace are important.
Annie: “So, who do you know who really loves
acupuncture in your hospital? Who can become your physician
champion? And, as you find a champion, you know, what is their dream
for your dream?”
Allow them [your physician champion] to help you grow and
[expand your work/your program].
Find your physician champion. This is your advocate to
help you grow and connect with others.
Ask your hospital champion what you can do for them.
Don’t email your champion too frequently.
Be concise, courteous and respectful of their time. For
example, when communicating with them, use three bullet points, no more. They
are very busy and get hundreds of emails a day.
Luckily at Huntsman, we have had a number of physician
champions through the years that have… really allowed acupuncture to become a
very integral part of their oncology practice or surgical practice.
Megan’s note on “physician champion”:
Sometimes we talk about them as our “change agents” or
our “advocates” or “hospital sponsors”. There are different terms for
this. In the Project, I call them our “hospital sponsors” because
sometimes they are not a physician, sometimes they are a nurse
practitioner. Basically, a sponsor or champion is
someone very established in the system who wants to advocate for you. This is a
very important connection. More
on this subject here.
Metrics and Integrative Oncology
How do you define success for an integrative health
program within a mainstream oncology/cancer care clinic and/or wellness program?
Look at programs that have acupuncturists integrated as
part of the treatment team. It is important to measure patient results, such as
patient outcome measures and patient satisfaction. You should have research
projects in place.
What are meaningful metrics for a patient-centered oncology
program?
The website has an extensive set of oncology issue-specific
questionnaires. It includes the following types of questions: pediatric
oncology-specific, general adult functional assessments, metrics specific to
the type of cancer, metrics specific to cancer
therapy,
specific to symptoms, specific to treatments, for patients receiving enteral
nutrition and feeding, for non-cancer specific measures like dyspnea in chronic
illness and palliative care.
Dr. Annie Budhathoki’s Recommended Reading for the
Prospective or Current Hospital-Based Practitioner interested in Oncology and
Wellness Center Work
minute 27:00
Annie likes reading material that helps her better
understand other perspectives, such as the patient’s perspective and the
oncologist’s perspective.
Annie: “I love to read books by physicians and patients
about my specialty on cancer and oncology as a lay book or as an easy reading.
I like to go outside of our box and get into the physicians’ minds. I really
love reading books that are written by physicians about acupuncture and
oriental medicine or integrative medicine.”
Book that Annie recommends to everyone reading this
article or watching the interview is
Kitchen
Table Wisdom: Stories that Heal by Rachel Naomi Remen, MD. This is
a gathering of short stories the author compiled as she learned to practice
compassion in her oncology practice.
Annie: “These types of books inspire me every day to
become a better provider. [They help me keep a patient-centered] focus. And
they help me see the physician's perspective and the conventional medical
perspective. [I like] reading material that helps me put [myself] in the shoes
of a physician [or the] shoes of the whole team. And, [books that put me] into
the shoes of [my] patients, of course.”
Megan: I love that idea… for perspective, to read what
physicians write about what we (acupuncturists) do so to better understand
their perspective. And so, improve our communication with them.
Closing Notes
What else do you want the hospital-based acupuncturist
community to know about integrative oncology and acupuncture?
Annie: Please wear gloves and work alongside with your
infectious disease nurse to develop patient safety protocols in your hospital.
I really love integrative medicine and acupuncture. I am
excited to see the research move forward. We are right on the cutting edge of
integrative medicine. It is a powerful place.
Want to learn more?
- You can learn more about Dr. Annie Budhathoki’s work, and
the programs at The
Huntsman Cancer Institute’s Wellness Center website.
- Links to Research work, etc, on Her Program
- There are two acupuncture studies that are in progress
that can be viewed at their ClinicalTrials.gov weblinks.
Video editing acknowledgments
Definitions of terms used in this article
PRN = “pro re nata” or as the situation arises aka “as
needed”.
Related blog posts
Other Program Interviews
Oncology and Acupuncture
Research Literacy and Hospital-based Practice, some
Resources
- Practicing
research literacy is an essential skill for acupuncturists working in a
healthcare system. It is listed as one of the “5 ingredients” in the HH
Project resource booklet, Getting
Your Foot in the Door of Hospital-Based Practice: First Steps
- For a list
of research resources for the hospital-based practitioner, go to the appendix
section, page 21, of First
Steps.
- Also, see
these blog posts and articles on the topic:
- Cost-effectiveness
and acupuncture research citations. In this article’s section, “What is
the goal of integrating acupuncturists at Huntsman?”, Dr. Budhathoki mentions acupuncture as a cost-saving measure in the hospital. Here are some article citations on the subject.
- Acupuncture’s
Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and
Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method
for Pain Relief and Management (Sept 2017)
- Lunchtime
Listen: An
Historical Perspective of Integrative Health Models in the U.S.
Healthcare system
- “Cost
Savings from Reducing Pain Through Delivery of Integrative Medicine Program”.
- Citation: JA Dusek, Griffin KH, Finch MD, Rivard RL, Watson D. Cost
Savings from Reducing Pain through Delivery of Integrative Medicine
Program. The Journal of Alternative and Complementary Medicine.
Jun 2018. https://doi.org/10.1089/acm.2017.0203
- “Cost-Effectiveness
of a Team-Based Integrative Medicine Approach to the Treatment of Back
Pain.”
- Citation: PM Wayne, Buring JE, Eisenburg DM, Osypiuk K, Gow BJ,
Davis RB, Witt CM, Reinhold T. Cost-Effectiveness of a Team-Based Integrative
Medicine Approach to the Treatment of Back Pain. The Journal of
Alternative and Complementary Medicine. Mar 2019. Ahead of print. http://doi.org/10.1089.2018.0503
- Related
tags and search terms in the blog: metrics, research literacy
Recommended Reading Lists
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subject matter information in this blog: research and metrics,
hospital employee, leadership and workplace, interview series, integrative
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