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Robin Daly
Hello and welcome to the Yes to Life show. I’m Robin Daly, host for the show and founder of Yes to Life, the UK’s integrative cancer care charity, helping people with cancer to find out all the options available to support their wellbeing, whether in mind, body or spirit, as they meet the many challenges of cancer. My guest on the show today is someone who is committed to providing integrative cancer care and who offers training to both those with cancer in their families and oncology healthcare professionals. Delia Chiaramonte is founder of the integrative palliative institute and I’m speaking to her over the internet on the east coast of the USA.

Delia Chiaramonte
Thank you so much for having me.

Robin Daly
Okay, so now you’re speaking to us from the east coast of the US, in the Washington area, I believe.

Delia Chiaramonte
Yeah, Baltimore, near to Washington.

Robin Daly
Yeah. All right. And you’re running the Integrative Palliative Institute, which features a training course for oncology professionals to learn about integrative medicine, which all sounds a brilliant initiative. Were this here in the UK, then the big obstacle you’d face would be that the people you most want to attend would be the most unlikely to. And I’m talking about the oncologists. I wonder how the things stand in the US.

Delia Chiaramonte
Well, there is some of that. I will say it is a challenge, but I did run recently an integrative palliative program where I worked almost exclusively with oncology patients and with oncologists. And what I found was once I introduced the ideas from an evidence-based perspective, they’re actually very open. So I think mostly people are close to things when they think it’s not evidence-supported, they think it’s wacky and it’s not real, but once they see that there really is evidence and that there are physicians who believe in this because it’s part of helping patients feel better, they become much more open.

Robin Daly
Right yeah I think that’s the you need to get them in the door basically it’s say the case is an easy one to make once you have the audience but it’s the difficult bit is getting them across the threshold. So I’m interested I mean I think you do have a better take up in the US of interest in integration and I’m just wondering what your feeling is about what are the the factors that have led to that the evidence has clearly helped but you know where the same evidence is available in the UK we’re interested to obviously to know what we can do to move things forward here much more so I wondered what your perspective was.

Delia Chiaramonte
It’s a great question. I think really there’s two big things. And one of them is being driven by the patients and families themselves. So when patients and families believe that something can be helpful, or they’ve tried it themselves, or they’ve seen someone else benefit, and then they bring that to their doctor, maybe the first few patients didn’t get much movement. But when patient after patient after patient brings the same approach, I think physicians are realizing that they have to at least be able to engage in the conversation. So that’s one. But then the second is when they see that it really works, because the integrative approach is not aimed at taking away what oncologists do. It’s not generally, from my perspective anyway, not aimed at curing cancer, meaning don’t use chemo, use herbs instead. That’s not the goal from my perspective. But it is very much the goal to help patients feel better, to help manage symptoms, to help manage pain, and nausea, and fatigue, and sleep dysfunction, and anxiety, and depression, all of which cancer patients suffer from. And oncologists know this. And the conventional medical treatment isn’t great at managing all of those things. So I think when we as integrative oncology providers or integrative palliative providers can show benefit to the oncologists, like we can help your patients with the stuff that’s hard for you to help them with, then they’re grateful instead of resistance.

Robin Daly
So the kind of groups of professionals who are more naturally drawn into this area seem to be like nursing professionals and people like that. Is that the same situation for you? Are you training a lot of people who are ancillary to oncologists?

Delia Chiaramonte
There’s no question that the hospice movement was nurse-driven in the beginning for sure, and palliative and hospice are connected, although not the same. And so palliative medicine or palliative care is just really about helping people reduce symptoms. So it’s not focused on cure. Oncologists are generally focused on cure, if that’s an option. Palliative providers are focused on reducing symptoms, even in people who are trying to get cured. So whereas hospice is sort of acknowledging this might be the end of your life, palliative care is definitely not saying that. It’s just symptom-focused care for people with serious illness. And so in that mode, it’s really very appropriate for physicians as well, because some of what we do is medication. So the integrative part, it’s not alternative, right? Alternative would mean no medicines, just herbs and massage. That’s not my approach. The real integrative approach is medicines, including opiates if they’re needed for pain, antidepressants, anti-seizure medicines to help with neuropathic pain, et cetera, nausea medicines, as well as acupuncture, massage, positive psychology counseling, cognitive behavioral therapy, et cetera, et cetera. So using all the tools that work to help people feel better, help reduce physical symptoms and help reduce emotional symptoms.

Robin Daly
So I think it’s an important distinction you’ve made there with the word palliative, because I think it’s kind of got hijacked slightly, it’s been used as a kind of euphemism, I think, for saying, well, we’re going to put them onto palliative care as a way of saying they’re not going to survive. There’s another way of not saying that directly. And so it’s actually usurped the real meaning of the word palliative, which you just described there, which is actually to help people feel better.

Delia Chiaramonte
Yeah, exactly right. I think you raised such an important point because many people have things for a very long time. I mean, the truth is none of us live forever, right? On some level, we’re all sort of dying slowly, as in we don’t get to live forever. So people who have serious illness may not be dying any time soon, but they may have symptoms from their primary illness or they may have symptoms from their treatment, right? People trying to get cured from cancer if they’re chemotherapy, they probably feel worse, not better in the beginning. So palliative care is appropriate to help them manage those symptoms too, even if they’re trying to get cured.

Robin Daly
Hmm. So interesting. So you’ve got palliative in the name of your institute. So it’s clearly very specific what you’re trying to offer to oncology there in bringing in extra raft of techniques to deal with people’s well-being to deal with their state of mind, their suffering of pain or whatever through their treatment time.

Delia Chiaramonte
Exactly right. And I actually started in integrative medicine separately in just integrative medicine. I was the associate director. So I was the associate director of a center for integrative medicine and medical school for almost 10 years. But what I found there was, it’s, of course, a wonderful field and does tremendous good for many people. And the focus sometimes is more on prevention, which is great, if you can prevent a disease, great. But it felt to me like it left out some of the people who already had things who already had serious conditions that it was almost like, well, it’s not really for you. We’re trying to, you know, make people eat better so they prevent diabetes, which is great, but it just felt like there was a hole to me. And so then in doing palliative care, the palliative providers had this approach that you and I are talking about. But their only tool really was medicines and procedures. And there were so many benefits in the integrative world of acupuncture and mind, body medicine and massage, etc. So it’s really just the symptom focused approach, meaning making people feel better using all of the tools that work, medical kind of tools and then complimentary.

Robin Daly
Interesting. Well, you know, completely with you in as much as the difficulties of getting through oncological treatments is legendary, of course, they’re some of the toughest out there. And the toolbox for helping people to do that, to get through, I think, is unbelievably limited. And, you know, you’ve probably told us about most of them in a, you know, less than a sentence. There’s some good ones there. I mean, let’s face it, there are times when opiates are the thing, you know, for severe pain or something. But nonetheless, it’s a very limited toolbox and none of the things are kind of wellness promoting. They’re only symptom-damped things. So I think this is a huge area where integration can offer a great deal to people.

Delia Chiaramonte
I completely agree with you. And it’s funny to me, and this is almost the driving force for why I started this institute, because there’s just so much misunderstanding on both sides. There’s misunderstanding of the integrative approaches. So some physicians feel like that’s weird. There’s no evidence. That’s not for me. That’s for other kind of people. My patients shouldn’t be doing those things. It’s dangerous. And some physicians just feel like they just don’t want to look in that world at all. And then as we talked about the palliative part, many people, even physicians, completely must understand what that is, and they think it means you have one foot in the grave, which is also not true. So it just became important to me to share and teach people how beneficial this approach is, which is anybody with a serious illness, regardless of if they’re trying for cure or not, who is having symptoms that’s reducing their quality of life, let’s just use all the tools we’ve got. Let’s use a lot of medicines if that helps, and let’s use a lot of complimentary therapies if that helps so that we can help people live their life like we’re all trying to do, enjoy their day, like we’re all trying to do.

Robin Daly
Right, excellent. Well, here in the UK there’s this big distinction between what goes on in hospice and what goes on in the hospital. Hospices have embraced this type of palliative care pretty broadly and in massive contrast to hospitals, which they do have complementary medicine units attached to them, most of them now, the cancer units, but they’re charities, all of them. They’re not really sort of add-ons and they’re there because the patients got them there, you know, through sheer determination. But nonetheless there’s not a real embracing yet of integration within the hospital itself and the great work that’s being done in hospices is not being emulated, not saying, oh we should do that here, which is a crying shame. I think there’s so much they could learn from there. And some of the hospices are actually sort of trying to rebrand themselves as not places for people that are going to die, for places they’re going to make people well again. So it’s all a bit of a mishmash and I don’t know how it’s going to work out, but I do hope that the people who are going through treatment end up with much better support.

Delia Chiaramonte
Absolutely. And I think one of the things that’s within what you just said is really important to highlight, which is an issue we also struggle with in the States. Sometimes complementary therapies are added on kind of like a spa service, like you could get your hair done, or you could go get acupuncture, which is not terrible, but it’s not as good as it could be. Because the truth is, acupuncture, just as an example, has evidence support for some things, but not other things, just like medications do, right, procedures do. So we don’t say to people, what procedure would you like? Or what, what antibiotic would you like, right? We collaborate and say, I have this expertise, I’m aware of the medical literature and what there seems to be benefit for with this modality or this medicine. Tell me what you’re looking for, let’s work together to make a plan. And so I think it’s important that all of these modalities be integrated into the medical world, and not just add ons that seem like, oh, I feel stressed, I’ll go get a massage. So on the one hand, great, go get a massage. But on the other hand, if you are fatigued, because you can’t sleep, because you have neck pain, that a specific kind of massage focused on your neck and shoulders would actually help your pain, help your sleep, help your fatigue. And you probably won’t get that if you just go to a spa, whether they do a whole like massage your fingertips kind of thing.

Robin Daly
Yeah, yeah, no, absolutely good point. Yeah, well, you know, it’s one of those things that is, it’s probably about 20 to 25 years down the road we are now with the complementary medicine units. And of course, they are a lifeline for patients who before they arrived, they were just like, well, lie down and take this horrible treatment and don’t complain. You know, so they’re marvellous things and the people who’ve done fantastic work in them, usually for nothing, you know, working for free and all this stuff, just in order to alleviate symptoms in any way they can. And I think over that time, slowly, slowly, slowly, there is some buy-in to having the service there. But nowhere in Britain is there anything apart from private care, but within the public health system, there’s nothing that I would describe as integrative medicine hasn’t happened yet. So I’m waiting for the day and I hope that your work encourages it to happen.

Delia Chiaramonte
Absolutely. And I think I hate to say it, but I think the way that we make changes systemically like that is by showing financial benefit. And you know, I hate to have that be the focus, because my focus is on the patient feeling better. But administrators want to know, does this benefit us in some financial way? And the truth is, it really can. Because a big part of the integrative approach is teaching patients things they can do at home to support their own well-being. So manage their own pain, manage their own anxiety, which helps keep them out of what we call the emergency department. It helps keep if they’re at home, and they have pain, and they can’t sleep, and they’re anxious, and they’re getting really agitated, and they go to the emergency. Well, that costs somebody a whole lot of money. If we had taught them tools like, oh, this is my anxiety, I have my toolbox, let me go do the things I talked about with my doctor and nurse or provider, and then they feel better and they go back to sleep. That just saved the

Robin Daly
Well that’s exactly the direction of government policy and has been for quite a long time. So I do hope somebody listens sometime soon and realises that these kind of integrative techniques are about self-care which is exactly the thing that the government is trying to promote for all the reasons you just said.

Delia Chiaramonte
The good thing is it works and it gives people a sense of control. It’s terrible to be at home and feel awful and think there’s nothing you can.

Robin Daly
Yeah, what’s the worst? Yeah, no wonder they call the emergency department. Okay, so look, maybe we should talk about your course now, what its aims are, who it’s appealing to and what it consists of.

Delia Chiaramonte
Absolutely. Thanks. So my, my Institute in general will have two has two paths. One is focused on training positions because of exactly what you talked about. The other is focused on supporting patients and families through education themselves. But my feeling is if we if we only support patients and families, then we left positions off the hook, and they never have to engage, and then it doesn’t get integrated into the medical system as you were talking about. So I think it’s really important to train physicians as well. And so the course that I’m that I have run and I’m running again for physicians is two things. One is a didactic component. So takes about 12 weeks to get through the evidence supported, knowledge based didactics of here are the things that might help sleep here, the things that help nausea, here are the things that help pain, here’s what central sensitization is, which is when our body, our nervous system gets turned up so high when we have chronic pain, and the pain now becomes neurologic, it’s no longer tissue based pain. And so opiates don’t work anymore. And so there are all kinds of tools that do work, but the conventional medical world doesn’t really talk about that much. So it’s didactics for physicians, so they see the evidence, they learn where to use these things. And then weekly calls live with me to actually process and go through cases. Because what I have seen is that you can learn it up here. But then if you go back to your clinic, or your hospital, and no one else is doing it, it just falls away. And you, and you don’t, you know, you try it once, and the person says, I don’t know, I don’t know. And then you get scared, you don’t do it again. And so having an ongoing community of other like minded physicians is really important. And to process, here’s a difficult case that I have, how would we work that out? How do we make an integrative treatment plan for that case? So that tactic component, and then the coaching and collaborative with other physicians components.

Robin Daly
That’s exactly the kind of physicians equivalent of you know being given a piece of advice to go off and make some lifestyle changes and it falling flat because you haven’t got the support. So yeah need it the other way around. Really interesting yeah okay so you say on your website you’ll rediscover the joy in your practice and your patients will thank you. So do you want to explain how and why?

Delia Chiaramonte
A hundred percent. And that actually is the other extra benefit of learning this approach for physicians is patients get better. And the patients who get better are the challenging patients, the one that physicians typically find challenging because they gave a medicine and the person comes back and says, I still feel terrible. Do something. And they don’t have a great medicine to help them. So the patient’s frustrated. Maybe they get a little annoyed at the physician and the physician feels lower. Right. We get by helping people. We do every no matter who you are now is a physician. You went into medical school to help people. And when you help somebody feel better, you feel better. And so what happens with a lot of these challenging situations is it’s really a web. It’s not one thing, right? You’re fatigued because you can’t sleep and you can’t sleep because you’re nauseous and your nausea is worse because you’re anxious and you’re anxious because you’re fighting with your husband. And so there’s no pill for that, right? So a big part of the integrative approach is untangling this web. What are all of the pieces? What’s underneath? So it’s not just like a pill for fatigue, because if we don’t fix the anxiety and the nausea and the sleep, we’re not going to fix the fatigue. So how do we pull apart all these pieces and make a treatment plan that addresses all of them? And when you do that, people feel better. And they say, Oh my gosh, you’re so well. Thank you so much. You’re amazing doc. So happy to have you. And then the doctors feel better, right? They feel happier and they feel like, Oh, I know what to do now. When I see a patient like comes in like that, instead of feeling, Oh no, what am I going to do? I’m not going to help this kind of person. They have a plan and they say, Oh, I know what to do. And they do it. And then the patient feels better. And then the doctor feels better and then practice before.

Robin Daly
So, your course in a way is making kind of expert sign posters out of oncologists who are the very right.

Delia Chiaramonte
That is, that is right. And the truth is, this came about, because I was running this program, and the conversation came up, okay, let’s find another integrative, palliative person, like we need another person. And I didn’t know anybody else. Because this isn’t really a specialty, per se, integrative medicine is a specialty, palliative medicine is a specialty, oncology is a specialty, there’s not a lot of overlap, there’s some, but not enough. And so I really felt like we need to train more physicians to do this themselves. Because the truth is, it’s not rocket science. Like, it’s not that hard to go from I have no idea what to do with that fatigued, anxious, nauseous, not sleeping person, to knowing exactly what to do. It’s not that hard. But nobody teaches you that in medical school. So I want to teach that so that physicians can be better.

Robin Daly
Well, it’s good to hear that you feel that it isn’t a major thing because, of course, that kind of overwhelm is always a big feature of oncology. And there’s like no extra bandwidth and all the rest of it. And of course, we can’t expect oncologists to be nutritionists as well. But we can reasonably expect them to know when they need a nutritionist and to go on in. And I think that that’s exactly what we would love to happen here. Is, you know, one thing that’s very clear about the relationship between an oncologist and their patient is that they’re very often at one of those key teachable moments, you know, because the patient wants to know anything that’s going to change their chances or improve their quality of life and got their ears open like no other time. And all too often they’re told, well, there’s nothing for you to do. It doesn’t matter. Just, you know, eat what you want. Try and enjoy, you know, whatever all that stuff they get told to do. And we’re doing all the heavy lifting here in oncology. And it’s like almost it wouldn’t matter what they told them to do. Be better than nothing is my feelings. Like get them involved, engaged. You know, of course, something productive. It’s a control.

Delia Chiaramonte
A sense of control is really important for well-being, absolutely.

Robin Daly
So I think that signposting could be enormously important coming from them, particularly. It’s like a, it gives it a credibility as well, which means, okay, this is evidence-based stuff, they wouldn’t be telling me otherwise. It’s great because it’ll even open the door for people who’ve been kind of cynical about integrative approaches, they might even give them a go on the basis of the oncologist.

Delia Chiaramonte
100% that was my experience. So the oncologists that referred to me, often their patients would say, I have no idea why I’m here. But Dr. X said I should come and that it was great. And now I’m here. They have such respect for their oncologists and will often do what they say. And so then these people though, they have no idea why they were there. But then they almost always said, I’m so glad I came. I feel so much better. I have so much more control over my symptoms. I’m happier. My family’s happier. Thank you. Thank you. Thank you. But they didn’t come because they wanted it per se. They didn’t know what it was, but they came because our oncologists suggested it.

Robin Daly
Great. Love it. So integration all around the world, I think, is a patient-driven initiative, basically. And you can see why, of course, because they have to go through all these very difficult treatments and the rest of it. And many of them are aware of the fact there are things that can help, and they’re not being encouraged to do them, sometimes discouraged from doing them. So that’s very galling. And you can easily see the patients having the initiative and wanting to reap the rewards of that. But I think you’re quick to point out, and other people have as well, that there is this huge win-win aspect to integration, which means that it’s not just the patients who benefit and that there is actually a built-in kind of suffering in our medical systems, which all of the medics are suffering from all the time, which it comes from somehow having their hands tied behind their back, only doing what it says on the computer, and doling out treatments which are very, very unpleasant without feeling they can really support people well enough. And so reaping the benefits of actually providing that kind of support and what it does for the patient-doctor relationship is, I think, is massive. Do you want to say a little bit more about that? Because there’s obviously something you feel strongly about.

Delia Chiaramonte
I do. Absolutely. And there’s there’s even a layer deeper, which I think this is a good place to share about it, which is you can’t really provide good integrative oncology care or integrative palliative care, unless you also take care of your own house, meaning your own health, and manage your own well being. So when you manage your own well being using often the exact same tools, because I’m a person, right, every physician is a person, we have sleep troubles, we feel anxious, sometimes we feel sad, we have negative thoughts, we have pain. So managing our own stuff is a huge part of showing patients how to do it. And so physicians can and should practice guided imagery, meditation, exercise, moving meditations, they should try out acupuncture, so they see what it is, they should try out a chiropractor, if they feel that safe to see what it is, so that they manage their own stuff. And then we become so much better at teaching our patients how to do it, because we believe it, because we tried it, right? Because it works for us. Yeah, it’s not theoretical. And while doing that, so not only are we better at teaching about it, but we have filled ourselves up. So our empathy is higher, we are calmer, we feel better able to manage the really tough stuff, like when we can’t save somebody and they die and families upset and we have grief. So it just becomes a much happier soup all around for the patients and families and the physician, it’s not just let me learn more things that I will impose upon my patients, it becomes a real health and well being collaboration. And that’s another reason why physicians who practice this way are happier, because they are actively managing their own stuff.

Robin Daly
Yeah, very good point. Yeah, I mean, you also create the satisfying practice that you imagined when you started medical school. Now, I think that’s really important because I’m completely with you there. I think nearly every person who starts off in medical school starts off with a desire to really help in that way and to contribute. And we have these medical systems have been built, which are stunningly devoid of the quality you just mentioned, empathy. It’s kind of like it’s seen as a weakness, I think, in general, and it’s beaten out of people in the first year. And then they sort of tough their way through it from then onwards. And it’s a difficult thing to bring back in the door again in a system which is kind of excluded from. And so I feel that actually integration is the route to actually bring it back in the door because integrative medicine largely has built around patient-centered empathic care. I mean, that’s where it’s come from. All of the integrative strands of medicine are those kind of listening, caring, having time for the patient kind of approaches. And so all the skills that are kind of needed to be brought back into medicine in order to make it much more caring, they’re already there. There are experts in it all over the world and they just need to be allowed in the door. So I completely agree with you that this integration is the way to improve everybody’s experience, including all the doctors who are working within that system, which is kind of brutal, basically.

Delia Chiaramonte
100%. Can I tell you a story? Sure. I was very early in training. I forget it was either a fourth year medical student or a first year intern. I was on a surgery service and we had the surgical attending in charge and all these little ducklings like us, you know, following behind and he first to this patient’s room didn’t knock. They told us we were supposed to knock. He didn’t knock his burst in the room in the hospital. She was naked on the commode on the toilet and she covered up herself and looked horrified and he said, your biopsy was positive. Oncology will be by later. And he spun around and left and everybody followed him and I was mortified and I just put my hand on her hand and said, I’m so sorry. I’ll be back later to talk to you. And so when I got back to the group that was in the hallway, I was, you know, 10 seconds behind everybody and he stopped. The attending stopped, pointed at me and said, did you stay back to talk to her? And I, so most of the tears, yes, I did. And he said, you are weak and you will never make it as a doctor.

Robin Daly
Right. Well, there it is. I mean, that was an amazing summary of exactly what I was just talking about. You know, I had my own story of a very similar nature with my daughter who had cancer and she had cancer three times. And the third time it was fatal. And when the doctor came in there to announce to her that she’d been re-diagnosed, he actually brought all his trainees in with him. So the room was full. To announce this thing to her, she knew what the ramifications of that were. She knew how serious this was. They actually did it with all this bunch of young students there. Just unbelievable. And, you know, I went off. I took the guy aside later on to tear him off a strip. It was like wardrobe a duck’s back. He didn’t know what I was talking about.

Delia Chiaramonte
It is shocking how little the experience of the patient and family is discussed. That’s the whole focus, honestly, of palliative care is exactly that. The oncologist just thinks about the cancer. Is the cancer there? It’s not there. What medicine should we use? But the suffering, the deep suffering of the patient and family is often just ignored and let go and seen almost like, well, yeah, it would be nice if they felt better, but what really matters is this. But the truth is it all matters.

Robin Daly
absolutely right anyway so yeah integration that’s the way to go because lots of people start off as I’m sure good empathic people and then maybe they’re empathic outside of the hospital even but within that system it’s just not tolerated really it’s not there’s no room for it so it’s seen as weakness and and that needs to change as soon as possible

Delia Chiaramonte
And that is also a big part of why I’m doing what I’m doing, because I think the culture in medicine needs to change. And one thing that when you were chatting made me think about is, you’re right, there are so many practitioners of healing arts, acupuncturists, chiropractors, massage therapists, mind, body therapists, and many, many more reiki practitioners, etc., who do incredible work. And yet, if it only stays with them, the medical system isn’t going to change. And that’s hierarchical, and it’s not ideal. And I’m not saying it should be that way, but it’s just a fact. So physicians don’t enter into this world and accept it, it will always be other than and I don’t want it to be other than I want it to be part of. And so that’s why I think it’s so important to train physicians. And it doesn’t mean that physicians have to be acupuncturists, although they can if they want to be. But what we train the physicians to do is know the science, know which part you want to own, if any of it, like maybe you want to learn some office counseling techniques, or maybe you want to learn how to lead patients through mind, body techniques, meditation or guided imagery, maybe you want to become an acupuncturist, maybe you want a little bit of acupressure that you could do in the office, but then you also know who to refer to, right? I’m not an acupuncturist, so I don’t have to be one, but I know for you patient, I think acupuncture would help you for the following reasons, because I’m aware of what the evidence shows. And I found a great acupuncturist in town, and I would like you to go see that person. So the physician needs to understand how it fits into the treatment plan and then know how to get the patient what they need. Some could be in their office. They could hire people in their office. They could have volunteers in their office. They could learn something with themselves. They could have good connections in the community. It doesn’t really matter how they do it, but they just have to get that it’s part of the whole treatment plan and then know how to get the patient what they need.

Robin Daly
Well, I think you’re right. There have been endless, endless strategies in this country to try and work around doctors who want to maintain a distance from the whole thing. And of course, it means that it doesn’t really go anywhere. In fact, you need the buy-in of the doctors who are the main people before it will really take off and really deliver what it could. So you’re absolutely right to go straight for getting doctors to train and I think it’s a great move.

Delia Chiaramonte
And it’s also why in the program, we have this group weekly connection time, because part of what we do there is practice things ourselves as doctors. Because, again, if it just stays in your frontal lobe, and you learn about it, you might have believed it a little bit, but you don’t believe it in your heart and soul, the way you do if you try it, if you practice it. So I did one recently, and we practiced EFT emotional freedom technique, sometimes called tapping, and practiced it as a group. And we had everybody write down in the beginning before they started, think of a thing that they’re stressed about, what’s the numbers, zero to 10 of how stressed, we did the tapping together for about 25 minutes, and then what is the number afterwards, and every single person markedly lower. And they were that we talked about it, these are all physicians, and they were like, wow, like that seemed really weird. And while we’ve started, why am I doing this, this is really weird. But the truth is, I’ve been so much better now. So there’s no amount of teaching on a slide or a lecture that could get the awareness that all of those physicians got of like, wow, that’s weird. But it actually works because it worked on me. And so now when they talk to their patients about it, they will be in a completely different place.

Robin Daly
And interestingly, one thing that is seen as being like strange, but actually works, opens the door to others as well. It brings open-mindedness that maybe, you know, if you can shut the whole lot out, then you can keep it that way. But once you’ve let one thing in, it can herald a much more open-minded view of, you know, what integrated medicine has to bring in all together.

Delia Chiaramonte
That’s a great point. I hadn’t really thought about that, but I think you’re exactly right.

Robin Daly
So look very important point for us people over here is that your trading course is it just for Americans or can a British practitioner sign up?

Delia Chiaramonte
Absolutely. No, it’s online. Anybody is welcome.

Robin Daly
Right, good. I’m glad about that. Okay, so I wondered if you could tell us a little about yourself now, your direction of travel. Did you, I’m interested, did you start outside of conventional care and move into that arena or have you just expanded your interest starting from within conventional medicine?

Delia Chiaramonte
So I was a regular old family doctor first. and trained in a standard medical school where I didn’t learn any of these things. And the way this happened for me was I was just a regular family doctor and what I had been taught in medical school was you figure out a disease, you know the right medicine, you give the medicine and the patient gets better. And then you go into practice and you realize that’s not always true. It’s so many women, 30, 40, 50s women, fatigued, jaw pain, headaches, chest pain, but cardiology said it was nothing, they can’t sleep, they must have cancer, we check there’s no cancer, we must have thyroid disease, we check there’s no thyroid disease. And it turned out, you know, it was life, right? And so I just started saying, what’s happening in your life? Tell me about your life. Well, what if you work on this thing and do this other thing differently and come back next week and let’s talk about it again. And I started sharing with them some of my own wellness practices. I was meditating and doing guided imagery and believed in manual medicine, mind-body therapies. And I just started sharing some of that, like, well, you might as well try this because I can’t find anything that I have a pill for and they got better. And then they brought their friends and said, this doctor will help you get better of your chronic whatevers. And more people got better. And I thought, what is this? And how come I didn’t learn this in medical school? And then I discovered there was this whole field of integrative medicine. And so I ended up in the integrative medicine world because of that. But then, as I said before, I did start to feel like a lot of it was about prevention and I wanted to focus more on the really deep and important stuff that happens when you get faced with a serious illness. And I ended up as a hospice doctor just on the side. And what I found there totally shocked me. So a lot of the patients in hospice were happier than my family medicine patients, which was a total opposite of what I thought I learned in medical school, right? Treat the people, they get better, then they’ll be happy. These people were clearly going to die of their disease. And yet they were happier. And I was blown away, like, what is that? And of course what it was is when you were faced with a shortened time, if you still feel kind of well, but you’re faced with a shortened time, you change the way you live your life.

Delia Chiaramonte
and you stop hanging out with the people that you don’t like, and you stop doing things that you don’t want to do, and you focus on today, because that’s what you have, and you get all the juice and joy out of today that you can. And turns out when you live like that, you’re a happier person. That just blew my mind. And I thought, well, can’t the rest of us learn that? Do we have to wait till we’re on hospice to learn that? Can’t we learn that? And that really is the whole point of palliative medicine, to be honest with you, because if you’re nauseous or you have pain, you’re not going to go play with your grandkids. You’re not going to go out to lunch with your friends. And when you stay in the house too much and you don’t see other people, you get lonely. And when you get lonely, you feel sad and then you’re more tired and then you don’t exercise and it becomes a downward spiral. And you can turn the spiral the other way, whether or not you have a curable cancer or some other condition. It’s really about wherever you are, whatever your situation is, how can we make it the best it possibly can be so that you can enjoy your life today, which is the same for you and me and all of us.

Robin Daly
Absolutely. Yeah, great. Got the description. Now I’m interested just to roll back a little bit. So you said that you started kind of recommending things that you found were helpful for yourself to some of your patients when you’re a doctor there. The fact that you’re an a regular doctor and you’re already using other things for yourself is unusual because most people you think who are trained in regular doctoring would use the regular methods because that’s where they put their faith. So what has led you to look outside the box for yourself?

Delia Chiaramonte
That’s a great question. I think because I was young and I didn’t want medicines and before I started medical school, I didn’t go to doctors much and I just, I lived in California, maybe that’s part of it. Okay. I just was an explorer, I think. I wanted to look at all the things that could be helpful and I wanted to be a full and authentic person and check in with my own struggles and see if there are things I could do to make them better so that I could really show up to the world as an authentic person just in general, which was related to why I wanted to be a doctor and help people. And so I just, but those modalities seemed to be on the side. That was like my personal life and then there was medicine. And what I came to see is that those are not separate things that when you focus on the wellbeing of the human, the person and their family, whatever works is what you should do.

Delia Chiaramonte
So the other thing that I think was interesting for me is while I was the Associate Director of a Center for Integrative Medicine, we had an inpatient integrative medicine service, which was great. So we had nurses who were Reiki masters. We did a singing bowl. We did mind body tools for the patients in the hospital, but the palliative team was separate. So we didn’t have the ability to do any medicines at all. And that was also inadequate, right? Like complementary modalities are not the only thing that you need. Sometimes you need chemotherapy and pills, drugs.

Delia Chiaramonte
So that was also inadequate, and that’s when I really started to see they need to be together. There’s nothing wrong with medicines. I’m pro-medicine. I prescribe a lot of medicines. Medicines are great when they’re great, and these complementary therapies are great when they’re great. And that’s why you need to teach physicians, in my opinion, when to use what. And often it’s using a combination of things, but it shouldn’t be a random combination of things. You should be clear about, this is what I assess the problems to be. Here are the treatments. Some of them might be drugs, some of them might be massage. It doesn’t matter, but the point is this is the treatment plan I think will best help you feel better emotionally and physically.

Robin Daly
Well, I think I just put out a great slogan there, two word slogan, whatever works. And that to me is the patient perspective. If you really do patient centered medicine, you actually want to know is this going to help me? Whether it happens to be an integrative practice or a pill isn’t the most important thing. Is it going to help me solve this problem I’ve got right now? And so whatever works is actually where a practitioner should be standing alongside the patient.

Delia Chiaramonte
That’s brilliant. And I’m probably going to borrow that. So thank you so very much. You’re exactly right. That is the point. I actually don’t make this distinction in my head between this kind of practice or that kind of practice medicines versus massage. It is exactly what you said, I just want to make the person feel better. So the untangling the web of all of the things that are getting them in the spot that they’re in, that is reducing their quality of life, and then whatever works to help them feel better so that they can do what they want to do. Go for a walk, walk their dog, go play golf, whatever, whatever they want to do that makes their life feel good. That’s what I want to help them do.

Robin Daly
So you mentioned that you’re not an acupuncturist and something else you have not as well, but are you actually trained in any holistic practices at all?

Delia Chiaramonte
Yeah, mind body medicine is the expertise that I own the most. And I think actually, that’s one of the things that’s really important when we teach physicians about this, sometimes the ones who are interested get overwhelmed, I can’t be an expert in all of the things, and you don’t have to. So most people, physicians in this field, pick a thing or two that they’re particularly interested in mind body. Medicine is one of them, that’s the one that interests me, some people pick food, nutrition, some people pick herbs and supplements, some people pick manual approaches, some people pick traditional Chinese medicine or acupuncture, and there are others. A lot of people add Reiki and other energy medicine techniques, but many people pick a thing that they want to know, and then the other ones they learn about and they refer their patients out. That’s so my body medicine is my thing and counseling office counseling.

Robin Daly
Okay, great. So I gathered that you’re working on a book. Who’s this aimed at and what do you hope to offer to your readers?

Delia Chiaramonte
This book is aimed at family members of people with serious illness, because one thing that I have seen, as I’m sure you have lived, is that it is so heartbreakingly, painfully hard to be the loved one of somebody with a serious illness. And it is hard in a whole bunch of different complicated ways. There’s the practical ways in which it’s hard, as in how do I get my loved one the best care? How do I get the doctors to pay attention? How do I get their symptoms managed? How do I try to see is there a cure or a way to prolong their life or not? Are we getting the best care? Should we have another doctor? Like there’s a lot of specific stuff that’s important. There’s organizational stuff that’s important. How do we manage all of these medicines and papers and all that stuff? In the US at least, insurance issues are important. But then there’s a whole other piece that’s not that. That’s about how do I talk to my loved one about these really hard things? Do we, if things seem to be going downhill, do we say something? Do we not? What if mom says, I think this is my last Christmas? Do we say, oh, don’t talk that way? Or do we start a really deep conversation around that? How do we stop ourselves from going into separate corners? This happens sometimes in families. No one wants to cry in front of the other person. And so everybody’s sad, but no one wants to make the other person sad. So they separate. And just at a time when you mostly closeness, everybody’s going to their own corner, which is not ideal. And then there are really complicated emotions. Like sometimes you’re tired of it and you love your person deeply and you may not even allow awareness of this feeling of, I don’t want to do this anymore because that may feel so painful and you may feel guilty, but it’s real. And so a lot of times the family member gets kind of ignored. There’s the patient, everybody’s talking to the patient, but the family member’s wellbeing is ignored. They may talk to the family member about the patient, but we don’t often talk to the family member about them and how to help them go. So that’s what this book is.

Robin Daly
Sounds like it’s going to be very valuable. When do you think it’s going to arrive? Thank you.

Delia Chiaramonte
I think it will arrive by the end of this year.

Robin Daly
Okay, all right, I look forward to that. We’re coming to the end. Do you want to just give your website address? People want to find out a bit more about you and the other things you offer?

Delia Chiaramonte
I’d love to. So the website is integrativepalliative.com. And then I have also a podcast if people are interested in learning more about my stuff, and how to handle both their patients and themselves. And that is the integrative palliative podcast available in all the podcast places.

Robin Daly
Yeah. Excellent. All right. Well, look, really interesting chat. Lovely to hear what you’re doing. More power to you. You’ve got a stated aim of training 1,000 integrative palliative physicians across the world. I noticed on your website. Sounds great. I’ll back you in that. So I sincerely hope you’re successful in doing that. And it’s been really interesting and lovely to talk to you about this all today. So thanks very much for coming on.

Delia Chiaramonte
thank you so much for having me. I really enjoyed this conversation. Bye-bye. You have a wonderful day.

Robin Daly
Great to hear of Delia’s initiative and that her training is available here in the UK. Do check out her podcast that she mentioned and look out for her book later in the year. Thanks so much for listening today. I’m excited that now the show is available on multiple platforms. As usual it’s on UK Health Radio both as a scheduled broadcast and on Listen on Demand but now it’s also available as a podcast on all the main podcast platforms and on YouTube on the UK Health Radio channel and more. So do make a point of listening again next week to the Yes To Life show.