What he saw of the medical system during the deaths of his parents and four brothers led Dr. James McKoy on a mission to give patients the kind of care he wishes his family had received. Doctor stresses
integrated therapyJames McKoy says he
One patient's experience
especially values a positive
relationship with his patientsBy Helen Altonn
haltonn@starbulletin.comAs Kaiser Permanente's chief of rheumatology, McKoy practices "integrated medicine," combining traditional and alternative therapies to treat chronic diseases. "I don't like the term 'alternative,'" he said. "I like the term 'integrated' because I integrate the best of the natural with the best of the traditional medicine."
McKoy said he spends a lot of time with patients, getting to know them and their needs and "making sure they understand their illness, medications and what the future entails for them. I don't just treat bones and joints. I look at the whole patient."
McKoy stresses patient education, including the need for good nutrition, a healthy lifestyle, restful sleep, exercise, weight management and adequate water intake.
He saw little of modern medicine while growing up in North Carolina. Blacks were treated in two small rooms in the back of the hospital, he said, and doctors who made house calls would not go to his parents' home because they had no money.
He watched his mother care for his father for four years after he had a stroke and was paralyzed. Doctors appeared uncaring and used medical language his parents could not understand, McKoy said. "It created more stress, more fears. It took away hope."
He began questioning: "Why is it that he can't get care? Why can't doctors come see him? Why does it have to be about money?"
His mother died of diabetes and kidney problems, his four brothers of cancer. The youngest was 25 when he died 10 years ago. A fifth brother now has terminal lung cancer, McKoy said.
He was in college and unsure what he wanted to do, he said, when his two oldest brothers died. "It kept coming back to me: Why don't you become a doctor and see if you can make a difference?"
After a "totally black experience" in grade school, high school and college, McKoy ended up in an all-white medical school at the University of Iowa. "It was one of the biggest struggles of my life. ... But I got focused and said: 'This is what I have to do. I can't let the baggage of yesterday hinder me from accomplishing what I need to do.'"
He began reading about nontraditional approaches to medicine and for the past 10 years has been studying and going to conferences to learn more.
Most important, he said, is his relationship with patients, something he did not see in his family's medical experiences. His mother's compassion in caring for his father, who was never hospitalized, contributed to the compassion and love he has for his patients.
A charismatic rheumatologist he met while in training, Dr. Peter T. Singleton, also had a big impact because of his rapport and relationships with patients, McKoy said. He recalled a patient going to Singleton on crutches with arthritis.
"When he finished talking to her, she walked out without crutches," he said. "I automatically wanted to be what he was, rheumatologist."
Another turning point for McKoy happened in 1983 when he became a Christian. "Things of the past no longer plague me. Taking on Christianity uprooted those negative things."
He finished his residency in 1978 at the University of Iowa and his rheumatology specialty in 1981, then came to Hawaii in the Army as a rheumatologist at Tripler Medical Center. He remained here after discharge and has been at Kaiser for five years, tailoring treatment to his patients' needs.
Besides "evidence-based medicine," he uses a variety of techniques, such as visualization and guided imagery, breathing and relaxation exercises, meditation, aromatherapy and prayer.
Dietary supplements, massage, acupuncture, herbal remedies and exercise, such as yoga and tai chi, are among alternative choices.
"My first prescription is education," McKoy said, not only for patients, but through lectures across the state.
Every second Tuesday, he gives a lecture from 6 to 7:30 p.m. at Kaiser Permanente. He also lectures at 9:30 a.m. every third Monday. Anyone interested in registering for the lectures can call 432-8403.
McKoy also does marital, sexual and other counseling. He said he created the lectures and handouts about pain, stress, mind-body medicine, breathing and related aspects in response to a great need for counseling and information.
He is on the medical editorial board for the magazine Arthritis Today; he answers questions about alternative medicine and reviews all medical articles published. He was a contributor to "The Arthritis Foundation's Guide to Alternative Therapies" by Judith Horstman, an award-winning health and medical writer.
McKoy is one of the rare doctors combining Western medicine with less conventional therapies, Horstman said in an e-mail to the Star-Bulletin. But the number is growing, she said, because so many patients are using alternatives and asking about them.
"Indeed, many so-called 'alternatives' are becoming accepted by mainstream medicine. ... But people have to be wary of hucksters who promise to take away your pain but just take away your money and can leave you worse than before," she warned.
McKoy is concerned about information from the Internet and other sources about products promising "miracle cures for everything known to mankind" with no scientific proof.
"There are a lot of bad things out there to make money, and a lot of good things," he said. "The problem is, the patient doesn't know what is good or not."
Bernadine Chee was 28 when she began having symptoms of chronic fatigue syndrome and fibromyalgia. She was in Beijing, doing field work for a doctorate in anthropology at Harvard University. Patient doing well
By Helen Altonn
using integrated medicine
haltonn@starbulletin.com"I couldn't even ride my bike, I was so tired," Chee said. "And when you can't ride your bike in China, something's wrong."
Returning home, Chee saw "a rainbow of specialists," but it took five years to get diagnosed, she said.
Doctors said her fatigue was caused by depression and recommended antidepressants, which did not work, she said.
"I was doing everything I could to take a scientific approach to finding a solution to my medical problems, but that just wasn't leading anywhere," she said. "If anything, that created more stress in my life."
Chee, now 32, was referred to Dr. James McKoy, Kaiser Permanente chief of rheumatology, in September 1999.
"I walked into his office and he knew what I had," she said. "I felt like I'd been lost in the forest and been found."
Rather than trying different high-cost drugs, McKoy suggested "a whole different approach to healing my body that altogether made the biggest difference in my getting better," she said.
His approach included exercise, vitamins, herbal remedies and a mind-body connection to achieve relaxation, she said.
She suffers from extreme exhaustion, which stimulates her brain in a way that causes her blood pressure to climb and her heart rate to decline. At times her hands and feet were so hot, she had to use a cooling pad to go to sleep, she said.
"Some people are chronic and can't get out of bed. At least I'm operable," she said, but trying to write her dissertation "is mentally stressful ... so it's hard to finish."
Tai chi has helped her the most, she said. She also goes to a pain clinic McKoy has set up with the chief of pharmacy at Kaiser. "He gives me structure for exploring my own path or remedy. ... Being open to that has made a huge difference in my life."
Chee said: "He's been very, very positive. When I saw Dr. McKoy, a light shone. It was amazing."