Brittany Scurto, PA-C: How to Discuss an Integrative Medicine Approach With Patients

“When you do want to bring up some more integrative techniques, a lot of times I will say to the patient, ‘Hey, I like to practice a more integrative approach’ or ‘I like to focus on the whole person. So, we're going to still do this traditional treatment, but I’d like to talk to you about this as well.’ And I usually start with nutrition. I feel like nutrition is probably the most important thing, especially in the United States,” said Brittany Scurto, PA-C, in an interview with Dermatology Times.

Scurto, a board-certified physician assistant at Dermatology Associates of Lombard in Illinois, recently presented at the 3rd annual Diversity in Dermatology meeting in San Antonio, Texas. Scurto presented alongside Tracee Blackburn, PA-C, to discuss highlights from “Flash Pass to Integrative Medicine.”

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One of the first topics Scurto addressed with attendees was how to work integrative medicine into a routine that also involves traditional therapies for chronic skin diseases. Scurto noted that she still treats her patients with traditional therapies but also uses integrative medicine to focus on the root cause of the disease. She encouraged attendees interested in integrative medicine to focus on the science of various approaches to stay informed.

With integrative medicine, it’s also important to gauge how interested patients are. Scurto encourages asking patients how willing they are to make additional changes to their lifestyle, and then try to meet the patient at their comfort level. If patients are willing to make the change, she starts by encouraging nutrition changes, such as focusing more on whole foods and less on processed foods.

The other important topic Scurto covered was cutting out toxins as much as possible that are absorbed by the skin. Easy ways to start this include eliminating dyes and fragrances in skin care and body care products. If patients are willing, Scurto will recommend ways to make less toxic cleaning products.

Brittany Scurto, PA-C: Hi, my name is Brittany Scurto. I'm a physician assistant in the suburbs of Chicago at Dermatology Associates of Lombard.

Dermatology Times: What is your leadership role with Diversity in Dermatology?

Scurto: I am very honored that I was asked to be on the board this year. So, this was my first Diversity in Dermatology on the board. I am the medical language chair as well as the integrative medicine chair with Tracee Blackburn.

Dermatology Times: What advice did you share with attendees during your co-chaired session, "Flash Pass to Integrative Medicine?"

Scurto: At Diversity in Dermatology this year, my purpose was to bridge the gap and talk about how to integrate integrative medicine into your practice. Many of us are dermatology PAs or derm providers who have very short appointment time, sometimes 15 minutes or less. And so, if you're not very well versed in integrative dermatology or integrative medicine, or you're not doing it regularly, you might get overwhelmed at the thought of adding something else to an already time-constricted visit. So, what I did was talk about the basics of how we go about traditional medicine these days. We're focusing really on the disease and the disease state versus the root cause of it. We tend to follow protocols where we're using topical washes or creams. We're sometimes using pills or shots for treatment. And none of those are a bad thing, or typical traditional treatments are not bad, they can be really helpful to our patients. But I think it's important to recognize that we need to focus on the root causes as well. Why are these patients having so many of these problems? And how many of these diseases really, truly are chronic? And how can we mitigate that so they can have a longer, healthier quality of life.

So, we talked about how integrative medicine is bringing in traditional medicine with all other well-studied types of alternative treatments. And I like to reiterate that it is important that when you're using other types of medicine that maybe aren't traditional Western medicine, that it's still got some evidence base to it, that you're still looking at the science, there may not be as much science. But I think it's important to recognize that there are many other types of medicine that can be used in conjunction. And then just also talking to your patient about basic things that we get away from these days, like nutrition and sleep and exercise, making sure that we're working on a healthy gut skin brain access with regards to our microbiome.

When you're in a visit with a patient, you really want to focus on getting to know that patient. You really want to focus on having them trust you. The more questions you ask them, the more you get to know them and their lifestyle, and the more you can kind of get to the root of why maybe they're in your office in the first place. And you can start tweaking things to what might work well for them. I also think it's really important to look at how willing they are to make additional changes that maybe aren't as traditional, and kind of meeting them where they're at with their lifestyle and access and means. So, we really talked a lot about bridging that gap, being able to get to know your patient, let them know that "We're dealing with a chronic disease. we're going to see each other regularly, we're going to keep working on getting you healthy, putting the fire out now, but keeping you healthy for a long time and really working on your quality of life." When you do want to bring up some more integrative techniques, a lot of times I will say to the patient, "Hey, I like to practice more an integrative approach" or "I like to focus on the whole person. So, we're going to still do this traditional treatment. But I would like to talk to you about this as well."

I usually start with nutrition. I feel like nutrition is probably the most important thing, especially in the United States. I try to encourage them to eat more whole foods, i.e. things that come from a plant and not a manufacturing plant. I encourage them not to eat things that will outlive them. I like to encourage them to read the labels, and if you don't recognize it, maybe don't put it in your body. And this is not a perfect set 100% of the time. I also tell them that I get that every once in a while, you're going to have this sweet treat or something that's a little processed, and that's okay, but we want to try and push those healthy choices as much as possible. I try to give them an 80/20 rule.

The next step that I focus on which I think is really important for dermatology as well is decreasing toxins via our skin, things that we're putting on our body or near our body. And so, the big one that right off the bat is easy to cut out is dyes and fragrances, which we know helps a lot of chronic skin diseases, but also cuts down your risk of a lot of chemicals in your body that are hormone disruptors, and volatile compounds, and carcinogens. And then I go on from there, I kind of see how receptive they are. And then maybe in the next visit, we will talk about supplements, maybe we will talk about decreasing plastic use. A lot of times I'll give them recommendations on how to make their own cleaning products for the home or different products that are safer. I usually will recommend some apps like EWG.org, Clearya, or Detox Me where they can try and find healthier options and start their own journey. But really, it's just about putting the patient in the driver's seat and letting them help make decisions about their care and giving them the power to heal themselves. Not only with our traditional pharmaceutical medicine, but with a whole lifestyle, the whole person approach.

Scurto: I've been to a lot of meetings in the 19 years that I've been a PA and there is nothing like Diversity in Dermatology. I went last year before I was on the board. And I was honored at that time to speak about medical Spanish. And then coming this year, I was just even more impressed and so proud to have been asked to be a leader and to be part of this amazing group of people. Because there really truly is nothing like it on the meeting front. Typically, we go to meetings, and we hear the same old things. You might learn important pieces of information or learn about new medications or new science about disease states. But this conference is truly unique because it goes above and beyond to topics that I've never seen anywhere else before. That has really changed, as an experienced PA, how I approach things. So, I think it's a great meeting for anybody at any level.

One thing that I particularly enjoyed at this meeting was that we had a career lounge, and I was able to be a part of running the career lounge. We had PAs of all different backgrounds and all different experience levels coming in and asking questions or looking for help to progress their career, maybe it's that they're just starting out and they needed somebody to look at their resume. Maybe they have contract questions. Some people had been PAs for years, or NPs even for years, and they wanted to know, "What can I do next? I have this passion and this drive, and I feel like there's more for me and I need to try and find my path." Is that going into pharma? Is that going into administration? Is that being a mentor and teaching?

At one point, we had this big group of women, it was right after the women empowerment panel, and we were all sitting there sharing our experiences. It was just a very warm, cozy experience I really enjoyed getting to know peers that I wouldn't have gotten to know otherwise from all over the country and how we all really come from different backgrounds, but we relate it in a lot of the same ways just by being women in our profession and being able to lean on one another and support one another so that we could continue to promote improve boost our profession, but especially women in our profession. That was just something that I will always carry with me, it was such a beautiful experience.