The first installment of this two-part article explored how the attitudes of physicians and patients regarding complementary and alternative medicine (CAM) shape their communication on this subject. If you are inclined to use CAM therapies, clear and open communication with your physician is essential. Here, I offer guidance on establishing such a dialogue.

In the Patient's Best Interest

Although the methods they choose may differ, allopathic (conventional) physicians and alternative practitioners share a common objective improving or maintaining their patient's health. Keep this in mind when you raise the issue of CAM with your physician.

While most CAM therapies are safe, in fact far safer than their conventional therapeutic counterparts, there is a real risk of harmful interactions between the two. Physicians are in the best position to safeguard against these adverse combinations. If a physician suggests that CAM interventions can be harmful, remind him or her that is precisely why you wish to discuss it. Much of the harm that results from CAM treatments occurs for lack of proper supervision from conventional physicians.

Even more significant, your interest in alternatives of any kind speaks volumes about your worldviews, lifestyle, health beliefs, and therapeutic goals, all of which have tremendous bearing on your relationship with your physician and the quality of care you receive.

Patient Expectations

A clinician rarely practices two systems of medicine. Therefore, it is unreasonable to expect conventional physicians to be competent CAM practitioners. Many alternative systems of healing are very complex and require extensive additional training. While a growing number of physicians have gone on to obtain additional credentials in CAM, most have not and are unlikely to do so in the future.

However, it is not necessary for a physician to master an entire system of healing to competently use certain CAM therapies, such as herbs or mind-body interventions. Furthermore, some physicians may choose to adopt specific CAM philosophies without using its therapies. For example, many patients are attracted to CAM's holistic perspective and emphasis on self-healing. These two characteristics are not often associated with conventional medicine, but physicians can incorporate them into their practice.

Do not be surprised if you know more about CAM than your physician, particularly as it applies to your specific health concerns. In fact, the responsibility may fall on you to find the appropriate CAM therapy or practitioner. This is generally not a problem, as long as your physician is supportive and willing to to coordinate your care.

Patient-Physician Respect

Regardless of his or her specific expertise and beliefs, it is unprofessional for a physician to ignore, belittle, or dismiss your interest in CAM, or anything else related to your health. Do not tolerate it. Unless you have compelling reasons to continue working with such a physician, find another one. Hopefully, this will be less of a problem as more and more physicians become accustomed to CAM.

Some physicians may insist that CAM has not been proven effective. This is like saying that one kind of medication should work for all diseases. You may wish to remind your physician that complementary and alternative medicine encompasses a tremendous array of different therapies, some of which do appear to be effective. Also, don't forget that most conventional interventions have not been subjected to rigorous scientific testing either.

The Power of Placebo

While disregarding a patient's interest in CAM is unprofessional, it is also bad medicine. Every medical interaction involves, to some degree, the placebo effect the ability of a patient's belief in a treatment to significantly alter the course of the illness. This effect, which is independent of the effectiveness of the treatment itself, occurs with both conventional and alternative clinical encounters.

Physicians who disregard or discourage a patient's beliefs, therefore, may be working against their patient's best interests by minimizing the power of the placebo.

Consider, for example, a patient who consults her physician for chronic muscle and joint pain that has not responded to various pharmacologic treatments. She expresses an interest in acupuncture . Since the effectiveness of acupuncture for this medical condition is still largely unknown, her physician may respond in a number of ways; let's consider two possibilities.

"I think that would be a mistake. There is insufficient evidence to suggest that it would help, and I think you would be wasting your time and money."

If the patient tries acupuncture, its effectiveness may be diminished by her physician's negative attitude. The physician's response may be justified if there is a safe and effective conventional intervention that has not yet been tried, or if acupuncture poses a significant risk of harm. However, in this case, neither of those conditions applies. A well-trained acupuncturist is extremely unlikely to harm someone being treated for this non-life threatening condition. Indeed, this dismissive attitude may place patients at greater risk by discouraging them from discussing their interest in acupuncture and the possibility of adverse interactions.

Another approach would be:

"Some patients have had success with acupuncture for conditions similar to yours. Since we have not been successful at managing your pain, I think it is worth a try. Do you have an acupuncturist in mind? Acupuncture is generally safe, but you should make sure that he or she is licensed and has a good reputation. Please keep me informed of your progress."

This physician may not understand acupuncture or personally believe in its effectiveness. Even so, he or she recognizes the limitations of conventional medicine, has done nothing to thwart the benefits of acupuncture's placebo effect, and has reasonably safeguarded the patient's safety. This is an example of effective patient-physician communication.

Keep the Lines Open

Improving communication between patients and physicians is a laudable goal, particularly when it comes to CAM. An open dialogue with your physician will not only help protect you from harm, it will create the space for a healing relationship.