Talking to Your Doctor About Complementary and Alternative Medicine
In some ways the gap between complementary and alternative medicine (CAM) and allopathic (traditional) medicine is narrowing. But, significant differences remain. On one hand, this tension is not a bad thing. Tension often creates opportunities for medical change. However, in the clinic, the conflict can be destructive. Particularly if it leads to a breakdown of communication between patients and their physicians.
A Growing Interest in CAM
Americans continue to be attracted to CAM in considerable numbers. Over 40% of Americans report regularly using CAM products and services. This is up from about a third over the past decade. The majority of these CAM users also see their regular physicians for the same medical condition. Contrary to popular opinion, most people who find an interest in CAM do not reject traditional medicine. Rather, many patients are attracted to CAM because they find it to be consistent with their lifestyle, beliefs, and values.
Patients are far more likely to discuss both their traditional and CAM treatments with their CAM practitioners than with their physicians. In a survey of 86 breast cancer patients, women cited the following reasons for not discussing their CAM interests and practices with their doctors:
- Impression of physician disinterest
- Anticipation of a negative response
- Belief that the physician is unwilling or unable to contribute useful information
- Perception that the CAM therapies they are using are irrelevant to the biomedical treatment
- Their views regarding the appropriate coordination of different healing strategies
Women in this study also said they were not looking for physicians to endorse particular CAM therapies. Rather, they appreciated those who were respectful, open-minded, willing to listen, and honest about their limited knowledge of CAM.
Physicians Show Interest in CAM
Physicians show a range in their enthusiasm for CAM. A review of several international surveys found that many physicians selectively practice CAM, refer their patients to its practitioners, and/or believe in its effectiveness. The researchers found that
- 19% of physicians practiced ]]>massage]]> or chiropractic methods
- About 17% practiced acupuncture or herbal medicine
- 9% practiced homeopathy
- Physicians commonly referred their patients to acupuncturists and chiropractors (43% and 40%, respectively) but rarely referred patients to herbalists (4%)
- Roughly 50% believed in the effectiveness of acupuncture, chiropractic, and massage
- Only 13% had faith in herbal medicine.
Physicians cited four main reasons for their acceptance of CAM:
- Patient's lack of response to conventional treatment
- Patient's request or preference
- Belief in the effectiveness of CAM therapy
- Fewer adverse effects
Many of the surveys were conducted in countries more open towards CAM than the United States. However, a survey of US primary care physicians showed the same findings. A sizable but widely variable percentage of physicians use or accept selected CAM interventions. Their opinions vary according to the nature of the intervention. American physicians, for example, tended to be more enthusiastic about mind-body interventions (meditation and ]]>biofeedback]]> ) and less keen on those therapies that require the administration of medicinal substances, such as megavitamins or homeopathic remedies.
Physicians Have Concerns About CAM
While it appears that roughly half of physicians take at least some CAM modalities seriously, a considerable number remain skeptical. When asked why they oppose the use of CAM by their patients, physicians most often site one or more of the following:
- Alternative practitioners do not possess sufficient knowledge to properly diagnosis an illness.
- There is insufficient scientific evidence of effectiveness for CAM.
- CAM is potentially harmful either directly through its adverse effects or indirectly by delaying appropriate medical care.
One major reason for this skepticism is a lack of training and experience in CAM. Approximately two-thirds of the 125 American medical schools offer some instruction in alternative medicine. But all of it is elective, no school requires courses in CAM. This means that the vast majority of practicing physicians, particularly those with long established practices, have had little if any formal exposure to CAM. Any significant education with CAM, therefore, must be obtained independently, which helps to explain the tremendous variability of CAM in physicians' practices.
Moreover, the traditional model of disease dominates medical education in this country. Most American physicians graduate with an attitude towards health and healing inconsistent with many CAM philosophies.
The Scientific Mindset
The perceived lack of scientific evidence to support CAM is a source of controversy. While it is true that there is limited evidence for the efficacy of most CAM therapies, it is also true that many biomedical interventions also lack scientific evidence. It is interesting to note that, despite their concern for scientific proof, physicians' acceptance of any medical intervention, often has more to do with factors such as patient beliefs, the availability of referrals in the community, and cultural norms.
There is also the "plausibility factor". Many physicians will not accept the legitimacy of a therapy without a plausible scientific explanation for its effects. Interestingly, the plausibility factor often determines the constantly shifting boundary between CAM and conventional medicine. As scientific theories are developed to explain their effects, CAM interventions tend to cross over into the mainstream options.
Even if a physician knows very little about CAM in general, he or she is often more comfortable advising patients on therapies that conform to familiar biomedical principles. For example, the growing body of research that helps to explain the clinical effects of mind-body techniques, such as meditation and biofeedback, makes physicians more likely to engage their patients in these specific interventions. Physicians are far more reluctant to discuss interventions for which a scientific explanation is less plausible, such as homeopathy or energy healing.
An open discussion with your doctor about your desire to try CAM treatments is important. It can help to ensure there are no bad interactions with any traditional treatment you may be receiving and may lead to better health care for you.
If you are worried about a negative response from your doctor, keep in mind that patient's request or preference was one of the top reasons physicians do use CAM treatments.
American Academy of Family Physicians
National Center for Complementary and Alternative Medicine
Canadian Family Physician
Last reviewed November 2009 by ]]>Brian Randall, MD]]>
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