A woman told me she saw her physician recently and, when she told him all the things she was doing to help herself, naturally he told her he practices Western medicine and that he does not believe in that stuff.
Not a good conversation.
A number of research studies have found that one in three patients routinely use alternative treatments, but seven out of 10 users of alternative therapies do not tell their physicians. Complementary treatments are used more commonly among people diagnosed with chronic or life-threatening conditions. Patients with AIDS, cancer, and chronic mental-health illness often seek alternative treatments and practitioners because their conditions are not always adequately helped by conventional medicine.
Some of us have had a bad experience with patients who do not follow our expert advice, and we may react unfavorably to patients who want to follow their own path to healing. Many of us are concerned that when patients seek alternatives there can be a delay in diagnosis and treatments and delaying curable medical treatments.
Physicians may not be aware of the science behind complementary alternative medicine (CAM) and worry about the lack of proper training of practitioners and lack of regulation of practitioners. Physicians are also concerned patients are getting ripped off financially and are worried about the potential of interaction between natural health products and herbs and the drugs and treatment we are giving.
So how can we talk to patients about CAM?
1. Do ask, they’ll tell. The first and the most important point is asking patients if they are using herbs or natural health products or visiting an alternative practitioner. This should be standard as part of the history for any medical visit.
Some patients think that if it is natural then it can do no harm and see no need to tell their doctors. Other patients do not think their physician is interested or knowledgeable about CAM, so there’s no point in discussing it. Some physicians may feel defensive or criticized when patients tell them they are seeing a naturopath, acupuncturist, or other health care practitioner, and some patients feel their physician may feel threatened and refuse to see them or may suggest throwing all that junk in the garbage.
Whether you are an anesthetist or surgeon or psychiatrist, asking your patient is extremely important and the first step.
2. Explain the science. Make time to explain to patients that much of what we do in medicine is based on science and explain what a randomly assigned double-blind controlled trial is all about.
Sometimes people choose alternatives because they fear the adverse effects of conventional treatments, lack of efficacy of conventional treatments, and perceived poor doctor-patient interactions. Some people believe that “natural” is better, that CAM or “integrative medicine” is safer, and its approaches are more congruent with beliefs about the nature of health and illness.
Explain that many people get well from the placebo effect. So just because they read it in a magazine, or their friend got benefit does not necessarily mean it is useful or will work for them.
3. Be respectful and nonjudgmental. Patients want nonjudgmental, compassionate, honest advice about what they are doing. Do not instantly dismiss what they share as useless. Do not say to throw it all in the garbage. Patience is a virtue. Patients are trying to be autonomous and do things for themselves (self-care). At least we can acknowledge the importance of patients’ wishing to take responsibility for their own health and support their autonomy.
It is easy to understand how we can get quite frustrated when we offer an approach we know will work, but our patient chooses something else. Some physicians find the doctor-patient relationship difficult when the patient’s belief system is different from their own.
As a physician, it is always helpful to appreciate your patient’s ways of thinking about health and treatment and find some common ground where there can be agreement. Rather than attacking a patient’s beliefs, it is more helpful to understand where they are coming from and how they developed these misunderstandings and sometimes mistrust of modern medicine. I have learned a lot about alternatives by just listening to my patients’ experiences.
4. Collaborate. A herb or natural health product may be interfering with medical drugs or surgery. When patients and doctors work together as a team, health outcomes are enhanced.
The future of health care will, hopefully, be more collaborative. Patients will be better-taken care of when all the health care practitioners who are providing treatment communicate more effectively with each other. When physicians, chiropractors, dietitians, naturopaths, acupuncturists, psychotherapists, physiotherapists, pharmacists, nurses, social workers, dentists, massage therapists, and other allied health professionals talk to each other about what is being done, then the patient will benefit and our care will be truly integrative and collaborative.
5. Compromise and negotiate. Some physicians take the approach that it is either my way or the highway. They feel that unless a patient follows their advice then the patient should find another doctor. While this is perfectly understandable it feels more patient-centered and helpful if we are willing to negotiate and compromise.
If someone does not want your treatment, do not dismiss them. They may change their minds in the future and be more receptive if you treat them with respect. Medicine has always been a conservative profession, which I believe is a positive thing.
For the most part, when some new treatment is accepted by the medical profession, it has been thoroughly researched and tested. Even so, physicians often take years to accept new treatments. Physicians’ cautious mindset can be a defect, as revealed by history.
Take, for example, Ignaz Semmelweis, who, in 1848, introduced the washing of hands and using antiseptic procedures in gynecological wards. His new approach reduced mortality from puerperal fever by a factor of 15, yet he was ostracized by his colleagues who were offended at the idea that physicians could be carriers of death! So while we must not drop our scientific ways of dealing with new propositions, we need to remain open to new ideas.
Medicine is racing ahead with DNA mapping, stem-cell research, organ transplantation, MRIs, and new diagnostic equipment, as well as newer, more sophisticated drugs and surgical techniques. While we focus on eliminating symptoms and diseases with all these new tools at our fingertips, sometimes we forget that a person is more than the disease in their body.
When we in the medical professions forget that human beings are more than their symptoms or treatment, we undermine our work as healers. We can inadvertently cause harm. Many people in the healing profession have joined the trend back to a more natural, humanistic, and holistic approach.
As always, the challenge is to synthesize and integrate the scientific and the humanistic. When we work together, patients and practitioners are a powerful force for healing.
Mel Borins is a family physician author of A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t, and Why. This article originally appeared in MedPage Today.
