A woman told me that she had seen her doctor recently and when she told him all that she was doing to help herself, of course he told her that he practiced western medicine and that he didn’t believe that.
Not a good conversation.
A number of research studies have found that one in three patients use alternative treatments regularly, but seven out of 10 alternative therapy users do not tell their doctor. Complementary treatments are more commonly used in people diagnosed with chronic or life-threatening illnesses. Patients with AIDS, cancer, and chronic mental illnesses often seek alternative treatments and practitioners because their conditions are not always adequately managed by conventional medicine.
Some of us have had a bad experience with patients who don’t follow our expert advice, and we may react unfavorably to patients who want to follow their own healing path. Many of us fear that when patients seek alternatives, there may be a delay in diagnosis and treatments and delay curable medical treatments.
Physicians may be unaware of the science behind Complementary Alternative Medicine (CAM) and worry about lack of proper training of practitioners and lack of regulation of practitioners. Physicians are also concerned about patients being ripped off financially and worried about the potential for natural health products to interact with the herbs and medications and treatments we give them.
So how can we talk to patients about CAM?
1. Ask, they’ll tell you
The first and most important is to ask patients if they use herbs or natural health products or visit an alternative practitioner. This should be standard as part of the history of any medical visit.
Some patients think that if it’s natural it can’t hurt and don’t see the need to talk to their doctor about it. Other patients think their doctor is not interested or knowledgeable about PCMs, so there is 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 professional, and some patients believe their physician may feel threatened and refuse to see them or may suggest throwing all this mess in the trash.
Whether you are an anesthesiologist, surgeon or psychiatrist, asking your patient is extremely important and is the first step.
2. Explain the science
Take the time to explain to patients that much of what we do in medicine is based on science, and explain what a randomized, double-blind, controlled trial is.
Sometimes people choose alternatives because they fear the adverse effects of conventional treatments, the 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 that its approaches are more in line with beliefs about the nature of health and disease.
Explain that many people are cured by the placebo effect. So just because they read it in a magazine or their friend benefited from it doesn’t necessarily mean it’s useful or will work for them.
3. Be respectful and non-judgmental
Patients want non-judgmental, compassionate and honest advice about what they are doing. Don’t instantly dismiss what they share as unnecessary. Don’t say throw everything in the trash. Patience is a virtue. Patients try to be independent and do things for themselves (self-care). At least we can recognize the importance of patients’ willingness to take charge of their own health and support their autonomy.
It’s easy to understand how we can get quite frustrated when we come up with an approach that we know will work, but our patient chooses something else. Some doctors 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 to find common ground on which there can be agreement. Rather than attacking the beliefs of a patient, it is more useful to understand where he comes from and how he developed these misunderstandings and sometimes this distrust of modern medicine. I learned a lot about alternatives just by listening to my patients’ experiences.
An herb or natural health product can interfere with medications or surgery. When patients and doctors work as a team, health outcomes are improved.
The future of healthcare will hopefully be more collaborative. Patients will be better taken care of when all healthcare professionals providing care communicate more effectively with each other. When doctors, 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 , the patient will benefit and our care will be truly integrative and collaborative.
5. Compromise and negotiate
Some doctors think it’s either my way or the highway. They believe that unless a patient follows their advice, the patient should find another doctor. While this is perfectly understandable, it seems more patient-centered and helpful if we are willing to negotiate and compromise.
If someone doesn’t want your treatment, don’t send them away. They might 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 think is a positive thing.
In most cases, when a new treatment is accepted by the medical profession, it has been thoroughly researched and tested. Even so, doctors often take years to accept new treatments. The cautious mindset of doctors may be a flaw, as the story reveals.
Take, for example, Ignaz Semmelweis, who in 1848 introduced hand washing and the use of antiseptic procedures in gynecological wards. His new approach reduced mortality from puerperal fever by a factor of 15, but he was ostracized by his colleagues who resented the idea that doctors could be carriers of death! So, while we must not abandon our scientific ways of dealing with new proposals, we must remain open to new ideas.
Medicine is racing with DNA mapping, stem cell research, organ transplantation, MRIs and new diagnostic equipment, as well as newer and more sophisticated drugs and surgical techniques. As we focus on eliminating symptoms and disease 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 their treatment, we undermine our work as healers. We may inadvertently cause damage. Many people in the healing profession have joined the trend of returning to a more natural, humanistic and holistic approach.
As always, the challenge is to synthesize and integrate the scientific and the humanist. When we work together, patients and practitioners are a powerful healing force.
Mel Borins, MD is a family physician and Associate Professor of Medicine at the University of Toronto. He is the author of a new book “A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t, and Why.”