| Monday, July 09, 2018
Where does the average patient turn for medical advice? Well, between loaded online forums and databases, advice from friends and those dubious late-night infomercials touting miraculous benefits in "just 30 days;" health-conscious consumers have a wide spectrum of options, all claiming to help them manage their conditions. While all physicians hope that their patients seek trusted health authorities in their health matters. The reality is that the waters of what is and what isn't actually medicine gets cloudy for many patients.
"Alternative medicine" isn't a new development in the health market, but if the internet banners and chain vitamins & supplement shops are any indication, it's a market that isn't shrinking. However, the term "alternative medicine" can be a bit misleading. It's a broad identifier that casts a wide net, essentially functioning as an umbrella term for any array of therapies and treatments used either in place of, or in conjunction with, "conventional" or "allopathic" medicine. Alternative health treatments range from over-the-counter herbal supplements and vitamins (recent JAMA findings suggest that the majority of these supplements go towards sexual enhancement, bodybuilding and weight loss) to more intensive and specialized therapies like chiropractic, naturopathy, acupuncture, yoga and massage.
For us in the healthcare industry, I think it’s important for us to understand what the appeal of alternative medicine is. I believe, some patients, as shrewd consumers, may interpret "alternative medicines" as pleasant substitutions for "big medicine" that side-step what they perceive to be bureaucratic hurdles issued by a growing health care industry. There is evidence that many alternative treatments and activities do assist in managing certain medical conditions. Patients, under the direction of a trusted healthcare professional, who seek complimentary treatments in conjunction with their other prescribed medical treatments, often report increased levels of satisfaction and healing in the process. These treatments can help manage pain and other day to day difficulties that have been made more difficult by chronic or traumatic conditions.
Where alternative medicine and treatment starts to become an obstacle for physicians is when they lack the concrete scientific evidence to support their healing or therapeutic properties. Complicating the data is that alternative treatments range substantially one from another, and while some have been proven beneficial as a supplement to conventional medicine, others don't stand up as an adequate treatment alone.
Further muddying these matters are the false and sometimes “miraculous” health claims made by those selling or marketing alternative treatments. A quick scroll through your Facebook page will probably yield multiple posts from friends touting the success and health benefits of the latest oil, supplement, or drink. Another quick scroll on those friends’ profiles will most certainly show that they have no medical education or training. Despite these friends lack of formal medical education, they are friends, and to many, what your friends say, especially when it comes to health, is emotionally appealing.
What Can Physicians Do?
Smart physicians know that these alternative treatments should be considered and evaluated on a "case by case" basis. "Total health" for a patient, includes their entire portrait of health, including their diets, exercise routines and other lifestyle factors that extend beyond prescriptions and office visits. Yet, when and (more importantly) how a physician can express themselves on the matter of alternative treatment should be approached with care.
Physicians in the United States maintain a rigid divide on their positions when it comes alternative medicines, with some open to the prospect of integrating them into the conventional medicine sphere and others who regard them as little more than marketing buzzwords and bunk. While neither position is inherently "wrong," there are approaches that can land working physicians in front of the medical licensing board or undergoing costly litigation.
Advocating too strongly for an alternative medicine or treatment, one that lacks sufficient data to substantiate medical treatment or prescription, can leave physicians vulnerable to malpractice lawsuits or accusations of exaggerated claims. On the opposite end of this spectrum, vehemently opposing alternative medicines can alienate adherent patients who are already using alternative treatments subsequently causing them to feel less inclined towards transparency when sharing their medical histories, and less compliant in their treatment regimens later on.
Don't Underestimate Them
When asking for a patient's health history, well-meaning physicians may opt to skimp on patient inquiries about alternative medicines. Perhaps this is to avoid making patients feel uncomfortable, or because they see most alternative treatments as harmless derivatives from plants and herbs (i.e. natural sources.) Indeed, many herbal supplements are harmless, but this doesn't mean they can't pose a threat to patients. The Natural Medicines Comprehensive Database has identified over 1,600 potential interactions between natural products and conventional drugs. Additionally, a recent JAMA Internal Medicine article reported that 51% of all United States FDA Class I recalls from 2004-2012 involved alternative supplements. Though many alternative supplements aren't harmful, they can interact with other drugs and medications a patient takes, so a little background checking is crucial.
When patients follow or adhere to any kind of purported medical or health advice from an alternative care provider, questions of licensure and credentials come into play. Chiropractors and massage therapists are required to be licensed in the particular state they're practicing in, but other alternative care givers don't have to follow the same rigid requirements. Medical doctors, as trained specialists in a field of medicine, are inclined to know of any patients lifestyle activities or behaviors, particularly in cases where harmful care advice has been given.
Don't Overestimate Either...
All that being said, physicians shouldn't be too quick to sound any alarms over a patient who seeks alternative treatments. In many cases, the efficacy of these treatments exist largely in the form of the "Placebo effect" for patients. This phenomenon is "huge" (as quoted by Terrence E. Steyer, MD in a Medscape article) in helping patients feel empowered on their personal road to recovery.
Tactful physicians can examine a given situation, and even in instances where an alternative treatment is ineffective, know when to leave it alone. If the patient is getting relief from it, and indeed it's harmless, physicians can supplement their patients with additional information that doesn't divide, but informs.
A patient consultation shouldn't resemble an interrogation. For this reason, it's best to maintain neutrality on alternative medicines and avoid anything that can be construed as judgment or condescension. If patients feel that they'll come under condemnation for their chosen treatments, they'll hesitate to be forthright in their histories, closing an open and honest patient communication pathway and limiting the physician's ability to make an informed diagnosis.
While it's important to ask every patient about their use of alternative treatments, it's likely best not to refer to treatments by name so that patients don't suspect a "witch hunt" for information, or any pushback. Instead, frame these questions in non-harmful or charged ways like "is there anything else that may be interfering with this problem?" or "are you doing anything else for this condition?" Physicians can then do a quick check using available resources (for example, checking out possible risks with the FDA's list of tainted supplements online, posted on their website) before deciding to pursue the subject further.
Alternative treatments can be difficult to research, especially since many of them don't have hard scientific data to accompany them. However, this is changing as organizations like NCCAM and the National Cancer Institute's Office of Complementary and Alternative Medicine fund studies and post their findings.
Indeed snarkier corners of the health care world can produce certain opinions on alternative medicine (like this internet gem: Q: "what do you call alternative medicine that's been scientifically proven?" A: "medicine.") but patient-oriented physicians need not be so cynical.
Best practice? Stick to the irrefutable facts, and only advocate what can be proven as a medical treatment. Above all else, maintaining an open atmosphere where patients can feel safe is a large priority, so if no efficacy can be found in a treatment but there's no evidence of harm, counseling patients to stop using it, may not be as effective as simply helping patients feel comfortable and lending informed advice. As patient options change, and the individual laws and nuances of public healthcare change with each passing legislation, physicians can maintain a position of clarity and consistency within the maelstrom.
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Page, Leigh. "What to Do When a Patient Wants 'Alternative' Medicine."
Medscape.com. Medscape, 12 June 2013. Web. 12 Feb. 2014.
Parikh, Raul. "Why Does Your Doctor Hate Alternative Medicine."
Salon.com. Salon, 2 May 2011. Web. 12 Feb. 2014.
Shannon, Diane. "Why I Left Medicine: A Burnt-Out Doctor’s Decision To Quit."
WBUR. WBUR's Common Health Reform and Reality, 18 Oct. 2013. Web. 12 Feb. 2014.
Silva, John. "3 Words That Medical School Will Make You Hate: Empathy. Professionalism. Alternative Medicine."
Almost.thedoctorschannel.com. The Doctor's Channel, 14 Jan. 2014. Web. 12 Feb. 2014.