October 2000 • Post-Assembly Edition • Dallas
CAM is everywhere: Here are tips for dealing with it
BY SHARON DICKINSON DENT
Complementary and alternative medicine is ubiquitous -- patients everywhere are talking about it and using it. One study found that patients make almost twice as many visits to CAM providers as they make to traditional providers. And one conservative managed care organization has approved five botanicals for its formulary.
Get CAM information online
Interested in complementary and alternative medicine? Visit these Internet sites:
- American Botanical Council -- http://www.herbalgram.org
- The Cochrane Library -- http://www.updateusa.com/clibhome/clib.htm
- Herb Research Foundation -- http://www.herbs.org
- Integrative Medicine Communications -- http://onemedicine.com
- National Center for Complementary and Alternative Medicine -- http://nccam.nih.gov
- Whole Health M.D. -- http://www.wholehealthmd.com/
So said Laura Patton, M.D., clinical director of the alternative services program at Group Health Cooperative in Seattle, in her presentation, "Complementary and Alternative Therapies: A Practical Approach for Clinicians," Sept. 21 at the Assembly.
In Washington state, all health plans are required to provide patients with access to all licensed providers, including licensed providers of CAM. In response, Group Health Cooperative has offered a program of covered CAM services since 1996.
Group Health offers referrals for acupuncture, naturopathy and massage therapy services based on specific clinical conditions, she said. (The group allows patients to self-refer to chiropractors.) The health plan continues to fine-tune the program and develop evidence-based guidelines for referrals, she said.
Issues cause discomfort
Patton addressed some issues about CAM that make allopathic and osteopathic physicians uncomfortable at times:
- Alternative therapies aren't often taught in medical schools. "However many schools now offer CAM in electives, and some are making it a requirement," she said.
- Most alternative therapies are not evidence-based, according to Western standards of evidence. "This is a big stumbling block for most of us as we've hoisted the flag of evidence-based medicine," she said, adding that more researchers are starting to study CAM therapies.
- Alternative therapies are often marketed directly to consumers, and only 15 percent of people using a CAM therapy consult with a provider first.
Integrating referrals
Patton offered tips for physicians interested in integrating CAM referrals into their practices.
First, find out what vitamins, herbs and dietary supplements patients are already using -- and patients may not offer that information easily. "Somehow, we need to instill in our patients the idea that these are medicines; they have a physiological effect on you," Patton said.
Ask patients whether they're already working with a CAM provider. One approach is, "Have you consulted anyone else about this pain?" If so, find out what therapies were used and whether they helped.
Patton encouraged physicians to make a definitive diagnosis and discuss conventional treatment options before suggesting CAM therapies. Work with the patient to identify the major symptom or complaint and a measure of success to indicate when further treatments for that problem aren't necessary. Then refer for a limited number of CAM visits and follow up with the patient again after the referral expires. "Patients like that you're interested and that they're playing a part in increasing your knowledge base," said Patton.
Advise your patients on questions to ask the CAM provider, such as: "How many people have you treated with my condition? How can I expect to feel after treatment?"
Whenever possible, keep in touch with the CAM providers caring for your patients, Patton said. Good communication will ensure you're informed on all the treatments your patients receive.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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