Patients, Physicians Aren't Discussing CAM Use, Survey Finds

FP Offers Tips on Having That Important Conversation

May 25, 2011 04:20 pm David Mitchell

Many older Americans may be putting themselves at risk for potentially dangerous drug interactions by using herbal products and dietary supplements without discussing the products with their physicians.

[Stock photo image of ginkgo biloba loose leaves]

More than half of American adults age 50 and older have used complementary and alternative medicine, or CAM, remedies, according to a recent survey(nccam.nih.gov) by AARP and the NIH's National Center for Complementary and Alternative Medicine. More than three-fourths of respondents said they take at least one prescription medication. However, nearly 60 percent of those who have used CAM said they didn't discuss that fact with their health care professional, leaving open the possibility of serious side effects or drug interactions.

"The more patients can be open with their physician and pharmacist, the safer they'll be," said Reid Blackwelder, M.D., professor of family medicine and director of the Medical Student Education Division for the department of family medicine at Eastern Tennessee State University's James H. Quillen College of Medicine in Johnson City. "If we are all on the same page, the likelihood of a problem is minimized."

Web Portal Offers Docs Evidence-based CAM Information

The National Center for Complementary and Alternative Medicine, or NCCAM, which is part of the NIH, has created an online resource(nccam.nih.gov) designed to give health care professionals easy access to evidence-based information on complementary and alternative medicine, or CAM, practices.

"NCCAM is charged to study and provide evidence-based information on the safety and efficacy of CAM health practices that are readily available and already used by a great number of people," said Josephine Briggs, M.D., director of NCCAM, in a recent NIH news release(www.nih.gov).

According to the news release, the Web portal offers information on the safety and efficacy of a range of common health practices that lie outside of mainstream medicine, including dietary supplements and mind and body practices, such as meditation, chiropractic, acupuncture and massage. Specifically, the portal provides

  • links to relevant clinical practice guidelines,
  • safety and effectiveness information,
  • links to systematic reviews,
  • summaries of research studies,
  • scientific literature searches,
  • programs for continuing education credit,
  • patient fact sheets, and
  • NCCAM's toolkit(nccam.nih.gov) on communicating about CAM.

The NIH also hosts a consumer-oriented website(www.nlm.nih.gov) produced by the U.S. National Library of Medicine that is devoted to informing patients about the drugs, dietary supplements and herbal products they may be using.

Americans spend nearly $34 billion out-of-pocket on CAM products and practices each year, according to the NIH. Nearly 40 percent of U.S. adults and 12 percent of children use some form of CAM.

According to the survey, more than 40 percent of respondents said their health care professionals never asked them about CAM, and 30 percent of respondents said they didn't know the topic should be discussed. Survey results indicate patients are more than twice as likely as physicians to raise the subject during an office visit.

Sixteen percent of respondents said they didn't discuss CAM with their health care professional because they doubted their health care professional's knowledge of CAM, which also includes manual therapies and mind and body practices, such as chiropractic care, acupuncture and meditation. Twelve percent of respondents were concerned that their health care professional would be dismissive or advise them to not use CAM, and 11 percent were not comfortable discussing the issue.

"It's important not to belittle patients' choices," Blackwelder said. "If you just say the term 'alternative medicine,' some physicians are just going to shut down. They think it's not evidence-based."

Blackwelder said that if physicians react negatively to a patient's use of CAM, the patient will be less likely to provide information that could be vital to proper diagnosis and treatment.

"If we demonstrate a willingness to be nonjudgmental and open," he said, "people will tell us all kinds of things."

Framing a question properly also is important, according to Blackwelder.

"Don't say, 'You don't see a chiropractor, do you?'" he said. "Ask an open-ended question: 'Is there anyone else you see about your health issues?' Then follow up with, 'How is that working for you?' As opposed to saying, 'Oh dear,' or 'You're kidding!'"

Blackwelder said he asks patients whether they take vitamins, supplements or herbs -- specifically using all three terms -- because "people don't consider them the same things" and do not necessarily think of them as "drugs." He also asks patients about their prescription medications.

In addition, he asks where patients get their information related to CAM and why they use a product or service.

"It helps me know where they are coming from," Blackwelder said. "It also helps me know if they have a problem that I might need to diagnose and treat. Sometimes people are on things they don't need to be, and they can be expensive. We can help them make more informed choices."

Once an open discussion is started, Blackwelder said it can lead to a more collaborative approach to care.

"If we do that well, we'll be seen as trusted guides on their path to health,"
he said. "They'll be more likely to ask us questions. We can do a better job of giving them information to help make an informed decision."


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