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Patients, Physicians Aren't Discussing CAM Use, Survey Finds
FP Offers Tips on Having That Important Conversation
"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."
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.
Web Portal Offers Docs Evidence-based CAM Information
"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.
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 on communicating about CAM.
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.
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."
New Report Details Billions Americans Spend on Complementary, Alternative Medicine
Physicians Can Benefit from Adding CAM to Their Practices, Says FP
More From AAFP
American Family Physician: "Are You Talking to Your Patients About CAM?"
(August 1, 2009)
AFP By Topic: Complementary and Alternative Medicine