Does Your Doctor Brush Off Questions About Unconventional Treatments?
"Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission."

Did you ever go to a chiropractor, an acupuncturist, or some other unconventional therapist? If you did, would you consider discussing it with your regular physician? Well Winslow and Shapiro wondered about such questions so they decided to survey physicians in the Denver, Colorado metropolitan area to "see how they discussed" the subject of complementary and alternative medicine with their patients. Furthermore, they wanted to get some idea as to what was important in determining whether a doctor might engage in such discussions, and even go so far as to refer a patient for such therapy. The result of their survey was published in the May 27, 2002 issue of the Archives of Internal Medicine under the title "Physicians Want Education About Complementary and Alternative Medicine to Enhance Communication With Their Patients."

This was not the first time that the question of doctor and patient attitudes towards unconventional forms of medicine had been investigated. A national survey was done as far back as 1990 in the United States, and similar surveys or polls were reported in 1994 and 1997, which confirmed that interest in alternative modalities was increasing so rapidly that even insurance companies and managed care organizations were falling in line and offering benefits. In 1998 Wetzel et al published, "Courses involving complementary and alternative medicine at US medical schools" in JAMA proving that the trend had finally caught up with the majority of conventional medical institutions. Patients were way ahead of their doctors as shown by surveys revealing that up to 42% of the U.S. population has used one or more of the modalities, which include acupuncture, aromatherapy, biofeedback, chiropractic, energy healing, folk remedies, herbal (botanical) therapy, homeopathy, hypnosis, massage therapy, megavitamin therapy, relaxation techniques, reflexology, special diet, spiritual or religious healing, and yoga. Rates varied somewhat in other industrialized countries. It was estimated to be 10% in Denmark in 1987, 33% in Finland in 1982, and 49% in Australia in 1993.

The main things that Winslow and Shapiro wanted to find out were how physicians discussed this topic with their patients, and what factors influenced discussions and referrals. Physicians were contacted by mail and asked to complete a previously tested survey form. Only 43% of the physicians who actually received the mailings returned them. Obviously this puts a large dent in the final evaluation since it's difficult to tell why 57% failed to respond. It could have ranged anywhere from pure indifference to downright refusal to have anything to do with the idea that "I would use such nonsense for treating my patients." Conversely, those physicians who chose to answer may represent in large part the ones who were already better versed in using such techniques. The result of this type of survey is bound to be skewed in favor of those doctors with a more liberal approach to the subject. Due to this tendency, I examined the report for any commentary regarding the problem. The method described for overcoming the problem was to first follow up with two more mailings, then to actually call the nonresponders, and finally to gather demographic information with at least answers as to how they felt about unconventional modalities. I could only find reference to one more obvious shortcoming, the limitation of the survey to a single geographic area. Finally, the authors admitted to a less obvious deficiency, the tendency for many physicians to be comfortable with discussing one technique, but not another. This was not addressed because the questioning was about general rather than specific discomfort.

In the end, out of the 43% responders from the original 705 doctors who had received the survey, I was truly surprised to learn that 24% had actually used unconventional therapy for themselves. A whopping 76% said that their patients were using alternative methods. This doesn't imply that the doctors were responsible for this; they had merely been informed of the fact that it was so. Some other very interesting figures were also revealed: 59% of physicians had been asked about specific treatments; 48% had actually done the recommending themselves; of those doctors doing the recommending there was a strong correlation to having used these methods themselves; on the other hand very few physicians felt comfortable about actually discussing the topic with their patients; and an overwhelming 84% thought that they needed to be better educated about the subject if they were to discuss it properly with their patients.

You may wonder as to which alternative modalities were most recommended by these doctors. They were massage therapy, relaxation techniques, acupuncture, and biofeedback. To my way of thinking the first two are really not much different than procedures used at physiotherapy institutions, and biofeedback is likely to be more readily associated by a physician with other electro-mechanical approaches to brain wave evaluation such as an EEG, or even a lie detector. Acupuncture is a bit more off the beaten path, but does seem to have gained considerable ground in recent years, in particular when utilized for control of pain.

It seems from these results that complementary and alternative medicine is making a decided headway into conventional medical circles. This surprised me when I considered that the study was done in Denver, Colorado. When I lived nearby in Boulder I was aware of a rather conservative medical atmosphere, but that was a long time ago and things may well have changed dramatically in the intervening years. Given, however, the immense changes apparent in our modern society, I am much less surprised to learn that patients are taking a good deal of the lead in persuading their doctors to learn more about unconventional ways to treat them; in effect an example of "the tail wagging the dog."

Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission. Copyright © 2007 by Marvin Ackerman, M.D.

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