Original Research
COMMENTARY Pediatric complementary and alternative medicine use: physician-patient communication is vital Shelley R. Adler Department of
Anthropology, History and Social Medicine University of California at San Francisco San Francisco, CA Nancy C. Showen
Children's Hospital of Oalland Oaldand, CA
Correspondence to: Dr. Adler
[email protected]
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Increasing numbers of Americans are using complementary and alternative medicine for themselves and their children. In a recently published research agenda for pediatrics, Kemper, Cassileth, and Ferris1 describe the urgent need for research on the use of these treatments in children. Top priorities include clinical research on the effectiveness and safety of complementary and alternative medicine therapies and qualitative research on the consequences that diverse explanatory models of health and illness will have on patient-provider communication, adherence to professional recommendations, and satisfaction with care. As Lee, Highfield, Berde, and Kemper note in their survey of licensed acupuncturists in the Boston metropolitan area, little is known about pediatric complementary and alternative medicine usage, even for common modalities such as acupuncture. The overwhelming majority of adult complementary and alternative medicine users in the United States also use biomedicine, either concurrently or serially, but most patients do not tell their physicians about their complementary and alternative medicine use.2 This situation heightens the importance of physicians' awareness of patients' health-related beliefs and practices. Certain complementary and alternative medicine therapies have demonstrable beneficial effects; some can be harmful under certain conditions; others may interact with pharmacologic therapies in clinically significant ways. Findings from a population-based, prospective cohort study indicate that only 54 % of study participants who used complementary and alternative medicine disclosed their use to their physicians, while 94 % discussed details of their biomedical treatments with their alternative practitioner.3 In other words, information regarding patients' complementary and alternative medicine use is more poorly integrated into the medical encounter than details of biomedical treatment use are into discussions with alternative practitioners. Patients' disclosure is often cautiously modulated, even by those who would welcome open communication with their physicians. When asked for their reasons for not disclosing complementary and alternative medicine use, patients indicated that they anticipated disinterest, a negative response, or an unwillingness or inability to contribute useful information from their physician. They also perceived that the complementary and alternative medi-
Volume 171 September 1999
cine therapies used were irrelevant to the biomedical treatment course; and that they had made choices regarding the appropriate coordination of disparate healing strategies. In discussing health practices with patients (and, in pediatric cases, with families) it is particularly important not to make assumptions about who uses complementary and alternative medicine on the basis of stereotypes regarding age, socioeconomic status, or ethnicity. All patients have the potential to be interested in and use a variety of alternative treatments. Inquiries about complementary and alternative medicine should be a routine part of initial patient history-taking as well as subsequent visits. When the subject of complementary and alternative medicine is introduced in a respectful manner, most patients are willing to discuss it openly. Discussion should not be confined to a single interaction but part of a series of periodic inquiries to assess changes in patient interest and use of complementary and alternative medicine over time. Most patients greatly value their physicians' respect and understanding regarding treatment choices, even in the absence of mutual agreement. Patients and their families typically do not expect their physician's belief in or endorsement of particular complementary and alternative medicine therapies, but they do appreciate doctors who are respectful, willing to listen, and honest about the limitations of their own knowledge of complementary and alternative medicine. With more information available on complementary and alternative medicine therapies and greater access to these modalities in the United States, it seems likely that their use will continue to increase. Patient care, as well as physician-patient and physician-family relationships, will benefit when comprehensive discussions of complementary and alternative medicine use are better integrated into the pediatric medical encounter.
References
1 Kemper KJ, Cassileth B, Ferris T Holistic pediatrics: a research agenda. Pediatrics 1999;103(4):902-909. 2 Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998; 280:1569-1575. 3 Adler SR, Fosket J. Disclosing complementary and alternative medicine use in the medical encounter: a qualitative study in women with breast cancer. J Fam Pract 1999;48(6):453-458.
