Friday, December 31, 2010

Complementary/Alternative Medicine in the Family

I generally spend the week between Christmas and New Year's catching up with many of my old friends from home - it's one of the few times when we're all in Toronto (where I'm from). Yesterday, as I was catching up with 2 old friends, several topics of conversation led me to ponder more deeply about the relationship between family medicine and complementary/alternative medicine (CAM).

One friend told me that he was thinking about applying to a Doctorate program in Traditional Chinese Medicine (TCM). As he shared more about it, I realized the irony of myself, an ethnic Chinese and incidentally an allopathic medical student, being told about TCM by a Caucasian and traditional Chinese medicine student-hopeful.

Later, my other friend shared her ongoing struggle with depression and her attempts to explore CAM. In her ongoing relationship with her family doctor, she had repeatedly discussed CAM potential treatments only to have them ignored by her doctor.

Personally, I have often found a range of physician attitudes from disengagement to active hostility towards complementary-alternative treatment modalities. What brings this attitude?

Is it lack of knowledge leading to this attitude whether hostile or dismissive?
Is it because there lacks evidence in many cases regarding the efficacy of CAM?
Or is part of it from racist and superior attitudes (whether consciously recognized or not) that Western, white medicine must necessarily be better than anything that could come from other cultures, whether Chinese, Ayurvedic or others?

From my perspective, family medicine, based on its comprehensive and holistic approach to the body, seems ideally matched to act as a partner to complementary-alternative medicine. CAM can particularly be important to offer to patients in areas where western allopathic medicine is limited. This areas often include pain management, psychiatric illnesses, quality of life management and others. If family physicians are to effectively create patient-centered medical homes, they must be educated about and open to complementary-alternative medicine since many of their patients may be using them. An open dialogue must happen between patients and their personal physicians - this starts with
(a) physicians being open to dialogue and actively asking questions about CAM, and
(b) being educated enough about CAM to engage in an effective dialogue.

There are a few problems with complementary-alternative medicine before it can be an effective partner with family medicine:
1) Evidence-based practices: much of CAM remains word-of-mouth and "expert opinion-based." If CAM is to become a credible partner and treatment, it must produce credible clinical studies for physicians to embrace it.
2) Regulation: CAM for the large part is unregulated and practitioners can vary in terms of the amount of training they receive. To receive more credibility and standardization of practices, CAM practitioners must become regulated.

As we work towards these goals, both from the CAM and physician side, it will provide better patient management and ultimately work towards caring for each and every individual in the ideal, multi-faceted manner. Happy New Year!


  1. Good Comments and Questions, Sebastian. As a holistic Family Physician, I see many patients with varying levels of use and understanding of non-medical therapies/practices. I note the interface and overlap of their therapies/practices and medical practice.

    Notable is the system in which I practice that allows me to bill for medical therapies and practice. Also notable is the medical liability insurance that protects me from potential financial disaster, but only for medical therapies and practice.
    I am a Reiki master, also trained in non-directive imagery, neurolinguistic programming, sound attunement therapy, holistic chair massage, Healing Light energy method, reflexology, aromatherapy and prayer. None of these therapies is covered by my medical liability insurance and none are billable to medical insurance companies. They are billable separately to patients, but they almost never expect me to do something in my office beyond their insurance coverage. I use steps from Mind Body therapies and (non-measurable) energy therapies daily, but they are seen as interpersonal skills as used in family medicine office encounters.
    A key concept is "medical". Who wants to be a medical doctor and practice medicine? Who is excited with proofs of benefit from other therapies that therefore become "medical" and are no longer complementary or alternative? Who is angry with "medical" practitioners and intensely wants to do something alternative, never to desire the slightest overlap with medicine? Many such persons are offended that someone would try to imply that what they do is "medical" or desired by "medical" practitioners. The words and the definitions carry a lot of weight. Some imply boundaries that are important to persons with licensure in a profession.

    My TCM friend has no desire to practice medicine since he has a complete system of care already. My Reiki friends are often jealous of medical insurance that pays physicians to practice and prescribe a wide variety of therapies. All share varying levels of comfort with boundaries and legal definitions of their field of endeavor. Each generation of practitioners seems to have creative struggles to define their focus and debate others about theirs. Welcome to a great discussion guild.

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