By Concepta Merry, MB, BCh, BAO, BA

Associate Professor, Global Health, School of Medicine, Trinity College, Dublin; Integrative Medicine Fellow, University of Arizona, Tucson

Dr. Merry reports no financial relationships relevant to this field of study.


  • An analysis of the 2012 National Health Interview Survey data showed that 42.3% of people using CAM did not disclose this to the primary care provider, most often because the provider didn't ask or that the patient didn't think that the provider needed to know.

SYNOPSIS: More than 40% of patients report nondisclosure of complementary and alternative medicine (CAM; also known as integrative medicine treatments) to their primary care physicians. They cite failure of physicians to initiate conversation on CAM, coupled with a belief that physicians do not need to know about CAM usage, as key factors in nondisclosure, according to patient survey.

SOURCE: Jou J, Johnson PJ. Nondisclosure of complementary and alternative medicine use to primary care physicians: Findings from the 2012 National Health Interview Survey. JAMA Intern Med 2016;176:545-546.

According to a recently published study, one-third of the adult population in the United States uses CAM and 42.3% of these CAM users do not disclose this to their primary care provider.1 Jou and Johnson at the University of Minnesota analyzed data from the 2012 National Health Interview Survey, an annual study carried out by the National Center for Health Statistics.

A total of 34,525 adults completed the 2012 survey and 10,158 (29.6%) respondents reported use of CAM in the previous year. Of the 34,525 CAM users, 7,493 also had a primary care physician. Of the 7,493 participants who had used CAM in the previous year and who had a primary care physician, only 4,399 people (57.7%) disclosed CAM usage to their physician. The 3,094 people (42.3%) who did not disclose the use of CAM to their physician were asked further questions to help understand the factors behind this non-disclosure.

Survey participants were asked to select among several possible reasons for non-disclosure and were able to choose more than one response. (See Table 1.)

Table 1: Reasons Offered to Participants Regarding Nondisclosure

  • Belief that the physician did not need to know
  • Past discouragement of CAM by the physician
  • Potential discouragement of CAM use by the physician
  • Potential negative response from the physician
  • Doubts concerning physician knowledge about CAM
  • Failure of the physician to ask
  • Lack of time
  • Not using CAM at the time of the physician visit

The most commonly cited cause for non-disclosure was physicians not asking about CAM (1,759 people [57%]) followed by thinking that the physician did not need to know (1,432 people [46.2%]), not using CAM at the time of the consultation (785 people [26.4%]), and belief that the physician had less knowledge about the CAM type than the participant did (239 people [7.6%]). It comes to no surprise that patients like to use CAM and that they don't always disclose this fact to their own primary care providers. However, it is interesting to note that providers’ failure to simply ask patients about CAM is the single biggest factor in nondisclosure. Although it is disappointing that providers are contributing to the problem, on the plus side this is something that can be done. The first step would be to improve CAM training and education to equip clinicians with the information to start discussions with patients about CAM.


  1. Clarke TC, Black LI, Stussman BJ, et al. Trends in the use of complementary health approaches among adults: United States, 2002–2012. National health statistics reports; no 79. Hyattsville, MD: National Center for Health Statistics. 2015.