Many seriously ill patients are taking complementary and alternative medicine (CAM) treatments. Not all tell their physicians, and not all physicians ask about it.

“It is safe to assume that the majority of adults are employing some forms of CAM, regardless of whether they are honest in admitting so to their doctors,” says Philip M. Rosoff, MD, MA, professor emeritus of pediatrics and medicine at Duke University.1 CAM use, whether used openly or “under the table,” raises potentially serious medical issues. “The most obvious is the potential for dangerous pharmacological interactions with prescribed drugs,” Rosoff offers. There is the potential for erosion of mutual trust between patient and physician. “If the patient is taking nonprescribed substances and is not honest about this with the physician, this already implies a lack of confidence in the doctor,” Rosoff says.

Many physicians convey strongly negative views about CAM use to patients, either explicitly or implicitly. “This undermines the profound trust that must exist for optimal treatment outcomes,” Rosoff notes.

Doctors should acknowledge that CAM use is widespread and only ask for honesty, with the attitude of working with (not against) the patient. “In my experience, patients disclose CAM use if they are asked about it in a nonconfrontational and nonjudgmental way,” Rosoff reports. “Otherwise, they may not disclose.”

Fay J. Hlubocky, PhD, MA, a clinical health psychologist and research ethicist at University of Chicago Medicine’s MacLean Center for Clinical Medical Ethics, says, “Although our goal in medicine is always to respect patient autonomy, clinician-patient conflicts may arise in the context of CAM.” Physicians are obligated to protect patients from harm, including dangerous therapeutic modalities. “Many seriously ill patients are at risk of making a treatment decision based upon inaccurate information,” says Hlubocky, who authored a recent paper on this topic.2

Some patients choose unproven CAM over conventional treatment that has demonstrated efficacy. “Patients may attempt to pursue any avenue or use any resource that offers hope for a potential cure especially when faced with a chronic, life-threatening illness or a poor prognosis,” Hlubocky says.

Ideally, says Hlubocky, a “rigorous” informed consent discussion takes place, covering both the patient’s beliefs regarding CAM and the clinician’s recommendation. “Recognition of patient reluctance to self-disclose this information due to fear of clinician judgment is key,” Hlubocky offers. “For the clinician, it is also important to disclose what they value and can or cannot commit to if the patient does pursue CAM.”

REFERENCES

  1. Judson PL, Abdallah R, Xiong Y, et al. Complementary and alternative medicine use in individuals presenting for care at a comprehensive cancer center. Integr Cancer Ther 2017;16:96-103.
  2. Tenner L, Hlubocky FJ, Blanke CD, et al. Let’s talk about those herbs you are taking: Ethical considerations for communication with patients with cancer about complementary and alternative medicine. J Oncol Pract 2019;15:44-49.