April 24, 2000 (Berkeley, Calif.) -- When Leslie Palmer was suffering from painful and debilitating stomach problems, she called a gastroenterologist and was told the earliest available appointment was two months away.
Frustrated by the long wait, Palmer (not her real name) visited an herbalist and got a prescription for herbs, which she diligently brewed into a tea and drank daily.
Two months later, when she finally met with the gastroenterologist, she told him that she felt a lot better since she'd started the herbs.
"The strange thing was, he totally ignored what I told him," she says. "He didn't ask where I got the herbs or who prescribed them. I might as well have said my symptoms were better because I'd been howling at the moon."
Such disinterest is all too common. It's one reason that many patients prefer not to tell their conventional doctors about the alternative medicines they're using. As more and more patients try these therapies, the risk of a clash with conventional medical treatments has researchers worried.
A 1997 study by David Eisenberg, MD, of Beth Israel Deaconess Medical Center in Boston, found that almost half of all Americans use some form alternative medicine, but of these only a third told their physicians.
And a study published in the February 1 issue of Cancer shows just how little conventional doctors know about what their patients are doing. When researchers polled 50 men undergoing radiation treatment for prostate cancer, they were shocked to find more than a third were using alternative medicines -- the patients' doctors had estimated the number at around 4%.
That's a problem because certain herbs can make patients so sensitive that radiation treatments burn them, says Barrie Cassileth, PhD, chief of integrative medicine at Memorial-Sloan Kettering Cancer Center. Other herbs, meanwhile, can diminish radiation's effectiveness.
Almost every week, there is a new warning about the improper use of herbal or dietary supplements alone or in conjunction with prescription drugs. So why do patients remain reluctant to discuss alternative medicine with their conventional doctors?
According to a study of breast cancer patients published the June 1999 issue of the Journal of Family Practice, women did not reveal their use of alternative therapies because they felt their physicians would not be interested in the therapies, were biased against them, or simply didn't know enough to comment.
Another possibility, says Larry Borgsdorf, PharmD, at Kaiser Permanente in Bakersfield, Calif., is that patients don't really think of nutritional or dietary substances as medicine. "Dietary supplements are marketed as natural products. The verbiage is that they're natural, they're safe, they can't hurt you. Because of that, patients don't think of them as having pharmacological activity."
San Francisco General Hospital physician Donald Abrams, MD, recalls one man who came in with a rash covering his body. When Abrams checked the patient's chart, no medications were listed. But when he asked about herbal supplements, the man began ticking off a list that spilled over the 12 lines available as Abrams tried to write them down.
Even if patients do speak up, most physicians aren't trained to know much about alternative remedies, says Tori Hudson, ND, a naturopathic doctor who has been working with medical doctors in the Portland, Ore., area for 15 years. "It's not reasonable for a patient to ask, 'Should I take echinacea or glucosamine?' because the doctor probably has no relevant training."
The worlds of alternative and conventional medicine may never completely align. But practitioners from both sides say you can take significant steps to avoid a collision:
- Explain why you're bringing up the subject. "I would say, I wanted to let you know that I'm taking an herbal supplement, and I just wanted you to be aware in case it might not work with other medications you have me on," says Jamie Myers, RN, MN, an oncology clinical nurse specialist at the Research Medical Center in Kansas City, Mo.
- Make copies of articles about an alternative therapy and give them to your doctor to read before asking his or her opinion (but be careful not to overburden your doctor with a sheaf of documents).
- Indicate that you'd like the information about your alternative therapies to appear on your medical record. That way, your conventional practitioner will be forced to take notes. And if a problem arises later, important clues will have been documented
- If you are uncomfortable raising the issue with your physician, talk it over with the nurse first.
- If you can't bring yourself to discuss the matter with your conventional health care providers, consider consulting with a licensed alternative practitioner (such as a licensed acupuncturist or a naturopath with an ND degree) who works closely with conventional doctors. These practitioners can at least inform you about some of the worst risks of mixing alternative and conventional treatments.
- Finally, consider whether you're working with the right physician. If communication is extremely difficult, it may be time to find another health care provider who is easier to talk to and more supportive.
