In April of this year the AARP and the National Center for Complementary and Alternative Medicine (NCCAM) published the results of a collaborative survey of how many Americans make use of complementary and alternative medical treatments (CAMs), how they come to decide on what CAMs to pursue and how well their complementary treatments are coordinated with their overall medical care. Participants in this survey ranged in age from 18 to 85 and older. The kinds of CAMs surveyed ranged from herbal products and dietary supplements to physical interventions like massage and acupuncture, to mind/body techniques such as meditation and yoga.
In a previous series of blogs on CAMs I reported that a growing body of research indicates that many of them show promise. Some, like acupuncture and massage, can relieve symptoms such as pain and nausea and are very useful as complements to cancer treatment. Others are highly effective in reducing stress -- especially chronic stress -- which we are learning can play a major role in our resistance to illness as well as our recovery from it.
One lesson I drew from studying research on CAMs was that it is important to find one that suits you and then follow through with it. For example, the beneficial effects of massage therapy are likely to dissipate if it is discontinued. The same if true for yoga and other CAMs. In fact, prolonged practice of yoga leads to more beneficial results. If for some reason you need to switch to a different complementary treatment, stick with it.
An Unfortunate Gap
The AARP/NCCAM survey found that 50 percent of men and women reported using some form of complementary and alternative medicine (CAM). Of these, three-fourths used CAM to help prevent illness, and an equal number had turned to CAM to reduce pain or treat painful conditions. Clearly, there are good reasons why so many people are turning to CAMs as part of their efforts to stay healthy, treat health problems or both. But here is the catch: Fewer than one in three people who use CAM have discussed that use with their doctors. And even fewer turned to a CAM at the suggestion of their doctor.
These findings (which had not changed since a similar survey was conducted in 2006) represent a significant gap in many people's medical care. In a word, these people lack a holistic approach to medical care.
"What We Have Here Is A Failure to Communicate"
Why is there such a gap? Nearly half of the survey respondents stated that their health care provider never asked them about their use of CAM. Another 60 percent of respondents said that:
There wasn't enough time to talk about their use of CAM.
They didn't think their doctors would know anything about CAM.
They thought their doctor would advise them to stop using CAM.
They just weren't comfortable discussing CAM with their doctor.
Considering that every health (and mental health) care provider in America ought to be aware of CAMs and their potential uses, this failure to communicate is really scandalous.
Closing the Gap
In preparation for writing "Saying Goodbye: How Families Can Find Renewal through Loss," which is about helping families cope with terminal illness, Dr. Barbara Okun and I and our associates interviewed hundreds of individuals and found through our "informal" survey virtually the same results: patients and families faced with a fractured medical system in which providers do not communicate with each other, and patients and their families do not know what to ask (or what to share).
Many expressed what amounted to a common theme, succinctly expressed in one man's account:
"'We were a family but we each suffered from a profound feeling of isolation and lack of guidance. Throughout my sister's illness, we were catapulted into crisis time after time, with no one to turn to other than whoever the doctor-of-the-moment happened to be.'
"Part of this isolation, this man explained, was a total lack of information on what could help his sister relieve the pernicious side effects of the chemotherapy and radiation she received for her cancer."
There is potentially one simple solution to this gap and the potentially negative impact it can have on patients' overall care and that is this: It should not be the patient's responsibility to bring up the issue of CAMs; rather, it should be the health care provider's responsibility to inquire about patients' use of CAMs and how well they are working.
Holistic Health Care
I have learned through writing this blog that not all health care providers are unaware of -- much less indifferent to -- incorporating CAMs in a comprehensive and holistic approach to treatment. Fortunately for many cancer patients, oncologists appear to be in the forefront of this movement. At the Hope Lodge in Boston, for instance, patients can easily avail themselves of some CAMs such as Reiki and massage. Other cancer centers make CAMs such as acupuncture available.
As promising as these initiatives may be, the fact remains that the results obtained in the 2011 AARP/NCCAM survey closely mirror the results of the same survey conducted in 2006. That does not indicate much progress. In fact, one of the few significant differences found in the five intervening years between surveys was a trend indicating people make more use of the Internet now to obtain information about CAMs.
Apparently, then, until traditional medicine decides to catch up, it remains the patient's responsibility to research, select and pursue complementary treatments. It may be better to face this reality and change the system from the bottom up. What does that mean? Basically it means that we as patients need to close the gap by talking to our doctors about our use of CAMs. Which leads me to suggest the followng:
The next time you see your doctor, be it for a routine physical or for treatment of some ongoing condition, make a point of disclosing the following -- whether or not the doctor asks:
· Any CAMs you are using on a regular basis: herbs, supplements, mind/body techniques,
· How you believe the CAMs you use may be helping you
If enough of us do the above we may begin to close the gap between traditional medical care and complementary treatments. Keep in mind that the information you share with your doctor may help the next patient he or she sees.
To learn more about helping families cope with terminal illness visit www.newgrief.com
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