Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2003; 8: 1–2
The argument I am about to put forward is disarmingly simple: if a large and growing percentage of the population use complementary and alternative medicine (CAM), healthcare professionals need to have at least a minimum knowledge of the subject. How else would they be able to advise their patients responsibly about CAM?
A recent international comparison1 showed that CAM is being discussed only in a minority of visits of back-pain sufferers to their doctors (back pain is the condition associated with more CAM usage than any other). In the USA, 40% of doctors discussed CAM but, in the UK, these figures were only 14%. What is more, usually the patient initiated this discussion.
In a larger study, doctors in the USA were asked about their experience with CAM and communication about CAM with their patients.2 Few physicians felt comfortable discussing CAM with patients and no less than 84% felt they needed to learn more about the subject in order to do justice to patients’ needs. When nurses in the USA were questioned, 83% recommended some type of CAM to their patients.3 This high figure was in stark contrast to the 24% of nurses that reported having had some type of formal education in CAM. Over 60% relied on their personal experiences when recommending CAM. These recent surveys are just examples of data to demonstrate the urgency of more CAM education – an urgency that is felt by conventional healthcare practitioners in most developed countries.
Many medical schools have recognised this need. The aim of the courses offered usually is not to train students in how to perform acupuncture, reflexology, homoeopathy, etc., rather, it is to educate them about CAM. At the very minimum, students need to know who uses what type of CAM for what condition and, most importantly, what the evidence for or against a particular practice is.
We can therefore be fairly optimistic that the next generation of doctors and other healthcare professionals will have been exposed to (at least a minimal amount of) formal teaching in CAM. But what about the existing generation? Healthcare professionals already in practice strongly feel the need to learn about CAM,2 yet few courses are available and the need remains largely unmet. The problem is usually time: most doctors are frantically busy with their daily work, so much so that they find it hard to keep abreast of the many important developments in conventional medicine. It is difficult to see how any reasonable amount of CAM education can realistically fit into this ever-tighter schedule. There are no easy solutions to this problem and, clearly, one has to make compromises between the desirable and the feasible. Our approach to offering a solution was to publish a book4 specifically aimed at addressing the busy clinician. It provides clinically orientated information on CAM based on the best available evidence (i.e. a multitude of systematic reviews). It offers easy access to the essentials of CAM in a language that conventionally trained doctors understand. The text is highly structured and uncompromisingly concise. A further important element is critical evaluation of the primary data. Our thinking was that even the busiest of healthcare practitioners would have time to look up the essentials about CAM if the clinical situation demands it.
If we want CAM to progress, we must find ways of educating conventionally trained healthcare professionals who are confronted with patients using CAM but know virtually nothing about it. To be successful, such education has to use a straightforward, evidence-based approach using the language they are used to. Preaching to the converted may be less demanding but it is also doomed to fail.
