The Doctor Patient Relationship

Complementary and Alternative Medicine:
The Importance of the Doctor-Patient Relationship

Recent studies have shown that 69% of Americans use at least one type of complementary and alternative medicine (CAM) therapy in any given year and 70% to 90% of physicians consider CAM therapies to be legitimate medical practices. However, it has been reported that approximately 60% to 70% of patients who use CAM therapies on a regular basis do not inform their physicians of such utilization-even before an important surgery. In fact, prior to surgery, over 22% of patients reported using herbal remedies, while over 51% of patients reported using vitamins and other nutritional supplements.

According to Dr. Tsen, "The use of such remedies in the presurgical population has implications because of the potential for drug interactions, side effects, and medical liability." Therefore, while

numerous studies have confirmed the beneficial health effects and safety of herbal remedies and nutritional supplements, the importance of informing your physician of such use cannot be understated.

Despite the fact that adverse reactions to prescription drugs cause over 100,000 deaths annually, presurgical patients who take herbal remedies and/or nutritional supplements tend to forget or overlook the fact that herbal and nutritional therapies are considered pharmacologically powerful, effective, and capable of interacting with anesthetic drugs. For instance, a recent study showed that 27% of surgical patients consumed alternative medicines that are known to inhibit blood clotting and thin the blood, a potentially life threatening situation in a surgical setting. These alternative medicines included vitamin E, garlic, ginkgo, ginseng, fish oil, and chamomile.

CAM therapies have been extensively demonstrated and recognized as safe, effective, and nontoxic additions to conventional healthcare. However, as with any self-administered medication, it is important to inform your physician of any and all use of herbal remedies and nutritional supplements, especially before surgery. This will allow your physician to prevent any possible adverse side effects associated with their use.

References
Kessler W, Goodkind M. (1999, September 23). Americans mingle complementary techniques with traditional medicine. Stanford Online Report. Retrieved from http://www.stanford.edu/dept/news/report/news/september23/altsurvey923.html .
Berman BM, Singh BK, Lao L, et al. Physicians' attitudes toward complementary or alternative medicine: a regional survey. J Am Board Fam Pract 1995;8(5):361-66.
Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998;280(18):1569-75.
Gulla J, Singer AJ. Use of alternative therapies among emergency department patients. Ann Emerg Med 2000;35(3):226-28.
Tsen LC, Segal S, Pothier M, et al. Alternative medicine use in presurgical patients. Anesthesiology 2000;93(1):148-51.
Norred CL, Brinker F. Potential coagulation effects of preoperative complementary and alternative medicines. Altern Ther Health Med 2001;7(6):58-67.
Norred CL, Zamudio S, Palmer SK. Use of complementary and alternative medicines by surgical patients. AANA 2000;68(1):13-18.