In brief
- Respect patient choice: Discuss complementary and alternative medicine (CAM) openly with patients, and identify potential risks or interactions so that patients can make informed decisions about whether to pursue CAM.
- Meet the standard of care: Physicians providing CAM must use evidence-based practices, and stay within their competence.
- Be responsible when promoting CAM: Share only credible, evidence-based information.
- Use caution with CAM referrals and affiliations: Ensure referrals are in the patient’s best interests and supported by evidence.
What is complementary and alternative medicine?
Complementary and alternative medicine (CAM) refers generally to a group of diverse therapeutic treatments, products, and practices that are intended to complement or serve as alternatives to conventional medical practice (i.e. practices that are commonly taught in medical schools and provided in medical practices and hospitals). Examples of CAM therapies include natural health products, chiropractic treatment, acupuncture, meditation, yoga, Reiki, and homeopathy, among many others. Indigenous healing practices are recognized as distinct healing systems and are thus generally not considered “complementary” or “alternative” forms of treatment.
The boundary between CAM and conventional medicine and Indigenous healing practices is neither fixed nor absolute. Some physicians practise CAM, either as a primary focus or as a complement to conventional medicine, and some form professional affiliations with CAM practitioners.
Discussions with patients about alternative medicine
Physicians must respect the autonomy, health goals, and treatment decisions of their patients, including the decision to pursue CAM instead of, or as an adjunct to, conventional medicine and Indigenous healing practices. As patients may be reluctant to reveal their use of CAM, consider proactively asking patients if they are using CAM.
When patients ask about CAM:
- Respond in a professional manner and within the limits of your knowledge but avoid making judgments on the patient’s choice to pursue CAM.
- Assist patients in making informed decisions about CAM therapies by providing information about known benefits and side effects, and known interactions with the patient’s existing treatments. If you believe that an alternative therapy may be harmful to the patient, share this information with the patient.
- Inform patients when you do not have sufficient familiarity with the CAM to provide information about the risks and benefits. Consider whether consulting with, or referring the patient to, another practitioner would be appropriate.
- Document discussions with patients about CAM in the medical record.
Providing alternative medicine
Physicians who provide CAM must do so in accordance with a recognized and accepted standard of practice, and within the limits of their skill and knowledge.
- Follow applicable policies of your medical regulatory authority (College) to ensure you fulfill your professional obligations. Whether providing CAM or conventional therapy, similar standards apply regarding taking a history, conducting an appropriate examination, rendering a reasonable diagnosis or differential diagnoses, and documenting informed consent.
- Any CAM provided should be based on reliable scientific evidence that confirms the therapy’s safety and efficacy in the patient’s circumstances.
- Document in the patient’s medical record the rationale for any CAM recommendation, assessments conducted, diagnosis made, and consent discussion held. This may include informing the patient of the strength of evidence and scientific reasoning that supports the decision to offer CAM, reasonable expectations for the efficacy of the CAM, and how the therapy compares to conventional treatment or Indigenous healing practices.
Alternative medicine and social media
Physicians using social media have an obligation to ensure that the information they share about CAM is supported by credible, scientific evidence.
- Be aware of and follow your College’s guidance concerning social media use and advocacy.
- Avoid providing personalized medical advice to individuals through social media, whether it relates to CAM or otherwise.
Professional affiliations with CAM practitioners
The integration of some CAM into conventional medical practice is increasingly more commonplace.
Consequently, some physicians may be interested in forming a professional affiliation with a CAM clinic or practitioner.
- Before doing so, consider if the practice is based on scientific evidence, and whether it creates more risk to patients than conventional therapy. Patients might view such an affiliation as an endorsement of the safety or effectiveness of the CAM.
- Ensure you fulfill any professional obligations imposed by your College when affiliating with CAM clinics or practitioners, including with respect to potential conflicts of interest.
Physicians working in hospitals or clinics where CAM is available may consider referring patients to CAM practitioners if it is in the patient’s best interests and there are policies that clearly define roles, responsibilities, and accountabilities within the healthcare team.
The policy might specify the following:
- The ultimate decision to proceed with CAM is to be made by the patient following an informed consent discussion with the CAM practitioner.
- The CAM practitioner is required to communicate the patient’s decision regarding CAM to the referring physician.
- Accountability rests with the CAM practitioner to assess the benefits and risks of the therapy in the patient’s particular circumstances, and to obtain informed consent. Patients should be informed of the separate roles and responsibilities of members of the healthcare team.
Physicians might be requested by CAM practitioners to refer them to another healthcare provider, or order bloodwork or other testing for their patients.
- You have no obligation to make a referral, order tests or investigations that have been requested by other practitioners. You should make your own assessment regarding the appropriateness and need for the referral, test or investigation in the circumstances.
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