Family Practice Physicians have been bridging the gap between the many medical subspecialties for years. This has benefited patients greatly by providing cost-effective, integrated care. As Managed Care plans have shifted more and more responsibilities to primary care physicians over the past few years there has been an associated increase in respect for and influence of Family Practice Physicians. Whatever the outcome of health care reform, Family Practice Physicians will be key players. 

The painful process of health care reform has largely focused on increasing efficiency (elimination of waste by improving delivery systems) and limiting expenses through changing incentives and means of reimbursement. The actual "product" being delivered (medical services), has been only nominally changed. The struggle for control and influence in health care reform has produced many casualties, including tragically the very patients who are supposed to be the beneficiaries of this reform process. 

This has not gone unnoticed by patients. Increasingly patients are taking things into their own hands when they feel their needs are not being met by a dysfunctional medical system. Another "Health Care Reform" has been occurring independently, quietly, as patients are turning to alternative and complementary therapies en masse for their unmet needs. The Eisenberg survey of complementary medicine use, published in the New England Journal of Medicine three years ago , is by far the most quoted of the many studies looking at this trend. One in three Americans were using complementary therapies (in addition to conventional medical treatment) in 1990 and the use of these therapies appears to be on the rise. Another interesting tidbit is that over 70 percent of the time patients did not tell their physicians about their use of complementary therapies. 

The lack of communication between patients and physicians on the subject of complementary therapies is probably due to several factors. A common scenario is that physicians will ignore what is said or give patients a blank stare when the issue of complementary therapies is brought up. Another common occurrence is that physicians will reprimand, ridicule or discredit patients who admit to using complementary therapies. Neither of these interactions encourage further communication by patients on the subject of complementary therapies. This essentially amounts to a form of aversion therapy that discourages patients from sharing important information with physicians. 

How can we talk intelligently and without condescending overtones to patients about something in which we are not trained and which we don't necessarily believe in? The first step is to have basic training for physicians to raise awareness of what alternative/complementary therapies are available, what these therapies consist of and in what conditions these therapies are typically used. In order to foster dialogue in this area physicians should also be non-judgmental toward patients using alternative/complementary therapies. 

Engaging our patients in thoughtful discussion regarding the use of complementary therapies has several benefits:

*	avoiding potential interactions and conflicts between incompatible therapies;
*	learning from patients' experiences (good or bad), may help to improve outcomes for other patients with similar conditions or using similar therapies;
*	anecdotal observations by patients may lead to fertile areas for clinical research;
*	helping patients avoid therapies that are clearly contraindicated, dangerous or exploitative.

 

The above benefits partly explain why there are now over thirty U.S. medical schools offering courses in complementary therapies. There is a textbook written by respected physicians for physicians on the topic of complementary therapies . A.M.A. publications regularly carry articles discussing the need for increased awareness of complementary therapies by physicians. There are frequent medical conferences around the country dealing with how conventional and complementary therapies can be integrated. Even former Surgeon General, C. Everett Koop, has added his considerable influence and efforts to promote education and research in complementary therapies. 

Family Practice Physicians are the most logical members of the medical community to bridge the communication gap with patients on the subject of complementary therapies. Our pragmatic perspective and ability to integrate and collaborate with a wide array of specialists and subspecialists is ideally suited to dealing with the many alternative/complementary specialties and subspecialties. One recent study identified over 300 different alternative therapies. The other gap Family Practice Physicians must bridge is with the alternative practitioners themselves.

Family Practice Physicians are in the ideal position to dialogue with practitioners of complementary therapies and collaborate with them to improve clinical outcomes. There are now many studies (including double blinded, placebo controlled studies), documenting the effectiveness of many complementary therapies in a variety of conditions. Several studies have shown improved or comparable clinical outcomes with substantially lower costs using complementary therapies - a point not overlooked by more and more third party payors. 

Larry Dossey, MD and David Riley, MD presented an excellent overview of what complementary therapies our patients are using at the 1996 CAFP (Colorado Academy of Family Physicians) Annual Scientific Meeting. Drs. Dossey and Riley are both highly respected physicians, excellent speakers and are nationally recognized for their work. I strongly encourage physicians to attend these types of programs as it will be an invaluable aid in bridging the gap with a large number of our patients.