Module Five

Working with Complementary Medicine Practitioners

This module will discuss both conventional health care providers and complementary medicine practitioners.

Conventional healthcare providers include for example: general practitioners, specialists, nurses, dieticians, pharmacists, psychologists and physiotherapists.

Complementary medicine therapies are not isolated to part of your healthcare. This is why learning to talk to your conventional healthcare providers about complementary medicine is important.

Many people are not comfortable talking about complementary medicine use with their healthcare providers because they are concerned that their healthcare provider will be upset about their use of complementary medicine. Often, healthcare providers do not ask about complementary medicine use, causing patients to not mention it.²³

It is important that your use of complementary medicine is documented in your health record. Your healthcare provider is more informed if they understand everything you are doing for your health and can provide valuable insight into how complementary medicine therapies fit or do not fit with your unique situation.

Finally, it is important to talk with your healthcare providers as there is evidence that shows some complementary medicine therapies:

Interact with other medicines
Increase the side effects of other medicines

Tips for talking with your health care practitioner

Bring up the topic of complementary medicine
State your personal values as well as your goals for using complementary medicine
Ask:
- What are the risks and benefits considering my unique situation?
- What's the evidence?
- What is known about this therapy?
- If you can't help me, who can? And can you refer me to them?

Choosing a complementary medicine therapy

When starting to identify possible complementary medicine therapies, you should start with two questions (see Module Three - SCOPED for more details):

What are my choices?
What are my goals?

When choosing a complementary medicine therapy that is provided by a complementary medicine practitioner, there is an additional question you will need to ask -

With whom should I work with?

Finding a complementary medicine practitioner

Ask your general practitioner or healthcare professional.
Contact complementary medicine professional organisations.
Ask trusted friends and family members.
Chinese Medicine Board of Australia (opens in a new window) - this covers acupuncture and Chinese herbal medicine.
Australian Natural Therapies Association (opens in a new window)
Australian Traditional Medicine Society (opens in a new window)

Complementary medicine professional associations

Most complementary medicine practitioners are members of a professional association. Organisations support practice of their members, and advocate on their behalf.

You can contact an organisation to:

Learn more about the complementary medicine therapies performed by their members.
Receive support in finding a practitioner in your area, possibly with the experience or specialised training you are looking for.

Regulation and professional accreditation of complementary medicine practitioners in Australia

Apart from chiropractors and osteopaths and, from 1 July 2012, Chinese medicine practitioners, there is no standardised national system for regulating other complementary medicine practitioners.²⁴ The extent and type of regulation varies from state to state and from one complementary medicine profession to another. Most complementary medicine disciplines are self-regulated, however, practitioners are subject to a range of Commonwealth and state legislation including the prescribing of medicines, health complaints, infectious diseases, the supply of services free of goods and services charges, etc.²³

Choosing a practitioner

Selecting a complementary medicine (CM) healthcare practitioner is an important decision and is essential to ensure that you receive the best possible advice and care. Complementary medicine may be practised by conventional healthcare practitioners with additional training such as medical doctors, registered nurses and physiotherapists as well as by other practitioners with relevant complementary medicine qualifications and experience. Some complementary medicine professions are unregulated by government, so practitioners have limited legal requirements to reach a particular standard of training. In these instances, being a member of a professional association provides some assurance that they have attained a certain level of training. However, if a complementary medicine practitioner has not undergone formal training and is not a member of a professional association, there is no assurance they have the necessary skills to provide the best possible advice and care.

Working with complementary medicine practitioner

There are four stages when working with a complementary medicine practitioner, each with a different set of questions to ask:

1. Preparing for the first visit

Before you visit a complementary medicine practitioner for the first time, you should ask some questions about their services. Consider:

What are your training and/or qualifications?
Is there a brochure or website with more information about your practice or your therapy?
Can you do a brief consultation in person or by phone? (This consultation may or may not involve a charge.)
Do you specialise in a particular area? How frequently do you treat patients with problems similar to mine?
How will your therapy help address my situation?
What will be involved in the first and on-going visits?
- Time per session?
- Clinic hours for appointments?
- Costs?
- Insurance coverage?
Determine whether the office location and hours are convenient for you.
Observe how comfortable you feel during these first interactions.

2. The first visit

The first visit is very important. Come prepared to answer questions about your health history, such as surgeries and illnesses, as well as prescriptions, vitamins and other supplements you take.

Not only will the complementary medicine practitioner wish to gather information from you, but you will want to ask questions too. Write down ahead of time the questions you want to ask, or take a support person with you to help you remember the questions and answers. Some people record the appointment (ask the practitioner for permission to do this in advance).

Questions to ask about recommended complementary medicine

What benefits/risks can I expect from this therapy?
- Do the benefits outweigh the risks for you?
What side effects can be expected?
Are there conditions for which this therapy should not be used?
Could the therapy interact with conventional treatments?
Will the therapy interfere with daily activities?
What is involved in the therapy plan?
- How long will I need to undergo treatment?
- How often will my progress or plan of treatment be assessed?
- Will I need to buy any equipment or supplies?
Do you have scientific articles or references about using the therapy?

Remember to evaluate what you learn in light of the evidence and safety information in Module Two and consider that information when making a decision (Module Three).

3. After each visit

It is important to reflect after each visit on how satisfied you were with the care provided. Here are some questions you may want to ask yourself after each visit:

Was the complementary medicine practitioner easy to talk to? Did he/she make me feel comfortable?
Was I comfortable asking questions? Did the practitioner engage with me, and were my questions answered?
Was she/he open to how both complementary medicine therapy and conventional medicine might work together for my benefit?
Did he/she try to get to know me and ask me about my illness?
Did she/he seem knowledgeable about the type of condition I have?
Does the complementary medicine treatment recommended seem reasonable?
Was he/she clear about the on-going time and costs associated with therapy?

Paying for complementary medicine
Complementary medicine can be expensive like conventional medicine. Therefore it is important that you carefully consider the costs involved when making your decision about complementary medicine;

Most complementary medicine requires you pay out of pocket and is a fee for service.
A number of complementary medicine therapies are covered by private health insurance, but the amount of coverage offered varies depending on the insurer and the therapy given. In addition, the health fund may only recognise certain complementary medicine practitioners. Check first to see if the therapy is covered, if your practitioner is part of your health fund's network, and what proportion of the costs will be reimbursed.
Even with insurance, you may be responsible for a percentage of the cost of the therapy as well as for any products such as vitamin supplements or herbal medicines.
You must carefully consider your ability to commit to using the complementary medicine product or participating in the complementary medicine therapy sessions. Things to consider include transportation, energy levels, fatigue, and the frequency of the treatments.

Potential warning signs: complementary medicine practitioners

Very expensive
Claim to be able to cure the condition
Not able to provide scientific evidence of effectiveness
No clear treatment plan
Unclear duration of treatment
Lacking detail of treatment plan
No clear goals for treatment

Remember YOUR goals for receiving treatment from the practitioner (more on goals in Module 3)

4. Ongoing visits

Each complementary medicine therapy is different in terms of length of treatment required and when the therapy may be most appropriate. Make sure you talk to your practitioner about your needs and expectations for treatment.
Remember to check in with your complementary medicine practitioner each visit and discuss the following:

Review your progress to date
How you have been doing since the last visit
Where you are in the on-going treatment plan

Can I change my mind?

Discuss with your complementary medicine practitioner if there are reasons you are not satisfied or comfortable with the recommended treatment/ Remember you can always look for a different practitioner or stop therapy. Talk with your practitioner before stopping any therapy as it may not be advisable to stop some therapies midway through a course of treatment or suddenly without a slow tampering dose.

Coordinating your care

Communicating with all your health care providers is key to ensuring the best possible health care. It is important to remember that everything you do for your health impacts your body and your health care. Complementary medicine treatments, therapies, and diet and lifestyle changes can all interact with each other. It is therefore important to tell all your health care providers about the treatments you are receiving.

What if I receive conflicting information?

Sometimes people feel caught between the recommendations of their complementary medicine practitioner and the concerns of their conventional health care providers. The conflict arises from differences related to how health and illness are conceptualised, beliefs and treatment, and what is considered to be "evidence" that therapy works and is safe (i.e. type and level of evidence (see Module 3), evaluation of the current evidence, and possibly different cultural ways of seeing health and illness. When this occurs, the patient often feels uncomfortable, because they are in a position of having to make a treatment decision based on conflicting values and information from different health care providers whom thy are relying on for treatment.

How conflicting information and recommendations about complementary medicine are resolved vary depending on the individuals involved and the patients particular situation.

This is an excellent time to apply the decision making framework SCOPED (Module Four). This recommendation is based on SCOPED's ability to help you balance YOUR personal goals with YOUR values and beliefs as you carefully consider the available evidence, possible benefits, and potential risks (including the amount of risk you are comfortable with) of the complementary medicine therapy or therapies you are considering, all in the context of your particular situation. This often makes the choice much clearer to the patient, and provides avenues for creating a solution. It also may bring options forward that may not have been identified before.

An example of conflict: Ron's dilemma

Ron will soon begin treatment for prostate cancer. He has consulted a naturopath in the past, and returns for a consultation because he wants to ensure cancer is stopped. The naturopath creates a short and long term plan, and wants to start boosting his immune system with:

"SuperImmune 7-IV" during his chemotherapy to help limit "damage" from chemotherapy and keep him healthy.
Ron's oncologist is concerned that several of the natural health products in "SuperImmune 7-IV" will interfere with the chemotherapy, preventing a full effect.

Ron deals with conflict by using SCOPED. He finds out there is not much evidence about whether the natural health product will interfere with his chemotherapy. He decides, however that he does not want to risk possibly making his conventional treatment less effective.

Through using the SCOPED process, he clearly articulated his goals (cure his cancer, prevent recurrence, and minimize nausea and fatigue), and approached both his naturopath and his oncologist to find other solutions that were more specific to his needs.

He found some complementary medicine options that his oncologist has agreed can be used during and post treatment for managing nausea and fatigue if they arise as well as learned more about the available anti-nausea medication. He has developed a long term health plan in collaboration with his naturopath to help minimize recurrence. As part of the health plan he is also considering yoga taught by his naturopath as part of a new focus on increasing exercise and reducing stress.

References

Robinson A, McGrail MR. Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Complementary Therapies in Medicine. 2004;12(2–3):90-98
NICM (opens in a new window)

« Home

Module Six »

Health Information