Confronting the communication gap between conventional and

alternative medicine: a survey of physicians' attitudes.

CONTEXT: An estimated 60 million Americans use some from of complementary and
alternative medicine, though approximately 70% do not tell their physicians about this use.
Open communication between conventional medical providers and patients in this area is
therefore lacking.
OBJECTIVE: To explore the dynamics that could potentially contribute to communication
breakdown between physicians and patients over the use of alternative therapies.
DESIGN: Mail-in, self-administered questionnaire. PARTICIPANTS: 96 practitioners in primary
care and medical subspecialties representing the local county medical society, Stark county,
Ohio.
MAIN OUTCOME MEASURES: Data were obtained on the following: (1) physicians' level of
familiarity with 23 different alternative therapies, (2) the question of whether physicians used
the therapies themselves, (3) physicians' assessment of the potential benefits and harm of
each therapy, and (4) physicians' response to the prospect of their patients using these
therapies.
RESULTS: Respondents reported the use of myriad alternative therapies. Only 28%, however,
referred patients for alternative therapies. The physicians demonstrated clear preferences for
specific therapies (i.e., when asked about benefits, familiarity, and reactions to patient use,
they responded differently depending on the therapy). Indication that the doctor-patient
relationship might be terminated as a result of alternative therapy use was more common
among subspecialists than among primary care practitioners.
CONCLUSIONS: Overall, physicians demonstrated an open attitude toward alternative
therapies. This finding indicates that patients should disclose their use of alternative therapies
to their doctors. Increased referral to alternative healthcare providers may require both
ongoing peer-reviewed studies of efficacy and increased physician access to information
concerning therapies that have undergone definitive study.

There is no alternative medicine. There is only scientifically proven, evidence-based medicine

supported by solid data or unproven medicine, for which scientific evidence is lacking.
Whether a therapeutic practice is "Eastern" or "Western," is unconventional or mainstream,
or involves mind-body techniques or molecular genetics is largely irrelevant except for
historical purposes and cultural interest. We recognize that there are vastly different types of
practitioners and proponents of the various forms of alternative medicine and conventional
medicine, and that there are vast differences in the skills, capabilities, and beliefs of
individuals within them and the nature of their actual practices. Moreover, the economic and

political forces in these fields are large and increasingly complex and have the capability for
being highly contentious. Nonetheless, as believers in science and evidence, we must focus on
fundamental issuesnamely, the patient, the target disease or condition, the proposed or
practiced treatment, and the need for convincing data on safety and therapeutic efficacy.

Context. Research both in the United States and abroad suggests that significant
numbers of people are involved with various forms of alternative medicine. However, the
reasons for such use are, at present, poorly understood.
Objective. To investigate possible predictors of alternative health care use.
Methods. Three primary hypotheses were tested. People seek out these alternatives
because (1) they are dissatisfied in some way with conventional treatment; (2) they see
alternative treatments as offering more personal autonomy and control over health care
decisions; and (3) the alternatives are seen as more compatible with the patients' values,
worldview, or beliefs regarding the nature and meaning of health and illness. Additional
predictor variables explored included demographics and health status.
Design. A written survey examining use of alternative health care, health status, values,
and attitudes toward conventional medicine. Multiple logistic regression analyses were used
in an effort to identify predictors of alternative health care use.
Setting and Participants. A total of 1035 individuals randomly selected from a
panel who had agreed to participate in mail surveys and who live throughout the United
States.
Main Outcome Measure. Use of alternative medicine within the previous year.
Results. The response rate was 69%.The following variables emerged as predictors of
alternative health care use: more education (odds ratio [OR], 1.2; 95% confidence interval
[CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI, 1.1-1.5); a holistic orientation to health
(OR, 1.4; 95% CI, 1.1-1.9); having had a transformational experience that changed the person's
worldview (OR, 1.8; 95% CI, 1.3-2.5); any of the following health problems: anxiety (OR, 3.1;
95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1.7-3.2); chronic pain (OR, 2.0; 95% CI,
1.1-3.5); urinary tract problems (OR, 2.2; 95% CI, 1.3-3.5); and classification in a cultural
group identifiable by their commitment to environmentalism, commitment to feminism, and
interest in spirituality and personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7).
Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only
4.4% of those surveyed reported relying primarily on alternative therapies.
Conclusion. Along with being more educated and reporting poorer health status, the
majority of alternative medicine users appear to be doing so not so much as a result of being
dissatisfied with conventional medicine but largely because they find these health care

alternatives to be more congruent with their own values, beliefs, and philosophical
orientations toward health and life.

Subjects were two groups of patients, one whose members were visiting a GP and the other whose
members were seeing a variety of Alternative Practitioners (AP), who were not significantly different in
terms of sex, age, level of education, marital status, occupational status, political views, newspaper
readership, ethnic grouping, religion, and income. The major difference between the two groups were
the fact that the AP group were more critical and skeptical about the efficacy of modern medicine; they
believed their health could be improved; they stayed loyal to their chosen practitioner; they had tried
more alternative therapies and have more self- and ecologically aware lifestyles; and they believed that
treatment should concentrate on the whole person and greater knowledge of the physiology of the body.