Get curious about CAM
You might be surprised to know that even if you're not utilizing complementary and alternative medicine (CAM) therapies, some of your patients probably are. Clinicians are often unaware that their patients are using CAM therapies, such as herbal or dietary supplements, massage therapy, chiropractic care, and acupuncture. In fact, a survey conducted by NIH's National Center for Complementary and Alternative Medicine (NCCAM) and AARP indicates that nearly two thirds of patients age 50 and older use CAM, yet fewer than one third discuss these practices with their health-care provider. Why not? Usually because the practitioner does not ask, the patient does not bring it up, or the office visit is too brief to include time for such a conversation (www.nih.gov/news/health/jun2008/nccam-06.htm, accessed September 16, 2008).
Your developing an intelligent curiosity regarding CAM can lead to valuable exchanges with patients. For example, just as drug-drug interactions can occur when multiple medications are used, CAM therapies can affect pharmaceutical treatments—sometimes derailing their effectiveness, sometimes enhancing it. Ask your patients to fill you in on everything they take, from prescription and OTC drugs to vitamins, supplements, herbs, and other CAM therapies.
The health-enhancing properties of some CAM therapies have been recognized for decades or even centuries, and current medical journals are publishing more and more studies that suggest positive relationships between vitamin or mineral supplementation and improved health. Case in point: Recent research suggests that vitamin D may reduce the risk of various cancers and may have a role in the prevention and treatment of diabetes and hypertension (ods.od.nih.gov/factsheets/vitamind.asp, accessed September 16, 2008).
CAM is guided by several principles, including attempting to trace the source of ailments by uncovering physiologic and biochemical imbalances. For example, you can measure serum 25-hydroxyvitamin D to determine the vitamin D status of a person who has or is at risk for osteoporosis, and you can employ a Heidelberg gastric analysis to determine whether hydrochloric acid is present in sufficient amounts so that calcium, magnesium, boron, and other essential minerals can be adequately absorbed.
Hypochlorhydria—too little hydrochloric acid in the gastric juice—could be a confounding problem in many patients with osteopenia or osteoporosis since the ability to produce gastric acid may decline with age. A common clinical indicator of low stomach acid is chronic indigestion. Patients can perform a simple “alternative” test at home by swallowing a teaspoon of lemon juice in a small amount of water during a bout of indigestion. If the indigestion improves, the diagnosis of hypochlorhydria should be considered. If it worsens, hypochlorhydria is less likely.
CAM focuses on treating the person, not just the disease. Practitioners attempt to investigate physical needs from a biochemical and sometimes genetic perspective, rather than from a purely symptomatic perspective. Environmental, nutritional, and emotional influences also are often linked to the patient's underlying health problems. As a result, CAM practitioners are challenged to maintain a working knowledge of current issues evolving from many fields of study.
So, in addition to reading your regular medical journals, try exploring one of the many journals presenting objective information on health and healing. Better yet, attend a CAM conference.