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1 July 1997 | Volume 127 Issue 1 | Pages 61-69
Alternative medical therapies, such as chiropractic, acupuncture, homeopathy, and herbal remedies, are in great public demand. Some managed care organizations now offer these therapies as an "expanded benefit." Because the safety and efficacy of these practices remain largely unknown, advising patients who use or seek alternative treatments presents a professional challenge. A step-by-step strategy is proposed whereby conventionally trained medical providers and their patients can proactively discuss the use or avoidance of alternative therapies. This strategy involves a formal discussion of patients' preferences and expectations, the maintenance of symptom diaries, and follow-up visits to monitor for potentially harmful situations. In the absence of professional medical and legal guidelines, the proposed management plan emphasizes patient safety, the need for documentation in the patient record, and the importance of shared decision making.
Author and Article Information
From Beth Israel Deaconess Medical Center, Boston, Massachusetts. For the current author address, see end of text.
PERSPECTIVE
Advising Patients Who Seek Alternative Medical Therapies
Acknowledgments: The author thanks Ellen Meisels, JD, MPH, Janis Claflin, PhD, and Rabbi Elaine Zecher for their contributions; Janet Walzer, MEd, Christopher Tuttle, Thomas Delbanco, MD, Thomas Inui, MD, and Debi Arcarese for editorial suggestions; and Debora Fischer for technical assistance.
Grant Support: In part by National Institutes of Health grant U24 AR43441, the John E. Fetzer Institute, the Waletzky Charitable Trust, the Friends of Beth Israel Hospital, and the Kenneth J. Germeshausen Foundation.
Requests for Reprints: David M. Eisenberg, MD, the Center for Alternative Medicine Research, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
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