Lise Alschuler, ND, FABNO discusses the importance of communication between conventional doctors and CAM practitioners.

by Lise Alschuler, ND, FABNO

I have been practicing as a naturopathic physician for 14 years. You would think that by now, I would have lost the ability to get my ire worked up about the lack of acceptance of CAM and integrative practices. Alas, that is not the case.

Last week, a very ill man in his 60’s entered my practice along with his wife.  It was clear as soon as he came into my office that he was feeling very unwell and had been feeling that way for some time. He had obvious ascites (abdominal fluid retention and swelling) and dependent edema. His balance was poor and he exerted himself with effort. His wife politely handed me a stack of records and reports. He began to tell his story with practiced familiarity. As I listened, I found my sense of compassion giving way to a sense of frustration and then outright anger.

This gentleman suffered from nonalcoholic steatohepatitis, or NASH. Over the past 5 years, his disease progressed to the point of frank cirrhosis. He had been hospitalized multiple times for edema and cellulitis, pain and sepsis. Despite a broad-ranging effort, no cause for his malady had been identified. His hepatologist recently told him that he needed a liver transplant. There were over 16,000 people waiting for transplants ahead of him in Arizona alone. His doctor assured him that his only chance to live was to join the list.

While that may, in fact, be true, I listened with amazement as the patient continued to tell me that at no time in the course of his illness did he receive any treatment (there isn’t much to offer allopathically) and that he was not encouraged to explore any other treatments outside of conventional treatment. Furthermore, when the patient recently presented his hepatologist with some studies using a specific combination of antioxidant therapies for hepatitis and fatty liver, the doctor emphatically told him not to try the antioxidant therapy or to seek any other alternative treatments. The patient decided to seek complementary therapies anyway, but the outright condemnation of these therapies voiced by his conventional doctor, had transformed his hope into fear. That was when I got mad. I found it inexcusable that his physician expressed complete dismissal of the use of evidence-based alternative therapies for a man whose only conventional treatment option was transplantation.

This encounter and the anger it left in me got me thinking. How could I transform this situation into an experience that offered healing for all involved? The patient asked that I did not send a consultation letter to the hepatologist and requested that I not call him either. Normally, I use my consultation notes as a communication vehicle and send them off in the hopes that the familiarity of the SOAP format, the level of scientific thought and the ‘medicalese’ of my charting will breakthrough a layer of skepticism on the part of the recipient practitioner and open an avenue of communication. However, honoring the patient’s request to not communicate with his doctor left me without a way to create communication and integration.

Unable to establish a collaborative relationship, I realized that the only tool of communication left was the patient himself. The patient would continue to see his conventional doctor and if he responded to the complementary therapies, his hepatologist would have no choice but to notice. If this physician has any level of inquisitiveness, he will then learn what will have caused the betterment of his patient’s condition. Perhaps, that observation would, in turn, crack open a willingness on his part to tolerate the idea that complementary and alternative therapies may provide some benefit to patients with NASH.

What a shame that our patients must be the battleground on which trust and openness are forged. The journey of illness is a journey that is, in and of itself, is a lot for patients to cope with. To add to demands of illness, a demand to mediate between providers seems, quite simply, wrong. Surely, tolerance of and even respect for a patient’s decisions is part of the Hippocratic Oath.  Even if the decision that a patient makes is contrary to our own belief system, we as providers have no right to judge or instill fear in the patient. That being said, I recognize that patients can make decisions which seem to us to be dangerous decisions. I understand the desire to educate patients away from certain decisions in their own best interest. What is at issue, however, is how that guidance is given.

Notwithstanding the ignorance and arrogance that run rampant within the ranks of healthcare providers (of all types), I assert that all providers have the responsibility to offer their opinions and guidance to patients in a manner which is respectful and non-judgmental. This holds true for integrative healthcare providers and allopathic providers. It is never appropriate to use our knowledge and our power to instill fear, rob hope, or dismiss the aspirations and considerations of our patients.

With this in mind, I renew a pledge to this patient and all future patients. I pledge that I will not be an instrument of fear. I will not allow my own ignorance and arrogance to mutate patients’ optimism into trepidation. I pledge that I will not only tolerate each patient’s ideas and curiosities, but, I will endorse their journey. This endorsement will require my honest opinions, which, at times, may include criticism of what they are interested in. However, even when I am critical, I will share my concerns as my concerns and will encourage the patient to incorporate my opinions into their considerations as additional information, not as dogma. In renewing this pledge, I hope that my subsequent actions will change, in whatever ways possible, the landscape of healthcare for the good of the patient.

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