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Lisa Corbin Winslow, MD; Howard Shapiro, PhD

Arch Intern Med. 2002;162:1176-1181.

Background  More than one third of patients in the United States use complementary and alternative medicine (CAM); most also visit conventional physicians. There is little information about how physicians and patients discuss CAM. We hypothesized that physicians frequently fielded questions about CAM treatments but felt uncomfortable discussing them owing to a lack of education.

Objectives  To survey physicians to see how they discussed CAM with their patients and what factors influenced discussions and referrals.

Methods  A total of 751 physicians in the Denver, Colo, area were asked about their experience with CAM and communication about CAM with patients. Analyses were conducted using the SAS system (version 6, 1989; SAS Institute Inc, Cary, NC).

Results  Of the 705 deliverable surveys, 302 (43%) were returned: 76% of physicians reported having patients using CAM; 59% had been asked about specific CAM treatments; 48% had recommended CAM to a patient; and 24% had personally used CAM. Physician recommendation of CAM was most strongly associated with physician self-use (odds ratio, 6.98; P<.001). Few physicians felt comfortable discussing CAM with their patients, and the overwhelming majority (84%) thought they needed to learn more about CAM to adequately address patient concerns.

Conclusions  Education about CAM modalities is a significant unmet need among Denver physicians, and education may help alleviate the discomfort physicians have when answering patients' questions about CAM. Physicians who use CAM treatments themselves are much more likely to recommend CAM for their patients than physicians who do not.

From the Departments of Rehabilitation Medicine and Medicine, University of Colorado Health Sciences Center (Dr Winslow) and HealthONE Alliance (Dr Shapiro), Denver Colo. Dr Winslow is now with the Center for Integrative Medicine, University of Colorado Hospital, Aurora.

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