Doctors and Complementary Medicine

Originally published in January 2003 icon

Pride & Prejudice

Why some doctors have a problem with Complementary Medicine (and the patients who ask about it).

Graham Henderson is a public health doctor working for the NHS in Surrey. He trained at the Royal London Hospital and worked in children’s and adult medicine, and in general practice in Australia, before specialising in public health. He has been a consultant for ten years and is a former medical director of an NHS trust hospital.

By Dr. Graham Henderson

Medical Report

Taking the kids to school this morning came the inevitable comments from the back seat; "Dad, you’re going too fast; Dad, you forgot to signal at that junction".

How many of us love back-seat driving, even when we love the people who’re doing it more than life itself? It’s even worse, especially if you’re having a bad day, if the back-seat driver is right, and you know that you did in fact make a tiny little error of judgement on that last roundabout!

When we’re ill we feel insecure, dis-empowered, unable to assert ourselves. We see our advisors, our doctors, as wise, all-knowing, confidence-inspiring. At least, that’s how we want them to be. They know that. It’s in all the training - "give the patient confidence". But the doctor also knows that he’s human; he’s not all-knowing; sometimes he makes mistakes; sometimes he can’t deal with the emotional stress of the consultation.

So what happens to the doctor when:

He (or she) hears you asking about vitamins, dietary approaches to cancer, or reflexology?

You arrive with a sheaf of printouts from the internet?

You want to know his views on a book by a cancer sufferer that he’s never read?

He gets scared, that’s what.

Because suddenly, he can’t do his job. The doctor’s professional respect, self-esteem, position in the community, everything, is tied up in his/her ability to give you the information, reassurance, treatement you need, or to send you to a man who does. You don’t say that someone "works" as a doctor; you say he or she "is" a doctor. So if he’s not a good enough doctor, he might feel he’s not good enough at anything at all! And most doctors don’t know much about dealing with illness other than with conventional (allopathic) medicine.

Clearly, it’s not the same for all doctors. They come in different shapes and sizes, like everyone else. But there is a pattern, conditioned by medical training, of feeling threatened by the knowledgable, questioning patient.

Modern medical training has spotted it, and younger doctors have been shown ways of dealing with it. But we’ve all heard too many stories of patients who "couldn’t get the doctor to listen", felt brushed off, or even, in the worst cases got laughed at, to believe that it isn’t a problem.

So, to go back to the surgery. We’ve got one sick person (you) who’s frightended because you’re ill. And on the other side we’ve got another person, the doctor, who’s frightened as well, because your efforts to help yourself, to get some control over your illness and what’s happening to you, have accidentally threatened the doctor’s very sense of self-worth.

Now we have to careful here. You, the patient, are frightened because you’re ill. Horrible things are happening to you. You’re in the middle of a disaster. You’re entitled to be scared. The doctor, on the other hand, is a professional who ought to be able to deal with this.

His difficulty dealing with it is professional weakness; letting that develop into irritation or anger is professionally unethical. So let there be no confusion about who’s right and who’s wrong. The point of this article is not to dish out blame. What both doctor and patient need is to get into a constructive conversation.

In my experience there’s three groups of doctors when it comes to complementary medicine - apart from the rare enthusiasts who actually know something about it. If you can spot which one you’ve got, then you can try and make the relationship work for you.

The first, and easiest to deal with, are the ones who accept that they ought to know about complementary therapies, but have never quite got round to finding out. These are the best ones to deal with, because you can challenge them to find out about it; perhaps even work with them to explore the subject together. You might want to offer them some info (gently!), but you should probably let them go off and do some research on their own before coming back to the discussion later. That way you can have a proper conversation; otherwise it’s just you giving them a lecture. Ideally, the conversation ends with "I’ve always wanted to find out about this, but never got round to it. Now you’ve given me a reason. Come and see me later in the week and we’ll go into it together".

The second group are the doctors who really don’t think it’s anything to do with them, and are fundamentally unpersuadable. They’ve either looked into it and decided its a load of old codswallop (of which more below) or, even worse, have not really thought about it but have decided the same thing anyway! Quite frankly, there’s not a lot of point pushing your ideas in this situation. You probably know more about it than the doctor, you’re very unlikely to bring them round to your point of view, and you’ll just be wasting your time. Take what they’re offering in the way of allopathic medicine and look for complementary help elsewhere. Or, if you need your doctor to understand complementary medicine, change your doctor.

Finally, and perhaps the hardest to decide about, are the doctors who know very little about complementary medicine but could be persuaded if you (and they) had enough time. Here is your opportunity to lead them into the subject gently. Not intimidating them and making them feel stupid with your superior knowledge, but leading them gently to the point where they actually want to spend the next few evenings reading the book you’ve suggested, researching the internet, or going to the library.

When I worked in a factory before becoming a doctor, the woman in the packing department gave me a piece of advice I’ve never forgotten. "If you want someone to do something for you" she said, "make sure they think it was their idea in the first place". I’ve since found out that you can earn a fortune as a "change management consultant" for telling people things like that. It was good advice then, and it’s where you’re trying to get to with your doctor. You want to leave him with the sense that he’s missing something really useful and interesting. Something that he really can’t afford not to know about.

The other thing I ought to mention, in a piece that’s trying to tell you how to understand your doctor, is why conscientious, caring doctors sometimes reject the complementary approach. Doctors today are trained in the scientific approach, although the best doctors combine this with the "art" of medicine, which accepts that science can’t explain everything about people. The scientific side of medicine asks that everything, all medicines, all operations, all treatments, be subjected to rigorous testing and "proof". So when a new drug is invented, or a new operation suggested, it has to be put to the test. Compared with the existing treatment, under controlled conditions, preferably in a "blind" trial where neither the doctor nor the patient knows whether they’re taking the old or the new treatment.

This means that all bias is put aside, and only rigorous objective measurements show whether the new treatment is as good as, better, or worse than the old. And as patients, we want nothing less. We want to know that we’re being offered the best treatment, not just the latest fad from a "modern" doctor, or the stuff they’ve always used from a traditionalist.

But a lot of complementary treatments haven’t been tested through this sort of process. Partly, this is because the process takes a long time, and is expensive, so it can only be done if you can get the money back from drug sales when the tests are complete. Or because many complementary approaches tailor treatments precisely for individual patients, making it very hard to test a "standard" treatment.

But perhaps most often complementary approaches are hard to test objectively because they rely heavily on drawing out the patient’s inner resources to fight the illness. This is often in combination with a very strong relationship between therapist and patient, and these factors are just not amenable to standardisation and reproduction so they can easily be measured.

So, sometimes, even the very best and most caring doctors find themselves unable to accept that complementary approaches may be the right thing for you; they may honestly believe that, in recommending you explore alternatives to their allopathic approach, they may be doing you harm. I know this article appears to ask a lot of you, the patient. It asks you to try and understand your doctor when he doesn’t understand you. It asks you to consider his vulnerability at a time when he really ought to be considering yours. But the ICON approach is about helping YOU to take control of YOUR illness.

Use your doctors for what they can give you. Help them to a greater understanding if you can. Listen to their advice, and understand their perspective. But remember, in the end, it’s your life.

The final decisions are your yours to make.