How Medical
Education can Influence a Doctor's Acceptance of Complementary Medicine
Different
sources have different definitions for the
terms used to describe complementary and conventional medicine. This article is using
definitions of complementary
and alternative medicine (CAM) and conventional medicine from the
National
Center for Complementary and Alternative Medicine. Conventional medicine is used to describe
medicine as practiced by Medical Doctors (MD's) and Doctors of
Osteopathy
(DO's). Conventional
medicine is also known as
Western medicine, orthodox medicine, or regular medicine. Complementary medicine is
used together with conventional
medicine
while alternative medicine is used in
place of conventional medicine.
The term MD
(Medical Doctor) is commonly, but
incorrectly, used to describe all doctors.
Look at a hospital's Physician Directory or flip open the
Yellow
Pages to the physician section, and you will see two different sets of
initials
immediately following the doctor's name – MD or DO. MD's and DO's attend two different types
of medical school. While
approximately 98% of the medical
training is the same, there are differences in philosophy that makes
one group
more open to CAM.
Doctors
who graduate from allopathic medical schools use the title Medical
Doctor, or
MD. Allopathic
Medicine is based
on patient centered medical research that follows standardized methods
and
scientific principles. An example of this is the "double-blind study"
often
referred to in news reports and articles.
The body is separated into systems, and each body system
is its own unit
unless a relationship with other body systems has been scientifically
established. Diagnostic
and
treatment methods are research based.
Historically the focus has been on curing disease, but
preventative
healthcare has become recognized as a necessary part of disease
management. Many
MD's consider CAM to be more
theory than proven practice because it has not been proven according to
the
scientific principles taught in allopathic medical schools. The majority of medical
schools in the
United States follow the allopathic model.
While MD's
trained in the allopathic model cite the
lack of hard scientific evidence as a reason to beware of CAM, the
reality is
they don't practice in a textbook or medical journal. So they can and
do use
treatments that are not 100% research based.
An example would be prescribing a medication for
"off-label"
use, like when certain antidepressants are used to treat neuropathic
pain even
though the manufacturer has not researched and labeled the
antidepressant as a
treatment for pain.
Osteopathic Physicians, or DO's, have
a different concept of health. Osteopathic
medical schools teach that the body is not a series of systems, but a
self-regulating, self-healing unit where the body, mind, and spirit
combine to
make a person. In
addition to
using standard diagnostic testing, DO's
are taught to
take a comprehensive history of the whole person and to use hands on as
part of
their information gathering. DO's can also use Osteopathic
Manipulation of the
musculoskeletal and nervous systems to facilitate the body's ability to
self-heal. Less
than 10% of conventional
physicians in the United States are DOÕs,
but that number is expected to grow as the need for individualized
primary care
and preventative care becomes more accepted.
Once medical
training is completed, DO's
work in hospitals, operating rooms, the Military,
clinics and private practice. They
can choose to embrace a holistic approach to health and healing, follow
the
more common allopathic medical model, or create their own combined
model of
practice. Guided by
the
Osteopathic philosophy, 60% of DOÕs
prefer Family
Practice, Internal Medicine, and Pediatrics over
specializing because these areas enable them to work with the whole
person as
partners in wellness, in addition to curing disease.
Dr.
Christopher
Laseter, D.O., an
Osteopathic Physician in Lancaster, Pennsylvania, uses advanced
Osteopathic
training to treat children with neurological and behavioral problems. He warns that, like MD's, DO's need specialized training
to work with Special Needs
children.
When asked
about what appears to be a struggle
between allopathic medicine and CAM, Dr. Laseter
replied, "DO's, by being
forced to train in both
allopathic and osteopathic schools of thought gain a little perspective
in what
amounts to a turf battle for hearts and minds. We have a foot in both
camps. In
the future, patients will demand their physicians be cross-trained in
several
medical models and tensions will lessen."
Does this
difference in philosophy mean that an MD
will not support your interest in CAM? Some Medical Doctors have a
personal and
professional interest in complementary medicine, but their ability to
recommend
or discuss CAM is limited by whether the treatment you are asking about
has
been researched within allopathic guidelines – or if they are aware of
the existing research. Some
allopathic
medical schools are now teaching Integrative Medicine, which combines
researched
CAM with allopathic treatments. Interested
M.D.'s are pursuing
additional training and certifications
in CAM treatments or partnering with a variety of CAM practitioners to
create
their own integrated practice groups.
What if you
feel that your child's physician is not
willing to discuss CAM? The
American Academy of Pediatrics Committee on Children with Disabilities
Policy Statement
on CAM, and children with chronic illness or disabilities, advises
pediatricians to respectfully listen to the desires and fears of
parents
seeking to discuss the role of CAM in their children's healthcare. Dr. Karen Summar,
M.D., Director of the
Jane and
Richard Thomas Center for Down Syndrome at Cincinnati Children's
Hospital Medical
Center, doesn't sugar coat this dilemma, "Go somewhere else. If you have a pediatrician
who won't
listen to you about CAM, he probably won't listen to you about other
things,
either."
Dr. Summar
added not to rush into a relationship with any practitioner,
conventional or non-traditional. "A
doctor or practitioner has expertise
in certain areas of medicine, but you are the expert about your child. If something is not
ringing true or
does not apply to your child, then go somewhere else."
She also advises to make an
appointment to discuss CAM treatments instead of trying to ask
questions at the
end of a visit. This
way the
doctor has time to research how the treatment relates to your child's
needs and
there will be time for a more thorough discussion. (See this month's "Did You Know"
for more information on
discussing CAM with doctors.)
As research on
the effectiveness of specific CAM
treatments grows, the M.D.'s
ability to partner with
you in this grows as well. When
one of my daughter's Neonatologists heard that I had a background in
Aromatherapy he showed me research about using Vanilla essential oil to
reduce
episodes of Apnea of Prematurity – and he wrote an order for her nurses
to use it on a schedule as they would any other ordered treatment. He found a way to
introduce CAM into a very
traditional medical setting. Don't
assume that because a doctor is an MD that he is close minded or stuck
working
inside the box. There is still room in conventional medicine for
creative and
intuitive individuals to work within the boundaries of medical
science while their
patients benefit from centuries of health knowledge.
CAM can be a part of the science and art of medicine.
So how do you find a doctor who is open to CAM and qualified to use CAM treatments in Special Needs children? Some online sources for CAM friendly physicians are listed below, and many of these organizations give tips on how to choose a CAM practitioner, but, a physician locator is just a starting point. Dr. Laseter recommends that parent to parent referral between like-minded parents be a part of your search for a physician who shares your family's philosophy of care.
*The
American Academy for Medical Acupuncture (http://medicalacupuncture.org/)
has a locator for conventional physicians who are board certified in
Medical
Acupuncture.
*Members of the
American Institute of Homeopathy (http://www.homeopathyusa.org/)
include
MD's and DO's with an
additional interest in
homeopathic medicine.
*The American
Osteopathic Association (http://www.osteopathic.org/index.cfm?PageID=findado_main)
website has a DO finder database.
*The Consortium of
Academic Health Centers for
Integrative Medicine (http://www.amfoundation.org/practitioner.htm#SCHOOLS)
has a listing of member programs.
*The Cranial Academy's (http://www.cranialacademy.org/index.html ) members include DO's and MD's
who have taken additional training in a specialized branch of
Osteopathic
Medicine called Cranial Osteopathy
*Holistic Health Now! (http://www.holistichealthnow.org/web/)
is the resource directory of The American Holistic Medical Association
(AHMA). AHMA
membership includes MD's, DO's,
and other CAM practitioners.
To download the
American Academy of Pediatrics full
Policy Statement on CAM and Special Needs Children, visit http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/3/598.
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