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How to address patients with "alternative" views

Discussion in 'Allopathic' started by SpecterGT260, Apr 17, 2012.

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  1. SpecterGT260

    SpecterGT260 Catdoucheus

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    So a friend of mine is convinced that doctors are corporate schmucks and that any new alternative treatment or diagnosis is supported and confirmed by stating doctors don't know everything. Her new kick is adrenal fatigue. I thought she meant insufficiency but after looking around online I found the voodoo she meant. Any articles I find she discounts as either being written by men :confused: or an artifact of lacking medical knowledge and counters with natural med blog articles.

    So how do we approach people like this? In some cases it may be harmless to let them think what they want, but in others it may be appropriate to challenge a patients beliefs.
  2. DrBowtie

    DrBowtie Responsible?!?! PGY3 Moderator Emeritus

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    You defriend them.
  3. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    In light of the recent thread on religion, I found it amusing how you could substitute "religious beliefs" for "alternative treatments" in this discussion and it is exactly the same.

    Anyway, those people are usually, to some degree, anti-establishment. They take solace in "knowing" better than physicians, and tend to harbor distrust for regular medicine. There's often very little you can do to change their mind, even when you reiterate that there is no evidence whatsoever to support their views (again, like religious people).
  4. DoctwoB

    DoctwoB

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    Agreed that there is little to nothing you can do to change a deeply held belief regardless of evidence (AKA a delusion), and will lack the time to try to do so in modern clinical medicine. Just give the patient your best recommendation and if they refuse, be ready to meet with them again if they ever change their mind.

    Competent patients have the right to make stupid decisions. Now when their stupid decisions effect others (e.g. not vaccinating), that's what pisses me off.
  5. wholeheartedly

    wholeheartedly Moderator

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  6. chasing5

    chasing5

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    You respect their views and not be an elitist shmuck. You somehow earn their trust by showing them respect and if perhaps they aren't listening to you with respect to one of your recommendations, perhaps your built up trust will allow you to influence them in other ways and, in time, you hope they can eventually come around. If you really are so confident in whatever view you are angry with your patient about then this would be the best course of action, rather than isolating your patient and forcing him/her to go to another doctor who supports their view which in your mind/heart is 100% incorrect.

    https://healthland.time.com/2011/08...e-patients-whose-parents-dont-vaccinate-them/
  7. SpecterGT260

    SpecterGT260 Catdoucheus

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    Amusement is often a result of unidentified ignorance ;). Pretty sure I didn't affiliate with any religion in that thread other than make sure the arguments made were valid.

    The point is that this will likely come up in clinic. Do we leave these people to the wolves? Darwinism at work? I am a little of the mindset that says if you don't like what I have to offer you are welcome to leave my office and subsequently remove yourself from the gene pool. But apparently that isn't touchy-feely enough for today's medical curriculum.
  8. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    My amusement had absolutely nothing to do with "unidentified ignorance", though I appreciate your attempt at an insult. My amusement stems from the clearly analogous situations (alternative medicine and religion) and how much of the same applies to both issues (fixed delusions).
  9. dr zaius

    dr zaius Lowly Intern

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    I agree with this, though I wouldn't call someone that didn't agree with quack remedies to be an elitist shmuck. If you disagree and rub it in their face you're mainly being a douche bag rather than an elitist.

    It is the duty of a physician to educate these patients. Doing so in a respectful way is key. Show them why colloidal silver isn't a cure-all in a way that doesn't call them an idiot.

    -written by a second year, so this is all coming out of my ass since I have no real world experience.
  10. Morzh

    Morzh Lifetime Donor

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    Meh... I don't think that the two exampled are really that analogous. You have to differentiate between them because religion and CAM address very different things. CAM purports to treat or alter the physical state of one's body. Science has the ability to explore and test things that are physical, hence hardcore CAM enthusiasts willingly disregard or distrust physical evidence regarding their physiology in favor of a delusion totally unsupported by science.

    Religion, on the other hand, focuses on the so-called spiritual state of a person. Science can't possibly touch that, and that doesn't bother most religious people. They don't believe science is wrong, only that there are realities beyond the grasp of our scientific method.

    You can call religion a delusion if you want, but between religion and alternative medicine, one has very clear actual evidence contradicting it, while the other deals with ideas and beliefs for which science can neither support nor disprove.

    Of course "religion" is a very blanket term and encompasses a wide range of beliefs and degrees of devotion. Some religions try to make a lot of claims about the physical world that are not based in science at all. To me, this opens them up to criticism. I was talking more about the general idea of religion and spirituality that there's some kind of spiritual existence beyond our lives right now, and so you should be mindful of how you live because it will actually matter after you die.
  11. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    You do make some good points, and I will say that much of what I was getting at had to do with the bolded parts above. For me, it weakens any integrity of a given religion when we have to start selectively choosing which things to believe when we know that other tenets or claims by that religion clearly go against all scientific data available. It may seem like waffling, but I think "deism" is a much more sensible approach to religion than devoting oneself to any particular named religion (especially when many are mutually exclusive, and the idea that one God would condemn the rest of the world for believing their own God was the one that exists is extremely troubling.

    Anyway, I digress. Sorry for steering things off topic. Can I interest anyone in some snake oil?
  12. TallScrubs

    TallScrubs Dr. Mantis Toboggan

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    If you have a patient like this you say, 'then why the hell did you come to see a doctor?'

    Doesn't make sense why people go to see the doctor--willingly--and don't plan on listening to him/her. Only a first year so what I say doesn't matter one bit.
  13. SpecterGT260

    SpecterGT260 Catdoucheus

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    I will admit to you that there are similarities. And in that thread I said it was inappropriate for religion to pass itself off as science and vice versa. So your amusement based on my input in that thread is in inappropriate extension of what actually happened.

    The key difference here is that alternative medicines attempt to pass themselves off as science. They come up with cockeyed mechanisms for why things work and actively contradict science while trying to replace it. Any time religion or religious people attempt to do this they are also wrong, and you will not find a single instance in any thread where I so much as imply anything to the contrary. That is why it wasnt only an attempt at an insut ;) you think based on false premise that I am taking a hypocritical position.

    but as far as the task at hand... rather than a pissing match....
  14. SpecterGT260

    SpecterGT260 Catdoucheus

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    agreed. The girl in question then began discounting any information I could give on the basis that the government has brainwashed me just like it brainwashed everyone to believe that milk is healthy (because anything that turns a 200lbs calf into a 2000lbs cow in a year cannot be healthy.... confusion of concepts of nutritious and obesity? :confused:)

    There are definitely people that will fight tooth and nail to deny good science. I am just wondering if anyone has seen anything particularly effective in getting such a patient to comply.

    Personally I believe that adherence to alternative treatments (aside from religious practices.... Im referring only to those neo-alternativismists (that is a word... I dont care if chrome put a red squiggle under it) who ascribe these techniques to science that science hasnt been smart enough to figure out yet) anyways.... adherence to such treatments is a vice of luxury and eventually such people will get sick enough that they will have to abandon such beliefs.
  15. Druggernaut

    Druggernaut Lifetime Donor

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    No, you don't. You say, "There really isn't any scientific evidence that this works, and plenty of signs that it doesn't. I can't stop you from taking it, but it's my expert medical opinion that you should be doing (actual medical treatment) instead. But if you do decide to pursue these alternative treatments, keep me in the loop, so I can make sure we don't end up with unexpected interactions or side effects."

    Telling them they're stupid or throwing a tantrum only alienates them, and pushes them farther away from what they should actually be doing. It's also not professional behavior, or even mature adult behavior.
  16. D elegans

    D elegans Cheers

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    My personal favorite gripe with with this concept of "energy," not the concept in physics, but this hazy, undefined positive or negative "force" that apparently governs health outcomes. Clearly, it was all the negative energy the person was internalizing that caused the mutation in the tyrosine kinase that gave him cancer. Maybe with a little more transmission of positive energy we can cure her rheumatoid arthritis.
  17. Perrotfish

    Perrotfish Has an MD in Horribleness

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    Theoretically: You politely, and non-confrontationally, educate them about what the literature says and say that their alternative treatment is not supported by the evidence. If their alternative treatment has inherent risks you advise them of it. If they're threatening to follow the alternative plan of care exclusively, rather than in addition to your plan, then you advise them of the risks of non-compliance. If they persist in their opinion your respect them and move one, while making it clear that you are always available for further questions. You never turn the situation into a confrontation, but at the same time you never validate a non-scientific plan of treatment just for the sake of improving your physician-patient relationship. If a patient is completely non-compliant with YOUR plan of care (which is not the same as just adding on some CAM) then you can fire them to make room for a compliant patient, but that is a last ditch option.

    Actually: A clinic appointment is 15 minutes. That's 15 minutes for reviewing the chart, seeing the patient, documenting, and entering the billing codes, which means your time in the actual room is about 5 minutes. If my patient mentions a relatively mainstream form of CAM that can't hurt them I respond with what I like to call selective deafness:

    Me: Are you on any medications?

    Patient: Well, I'm on warfarin, ginko, a selection of healing teas, I apply a poultice of native American herbs to my chest, and every night I shove three healing crystals up my ass.

    Me: Uh huh. What dose of warfarin?
    Last edited: Apr 17, 2012
  18. Tic

    Tic

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    People are autonomous and allowed to help or hurt themselves if they so choose. As mentioned above there are times when those choices also affect others and steps need to be taken. However in general you do your evaluation, educate the patient as best you can, make your treatment pitch, respect their decision whatever it may be, (document the hell out of why you're sending them home with flaxseed oil instead of an ACE inhibitor), and sleep fine knowing you did the best you could.

    It's not just about alternative healthcare views. Your patients are going to all kinds of things that don't fit into your value system. Smoking, doing drugs, eating fast food is just the tip of the iceburg. I've treated women with 5+ elective abortions, watched someone with obscure religious beliefs refuse surgery that would have saved him from being a quadraplegic, and treated a rather well-known mass murderer. It's all much the same; you just have to distance yourself, do your job, and move on to the next case. Making a stink, or taking it home with you, is a terribly fruitless endeavor for everyone involved.
  19. theseeker4

    theseeker4 MS 3

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    I am not sure that combining warfarin with potentially sharp-edged healing crystals up the ass is safe... :smuggrin:
  20. SpecterGT260

    SpecterGT260 Catdoucheus

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    ok cool.

    so the question I have then: if someone comes to you with a hokey idea on what will cure them and you believe it to be something different, will you prescribe/recommend the worthless treatment due to their stubbornness or send them home empty handed?

    I tend to feel that sending someone home with flaxseed oil would be compromising my care. They can choose to decline what I offer, but I don't think that humoring something ineffective is the right way to go. But im saying this as a medical student so I am open to ideas on how well this really works on the floor
  21. SpecterGT260

    SpecterGT260 Catdoucheus

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    :laugh:
  22. loveoforganic

    loveoforganic -Account Deactivated-

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    The solution is ypareht evitingoc

    "Adrenal fatigue is in fact exactly what I wanted to tell you about! It's the new mainstream medical model to explain blah blah blah!"

    (kidding)
  23. SpecterGT260

    SpecterGT260 Catdoucheus

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    even google didnt know what the hell you are talking about :confused:
  24. Perrotfish

    Perrotfish Has an MD in Horribleness

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    You don't need to perscribe CAM, since it is by definition non-perscription. They buy it themselves. You don't recommend it either: you firmly say that it doesn't work. However when they do it anyway, assuming they're still following your plan of care, you let them do what they want to do. I don't think that seeing a chiropractor on the side is sufficient reason to fire a patient
  25. Druggernaut

    Druggernaut Lifetime Donor

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    "Cognitive therapy" spelled backwards.
  26. loveoforganic

    loveoforganic -Account Deactivated-

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    You're smart, I'm sure you can figure it out based on the other part of my answer ;)
  27. SpecterGT260

    SpecterGT260 Catdoucheus

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    that is why I also included "recommend" Tic mentioned sending someone home with it... so for this instance, "prescribe/recommend" = "send home with"
  28. SpecterGT260

    SpecterGT260 Catdoucheus

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    ereht did uoy tahw ees i
  29. SpecterGT260

    SpecterGT260 Catdoucheus

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    awwwww dammit! now nobody is gunna believe I figured it out on my own! :mad:
  30. johnnydrama

    johnnydrama I'm no Superman

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    You forgot to spell "did" backwards!!!

    :laugh:
  31. SpecterGT260

    SpecterGT260 Catdoucheus

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    mom ruoy

    yeah... figure THAT one out, tough guy :laugh:
  32. johnnydrama

    johnnydrama I'm no Superman

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    You did it again! Seriously, you're bad at this!
    :laugh:
  33. SpecterGT260

    SpecterGT260 Catdoucheus

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    wow ruoy bib !

    ?
  34. Tic

    Tic

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    Sorry not meant literally... no you don't prescribe the alternative therapy (even in those rare cases when you actually can) if that therapy is in contrast to the standard of care. You do want to document what the patient is doing vs. what you recommended. And most of the time it's the case where you can actually support the patient without any harm being done. People swear by chiropractic for example, or acupuncture, or 3x dv Vitamin C therapy, all things which I don't personally hold the same stock in that others may but feel carry a sufficiently low risk-to-benefit profile for me to say "yeah why not?", all while maintaining that rapport of being on the same team.
  35. CaptainSSO

    CaptainSSO

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    It's hard to change someone's views.

    Re: carbohydrate hypothesis ;)
  36. SpecterGT260

    SpecterGT260 Catdoucheus

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    :boom:
  37. lacrosse87

    lacrosse87 OMS-2

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    Despite being totally addicted to pizza, cookies, beer, munchkins, etc, I actually think the carb hypothesis prob has some validity

    In short,

    [​IMG]
  38. SpecterGT260

    SpecterGT260 Catdoucheus

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    lol. I actually dont think she smokes weed..... that would actually legitimize her claim IMO. At least she would have an ulterior motive
  39. scarshapedstar

    scarshapedstar MD c/o 2016

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    E.g. 'ever see a Smurf win gold in the decathlon?'
  40. Tatiana3325

    Tatiana3325 Removed

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    Are you saying the energy rocks I bought at Phish shows are useless??! !
  41. SpecterGT260

    SpecterGT260 Catdoucheus

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    http://*********************/instances/400x/18848351.jpg
  42. xXIDaShizIXx

    xXIDaShizIXx Clinical Psychology Psy.D. Candidate

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    This reminds me of the retarded Christian "Scientists". Remember autism is caused by vaccines riiiiiight?:D
  43. Metagamer

    Metagamer

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    Tell them to watch this episode of Penn and Teller: Bullsh*t.

    [youtube]zBBJMGhe3S8[/youtube]

    There is stuff in this episode about adrenal fatigue.
  44. mmmcdowe

    mmmcdowe Duke of minimal vowels Moderator

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    I too have a friend that is utterly convinced that doctors are corporate puppets (ironically, she loves "Doctor Ron Paul"). It is best not to get to caught up in it because you can't win. I remember arguing with her about the influence of Big Pharma on my school, etc, etc. She brought up this page to make her point:
    http://www.drugwatch.com/influence-of-big-pharma.php

    When I demonstrated that drugwatch is a subsidary of THIS page

    http://www.petersonfirm.com/

    it made absolutely no difference to her. Apparently big law is much more ethical than Industry.... at least when it is supporting her side of things.
  45. johnnydrama

    johnnydrama I'm no Superman

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    Sadly enough, there are a few who are... There was something really sketchy that went down at the Cleveland Clinic over Vioxx, one doctor testified against it and was immediately fired.

    But yeah, no reason to endorse BS.
  46. Tatiana3325

    Tatiana3325 Removed

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    .
    Last edited: May 1, 2012
  47. CaptainSSO

    CaptainSSO

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    Thanks for that. I actually watched it with my Third Eye and I think that helped me absorb the message better.
  48. QuizzicalApe

    QuizzicalApe

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    A patient?

    Adopt a collaborative attitude. Don't lecture condescendingly, but recognize that you're more likely to get adherence to your own recommendations and plans if your work with them rather than against them. Express interest in the alternative practices they employ, and realize that it is actually important for you to at least be aware to keep an eye out for any possible interactions between your own medical recommendations and herbal supplements being taken.

    That's what to do if it is your patient.

    If it is just a tin-foil-helmed acquaintance who is preaching about the healing benefits of powdered unicorn tails and how reiki masters can throw fireballs, man, do what you want. Find a new acquaintance whose head isn't full of marbles, I guess.
  49. CatFactorial

    CatFactorial

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    A relevant and interesting article:

    http://www.economist.com/node/21552554

    I disagree with the notion that we have to keep patients well. It's their job to live their lives, our jobs to try and fix them when they are sick.
  50. SpecterGT260

    SpecterGT260 Catdoucheus

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    :thumbup:

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