Patients who want to try "Alternative Medicine"

[HemeOncHopeful19]

I thought about putting this in the tumor board thread but I didn't want to derail the thread with a relatively nonclinical question.

I've had a string of patients recently who all show up to my office for a new consultation and told me (before I even brought it up) that they did NOT want chemo or immuno-therapy and instead wanted to pursue XYZ herb formulation they read in a book or online. This isn't something I encountered a lot in my fellowship, so I'm wondering how people handle this or if anyone has come up with a way to respond that seems to work well for them? I'm not even particularly interested in convincing them to do otherwise, in my opinion the last thing I want to do is pressure someone to do something they don't want to do because then they'll have an adverse event and blame me 100%. I am mostly wondering what types of things you say or any good ways of phrasing "no I don't think that's a good idea because it's complete bat***t BS" without offending the patient.

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[Crabbygas]

Check out the book Supercommunicators by Charles Duhigg. It has a section about talking to antivaxxers. Not exactly the same but close enough that you might give his suggestions a try.

 

[dozitgetchahi]

I thought about putting this in the tumor board thread but I didn't want to derail the thread with a relatively nonclinical question.

I've had a string of patients recently who all show up to my office for a new consultation and told me (before I even brought it up) that they did NOT want chemo or immuno-therapy and instead wanted to pursue XYZ herb formulation they read in a book or online. This isn't something I encountered a lot in my fellowship, so I'm wondering how people handle this or if anyone has come up with a way to respond that seems to work well for them? I'm not even particularly interested in convincing them to do otherwise, in my opinion the last thing I want to do is pressure someone to do something they don't want to do because then they'll have an adverse event and blame me 100%. I am mostly wondering what types of things you say or any good ways of phrasing "no I don't think that's a good idea because it's complete bat***t BS" without offending the patient.

I’m a rheumatologist, but we certainly encounter this also.

Basically I tell patients that I was trained in the practice of modern rheumatology, period. I don’t have any expertise in alternative treatments and I cannot personally condone them because I know little to nothing about them. Sometimes people will try to get me to “bless” their alternative tx choices, “do you think this will be OK for me” or “do you think this will cause any issues with my other medications” etc. The answer again is that I don’t know anything about them and I can’t help with that. I am a mainstream rheumatologist, and I can help you in that direction only.

I’ve also seen pretty bad things happen after people started some of these supplements, including huge transaminase elevations etc. I explain that while any benefits of these treatments are unclear, negative effects are certainly possible.

I will spend one visit outlining what I think is the right idea, but I won’t spend multiple visits with these types of people debating the merits of western medicine as I used to. In fact, my overall happiness has improved as I’ve taken steps to flush this type of patient out of the clinic as much as possible. If you want to go do crazy town medicine with your chiropractor/naturopath/whatever, then go there and leave me out of it.

 

[MD46]

I have quite a few patients who bring things up like mistletoe, sea moss and other things.

I tell them, I am not an expert in alternative medicine, we practice allopathic medicine. Specially when it comes to chemotherapy and interactions with these substances, I am not sure however ideally would avoid as it could lead to negative interactions.

Having said this statement in the note I would assume also protects one from liability if there is a drug drug interaction.

 

[Mehena]

I sometimes run into these patients . I do my best to explain that there's no solid scientific backing. I often suggest a second opinion from another oncologist, hoping to guide them back toward evidence-based care. I’ve seen patients try things like "RSO oil" or "stem cell therapy" from overseas, along with other bizzare stuff. Even getting a family member to stick with standard care for ER+ early-stage breast cancer took a lot of effort.

I’ve looked into how to approach these conversations, and I’m honest about not being trained in alternative/complementary medicine. If they still want to pursue those treatments, I strongly advise caution and make sure to document EVERYTHING carefully. I’ve worked too hard for my MD to put my license at risk. While most cancer patients are understanding, there are some “difficult” ones or family members who seem determined to shoot down medical advice. Sadly, the outcome is never good.

More than ever, we doctors are up against a wave of misinformation, especially with all these “Dunning-Kruger public intellectuals” who think they know it all. One minute they’re talking about crypto, then they’re experts on cancer treatment, world politics, or economics. Next, they’re pushing extreme workouts for back pain, bizarre diets to live past 100, and then ketamine or hypnosis.

 

[CatFactorial]

I thought about putting this in the tumor board thread but I didn't want to derail the thread with a relatively nonclinical question.

I've had a string of patients recently who all show up to my office for a new consultation and told me (before I even brought it up) that they did NOT want chemo or immuno-therapy and instead wanted to pursue XYZ herb formulation they read in a book or online. This isn't something I encountered a lot in my fellowship, so I'm wondering how people handle this or if anyone has come up with a way to respond that seems to work well for them? I'm not even particularly interested in convincing them to do otherwise, in my opinion the last thing I want to do is pressure someone to do something they don't want to do because then they'll have an adverse event and blame me 100%. I am mostly wondering what types of things you say or any good ways of phrasing "no I don't think that's a good idea because it's complete bat***t BS" without offending the patient.

When I was a first year fellow, a stage IV colorectal adenocarcinoma requested "insulin-based" chemotherapy delivery, as they do in Mexico (?).

I told him I could only recommend treatments that have been vetted in clinical trials but that it was his prerogative to find out more. He left, reported my attending to his congressional rep (this was the VA), and promptly died.

#YMMV

 

[gutonc]

I would say that these people make up at least 1/3 of my patients. Not that they want to eschew standard therapy altogether, but that they want to use their magic mushroom elixir or whatever other bulls*** they found on the internet in addition to it. I do my due diligence (aka...I make my pharmacists look it up) and tell them whether it's absolutely contraindicated, or just that I recommend they don't do it and then they can be adults and make their own decisions. If their liver or kidneys take a dump, I tell them it's from whatever crap they bought off the internet that's causing it and I hold their standard treatment until it gets better or they die.

For the people who just completely peace out on standard treatment, I have them follow up with me on whatever standard surveillance schedule I would do if they were on treatment and offer them labs and imaging if they're interested.

I always document that they are going against my recommendations but that I will continue to care for them as needed.

The absolute worst cases are the ones who go see the "naturopathic oncologist" who treats them with whatever they can get the patient to pay cash for, until they run out of money, and then once they're on death's door (usually in 3-6 months, which would be the natural history of their cancer when untreated), they tell them they can't help them anymore and they need to come see me. At that point, they're usually highlighter yellow, cachectic and wheelchair bound with an ECOG of 3.8. I refer them to hospice and call it a day.

 

[HaemOnculus]

This resource is helpful.

About Herbs, Botanicals & Other Products

Find evidence-based information from our Integrative Medicine experts about herbs, vitamins, and other dietary supplements.

www.mskcc.org

 

[gutonc]

This resource is helpful.

About Herbs, Botanicals & Other Products

Find evidence-based information from our Integrative Medicine experts about herbs, vitamins, and other dietary supplements.

www.mskcc.org

I use it all the time.

But some of these people will come in with 15 different "medicines" they are taking. I don't have time for that nonsense.

 

[HemeOncHopeful19]

I use it all the time.

But some of these people will come in with 15 different "medicines" they are taking. I don't have time for that nonsense.

Interesting I’ll look at it this week! Just to clarify, do you use this yourself to look up whatever herb they’re asking about, or do you suggest THEY use it to look up whatever herb they’re asking about?

 

[gutonc]

Interesting I’ll look at it this week! Just to clarify, do you use this yourself to look up whatever herb they’re asking about, or do you suggest THEY use it to look up whatever herb they’re asking about?

I do it. I use the app so I just pull it up on my phone while we're talking.