Referrals and Shared or Collaborative Care: Managing Relationships With Complementary and Alternative Medicine Practitioners

Abstract

In this article we discuss steps that clinicians should take after deciding to include a complementary and alternative medicine (CAM) treatment that is beyond the clinician's expertise in a patient's treatment plan. We use the example of an adolescent patient with chronic recurrent headaches that have not been relieved by medication or other therapies and whose physician refers her to an acupuncturist for treatment. We focus on (1) circumstances under which referral is appropriate, (2) the nature of the relationship between the referring clinician and the practitioner to whom the referral is made (considering conventional health care and CAM, regulated and unregulated practitioners), and (3) considerations when undertaking shared or collaborative care with other health care practitioners (conventional health care or CAM). We also suggest best practices in managing such relationships. Pediatrics 2011;128:S181-S186

Concluding Comments: Maximizing Good Patient Care and Minimizing Potential Liability When Considering Complementary and Alternative Medicine

“…All health care providers, whether conventional or CAM, must be able to recognize limits to their own abilities and those of their profession and to refer appropriately. 7,17 …”

“…Referral must be timely to ensure that needed care is not delayed. 17 Ideally, physicians will become comfortable referring to CAM practitioners when the risks and benefits of therapy are favorable for their patient's condition. However, if a physician feels unable to appropriately advise patients about CAM, he or she should explain that to the patient, refer the patient to another practitioner who may be more comfortable advising about the referral or to a regulatory authority or professional association, and assure the patient that their relationship will not be affected by the patient's decision.…”

“…However, if a physician feels unable to appropriately advise patients about CAM, he or she should explain that to the patient, refer the patient to another practitioner who may be more comfortable advising about the referral or to a regulatory authority or professional association, and assure the patient that their relationship will not be affected by the patient's decision. 17 …”

“…Simply continuing to provide conventional care and monitoring a patient's health status while he or she receives CAM therapy from another practitioner should not, without more, involve the conventional practitioner so closely with the alternative treatment that he or she would be considered to have entered into a joint undertaking with the CAM provider and lead to joint liability if one or the other harms the patient. 10,14,17,18 When undertaking shared or collaborative care, clear communication among everyone involved is especially important. Patients, parents, and health care providers should understand (1) health care providers' individual roles and responsibilities, (2) decision-making processes, (3) policies about care provision, and (4) the care to be provided, all documented by appropriate record-keeping.…”

“…Patients, parents, and health care providers should understand (1) health care providers' individual roles and responsibilities, (2) decision-making processes, (3) policies about care provision, and (4) the care to be provided, all documented by appropriate record-keeping. 7,17,19 …”