Case Presentation, Part II
b. The "What, Whys and How does it help?" in dietary supplement history taking
In addition to Mrs. Nguyen, you also care for her entire family. In some families, there may be strong cultural or folk traditions that use herbs as remedies for ailments. Other reasons for HDS use may also include socioeconomic status, existing beliefs surrounding healing and wellness, or dissatisfaction with conventional approaches--especially with chronic conditions.
For you to make proper diagnoses and treatment plans, and help patients adhere to their treatments, you must know what self-care your patients are practicing and, specifically, what HDS they are using. Your role as a medical provider must include understanding why people use HDS, in what cultural content they use HDS, and how they think it helps them.
Patients will obtain information about herbs from friends, family, community healers, popular press, and the Internet. It is important for you to engage in open dialogue with your patients and help them weigh the risks and benefits of using HDS. Like any other medical treatment, it is vital that you approach the topic of dietary supplement usage in an open and non-judgmental way. You may find that by just asking a few open ended questions, you would be in a better position to asses a patient's beliefs and cultural practices regarding their use of HDS.
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Many clinicians who do not ask patients about their HDS use feel they lack adequate information or education to recommend an HDS or detect an adverse event.1-3 While the majority of medical schools now offer courses in CAM, these courses rarely provide detailed, practical clinical information about HDS, nor do they address communication with patients or teach how to document HDS and conversations about HDS in the chart.4,5 In a recent industry-sponsored survey of 1,184 healthcare professionals, 65% of physicians had received no formal education/training in HDS, but 75% of physicians expressed interest in continuing medical education in HDS.6 Both physicians (62%) and nurses (81%) expected such training would give them more confidence in talking to their patients about supplements.
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1. Flannery MA, Love MM, Pearce KA, Luan JJ, Elder WG. Communication about complementary and alternative medicine: perspectives of primary care clinicians. Altern Ther Health Med. Jan-Feb 2006;12(1):56-63.
2. Corbin Winslow L, Shapiro H. Physicians want education about complementary and alternative medicine to enhance communication with their patients. Arch Intern Med. May 27 2002;162(10):1176-1181.
3. Suchard JR, Suchard MA, Steinfeldt JL. Physician knowledge of herbal toxicities and adverse herb-drug interactions. Eur J Emerg Med. Aug 2004;11(4):193-197.
4. Shalansky S, Lynd L, Richardson K, Ingaszewski A, Kerr C. Risk of warfarin-related bleeding events and supratherapeutic international normalized ratios associated with complementary and alternative medicine: a longitudinal analysis. Pharmacotherapy. Sep 2007;27(9):1237-1247.
5. Sierpina VS, Schneeweiss R, Frenkel MA, Bulik R, Maypole J. Barriers, strategies, and lessons learned from complementary and alternative medicine curricular initiatives. Acad Med. Oct 2007;82(10):946-950.
6. Blateman J. Study Finds Physicians And Nurses Both Take And Recommend Dietary Supplements. April 2008.
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