Addressing use of herbal medicine in the primary care setting.
OBJECTIVE
To critically evaluate existing approaches to the integration of allopathic and complementary and alternative medicine (CAM) and develop a middle ground approach to addressing use of herbal medicine and other forms of CAM in the primary care setting.


METHODS
Extensive review of scientific literature and Internet sources supported by legal, philosophical, and ethical arguments.


CONCLUSIONS
A review of medical literature indicates that a growing number of people perceive both allopathic and CAM to be valued aspects of health care. Whether we agree with this perception or not, ethical, legal, clinical, and social considerations dictate that we assist patients in their efforts to derive benefit from use of CAM while helping them to minimize risks. Yet the current approach to addressing CAM in primary care is "don't ask, don't tell," with approaches to filling this clinical void ranging from "just say no" to CAM use, to allopathic practitioners who also are CAM practitioners.


CONCLUSIONS
It is possible to occupy the middle ground, neither rejecting nor embracing CAM, but recognizing its significant impact on health care. In order to do this safely, clinicians need to be informed about herbs and other CAM practices, document thoroughly the informed consent and decision-making process, and monitor patients carefully for adverse effects.
Egan
Colleen D
CD
The Wellness Center, Benefis Hospital Emergency Department in Great Falls, Mont., USA. cdegan@midrivers.com
D000529:Complementary Therapies / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D004992:Ethics, Medical; D029001:Herbal Medicine; D006801:Humans; D011320:Primary Health Care