title: Negotiating complementary and alternative medicine use in primary care visits with older patients.
abstract: OBJECTIVE
  To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits.
  
  
  METHODS
  Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning.
  
  
  RESULTS
  Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician-patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment.
  
  
  CONCLUSIONS
  Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions.
  
  
  CONCLUSIONS
  Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA 94121, USA. christopher.koenig@ucsf.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Koenig
authors.forename: Evelyn Y
authors.initials: EY
authors.lastname: Ho
authors.forename: Vivien
authors.initials: V
authors.lastname: Yadegar
authors.forename: Derjung M
authors.initials: DM
authors.lastname: Tarn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003142:Communication; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D009819:Office Visits; D010358:Patient Participation; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D013637:Tape Recording