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Reluctant Physicians and Complementary Modalities: What Can We Do About Them?

My most frequently asked question on my website is some version of “How do I deal with the doctor who is closed to the idea of complementary modalities?” Because of the number of people asking similar questions, I decided to write an article on the topic recognizing that many more readers are thinking about the question than those who actually send me an e-mail. I will be using my own experience at Mercy in Durango as the basis for the article, recognizing that each of us will have our own unique settings, culture, and requirements.

Here Are Several Ideas About Interacting With Reluctant Physicians.

First, it is most helpful to have a physician champion of the program who can talk with other physicians. It is even better if you have a few physician champions. It is even better if those physicians are in different sections of the hospital (e.g., a surgeon, a primary care doctor, a psychiatrist, and/or an oncologist.)

Second, if the nurses are the stronger advocates, you might choose to go through nursing services to initiate the program. That is what we did at Mercy. That allowed me to go to the individual physician department meetings and talk about the program as a FYI rather than getting their entire buy-in at the beginning. I did ask them if they would prefer to order the program or simply give their permission for nurses to ask the TLC team for sessions. They preferred to give permission since most of them didn't feel like they understood complementary modalities enough to order them. I then asked if they would like to be called for each patient or sign blanket permission. Initially, all physicians in each department meeting asked to be called. Over the course of the next year, nearly every doc signed a blanket permission both to prevent the hassle of being called about each patient and because they saw that the program was effective.

Probably three things were equally important in swaying the doctors toward the program. We asked each patient their anxiety and pain levels (0-10 scale) before and after each session so that we could accumulate statistical data that I could give to the doctors in a brief report every 3 months. Having the data helped doctors to approve of the program. Equally important was the subjective response of their patients who kept telling them that it was one of the most important parts of their healing process. Finally, it was essential that we had respectful holistic nurses who understood hospital culture as the TLC team kept political issues from building up during the time that we were changing the hospital culture.

It is important to offer education about the modalities to physicians. Right before we began the program, I did give a CME on the modalities that we were using and the research behind them, but it was poorly attended by the doctors. I think it was primarily of political importance in that it let them know that there was enough research to put on a CME session. I did, however, write up a one-page summary of the talk and put it in each doctor's mailbox. I don't know if they read it, but again the effort was made to keep them informed every step of the way.

Education is important, but experience may be even more powerful. We offered TLC sessions for doctors' day and that gave some more doctors an opportunity to experience what we were talking about. I offered to meet individually with reluctant doctors to discuss the literature in detail. My experience was if they were that reluctant, they didn't usually want to spend their time getting educated about the program, but, again, the effort on my part was worth the while. Mostly, we simply carried on as usual and gradually doctors came to appreciate and embrace the program.

As with any innovative program, we still have an occasional reluctant physician. With the sway of the entire hospital culture of 130 other doctors and having met with them to discuss the literature and our results with over 3000 sessions over 4 years at Mercy, at this point we are simply telling their patients that they must ask their reluctant doctors for permission to have a TLC session. It is admittedly dropping water on a stone, but with the improving understanding of patients' rights, I think eventually these doctors will change their minds. There gets to be a point where if you push too hard, physicians tend to dig in their heels and claim professional privilege, so I don't want to push too hard.

Nearly every program that introduces complementary therapies will encounter this issue. I hope that my experiences and thoughts are helpful to you as you face issues in your program. If you have other ideas about working with reluctant physicians, please share them with me.


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