Magazine article Clinical Psychiatry News

Manage Liability Risk When Referring for CAM

Magazine article Clinical Psychiatry News

Manage Liability Risk When Referring for CAM

Article excerpt

LA JOLLA, CALIF. -- When you refer a patient to a provider of complementary and alternative medicine, keep in mind five liability management strategies, David M. Eisenberg, M.D., advised at a meeting on natural supplements in evidence-based practice sponsored by the Scripps Clinic.

The strategies, which he developed in collaboration with Michael H. Cohen, J.D. (Ann. Intern. Med. 2002;136:596-603), include the following:

1 Determine the clinical risk level.

Decide whether to:

* Recommend yet continue to monitor the therapy.

* Tolerate, provide caution, and closely monitor safety.

* Avoid and discourage the therapy.

2 Document the literature supporting the therapeutic choice.

"It's very important to put this in the chart," said Dr. Eisenberg, an internist who directs the division for research and education in complementary and integrative medical therapies at the Osher Institute, Harvard Medical School, Boston. "By the way, that is also true when we're using a novel or experimental drug with an inpatient. This is the same approach."

If treatment with a certain herb is recommended, "document the choice of herb, any recommendation regarding product or brand, and any discussion regarding therapeutic dose, and associated uncertainties regarding use of the herb," he said.

He also makes it a practice to keep a backup file of articles supporting the discussion or recommendation. "You could say this is a bit too conservative, like have suspenders and a belt," he said at the meeting, cosponsored by the University of California, San Diego. "But I think this is the best advice."

3 Continue conventional monitoring.

"A lot of times we recommend something or accept that a patient is going to do something, and then we don't monitor or follow up," Dr. Eisenberg said. "Undue reliance on CAM may lead to a charge that the patient was dissuaded from necessary conventional medical care."

He added that maintaining conventional treatment "helps demonstrate that the physician has followed the standard of care, even if CAM is included."

4 Provide adequate informed consent.

Describe the risks and benefits of using the CAM therapy and of delaying or deferring the conventional therapy, and spell out potential adverse interactions. …

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