Regulation i_need_contribute
Doctors and CAM (complementary and alternative medicine) ( NZ )
source:WTMF 2020-05-26 [Regulation]

 

 

Background

 
1. Complementary and alternative medicine (CAM) refer to therapies and treatments that are not commonly accepted in
conventional medical practice. Complementary therapies are health care and medical practices that are used alongside
conventional medical treatments but are not an integral part of conventional medicine, while alternative therapies are used
instead of standard medical treatments.1
2. When complementary and alternative medicines are commonly accepted to have benefits and minimal risks for the patient, and
patients have made an informed choice and given their informed consent,2 Council does not oppose their use.
3. No person may be found guilty of a disciplinary offence under the Health Practitioners Competence Assurance Act 2003 merely
because that person has adopted and practised any theory of medicine or healing if, in doing so, the person has acted honestly
and in good faith3.
4. Notwithstanding this, the Medical Council of New Zealand (Council) expects doctors who practise complementary and alternative
medicine to do so in a manner that is consistent with their professional, legal and ethical obligations.4 This includes explaining
the difference between CAM and conventional medical care so that your patient understands and is clear about the different
approaches to treatment when making decisions about their care.
5. This statement has been written to inform doctors of the standards of practice that are expected of them by Council should
they choose to practise complementary or alternative medicine or if they have patients who use complementary or alternative
medicine. This statement may be used by the Health Practitioners Disciplinary Tribunal, the Council and the Health and Disability
Commissioner as a standard by which a doctor’s conduct is measured.

 


Doctors whose patients use CAM


6. CAM therapies are often used by patients. You need to acknowledge and be aware of CAM therapies irrespective of whether you
intend to use or recommend them. Ask your patients about their use of CAM and by whom the CAM therapy is provided. Where
appropriate, record any CAM therapies your patients use, including any details the patient informs you of, so that this information
forms part of the background you and/or other doctors have when providing care to your patient.

Potential for conflicts
7. Some CAM therapies can adversely impact on the patient’s health or compromise the quality of conventional medical care.5 As
a precaution, it is important that you explain that there could be implications from CAM therapies on any conventional medical
treatment your patient is receiving; and that you discourage use of CAM therapies for that period. In the event of a suspected
interaction between a CAM therapy and conventional medical treatment, consider discussing this with a pharmacist and/or
obtaining information directly from the CAM provider.
8. You should also take into account that CAM therapies may be practised within a specific cultural context such as Rongoā.6 You
need to be mindful of the cultural beliefs, mores and behaviours of your patients and must respect these.7
9. Some patients might be reluctant to tell you about CAM therapies they use to avoid being judged. In asking about CAM therapies,
you should be respectful and ensure that the patient is aware that these treatments may impact on the outcome of care.
Helping patients to make informed choices
10. If a patient expresses an interest in CAM, you should respond in an unbiased professional manner irrespective of your views
about CAM and whether you incorporate CAM within your practice.
11. Where a patient is making a choice between conventional medicine or CAM, or whether to engage in CAM alongside conventional
medicine, you should:
(a) assist the patient to evaluate likely benefits and risks of the proposed CAM treatment;
(b) make it clear to the patient, the level or limits of your knowledge about CAM;
(c) be aware that your views may influence your patient’s beliefs and choices;
(d) To the extent of your knowledge, skills and judgement, you should provide sufficient information to allow competent patients
to make an informed choice.8
12. The Medical Practitioners Disciplinary Tribunal stated in a 2003 decision:
There is an onus on the practitioner to inform the patient not only of the nature of the alternative treatment offered but also
the extent to which that is consistent with conventional theories of medicine and has, or does not have, the support of the
majority of practitioners…9
13. The Council endorses these comments and expects that if you include CAM within your medical practice or refer patients for CAM
therapies you inform the patient in the manner suggested by the Tribunal before obtaining consent (and as required by the Code
of Health and Disability Services Consumers’ Rights). Careful attention to the process of informed consent is always important and
you should advise patients when scientific support for treatment is lacking.
14. In the same decision, the Tribunal further stated:
The Tribunal recognises that persons who suffer from chronic complaints or conditions for which no simple cure is available
are often willing to undergo any treatment which is proffered as a cure. As such, they are more readily exploited.
15. You must never exploit patients or misrepresent any form of treatment or health service, especially when obtaining consent.10

 

Doctors who practise CAM or refer patients to CAM practitioners


16. Some doctors refer patients for CAM therapies or incorporate such therapies into their own practice. If you do so, you will be
held to the same standard of care as any other doctor. Where there is reasonable evidence of both safety and efficacy, there is no
barrier to making a referral to a CAM practitioner or to utilising a CAM treatment. To ensure optimal management of the patient,
it is important that you maintain professional relationships with any practitioner who also treats the patient.
17. You should not misrepresent personal or published information or opinion about CAM therapies or any other treatment. Where
you disagree with any personal or published information or opinion, you should explain the basis for your disagreement in
order for your patient to understand your reasoning. Patients must be made aware of the likely effectiveness of a given therapy
according to recognised peer-reviewed medical publications, notwithstanding your individual beliefs. In addition, you must make
it clear to patients if a particular therapy lacks evidence and is not supported by the majority of doctors.
18. If you practise both conventional medicine and CAM, it is important that your patients are aware of which modality you are using
and that the modality is agreed upon with the patient.
19. There must always be clarity as to which doctor is providing conventional medical care. This may or may not be the same doctor
who is providing CAM services. There must also be clarity on the responsibility for following up abnormal results of laboratory
tests or any investigations ordered. Such follow-up is almost always the responsibility of the doctor who ordered the test but there
may be shared responsibility on occasion. Clear communication from the doctor practising CAM to the patient’s usual general
practitioner and agreement on responsibility for follow-up is essential in such circumstances.
20. If you are providing or proposing to provide CAM to a patient, the matters you should discuss include, but are not limited to:
(a) the expected risks, side effects, benefits and cost of each option including there being limited evidence around safety and risk of
harm;11
(b) highlighting that manufacturing and safety standards of CAM products are often not as rigorous as conventional medicines;
(c) the frequency and duration of the treatment;
(d) whether there are any diagnostic tests associated with the treatment;
(e) information on the history and nature of the CAM treatment or product, and the philosophy behind its use;
(f) information on the safety, efficacy, benefits and risks of the CAM treatment or product;
(g) the circumstances in which private health insurers and government organisations (for example ACC, and Work and Income New
Zealand) may pay for or subsidise the CAM treatment; and
(h) the patient’s right to seek a second opinion or to decline the treatment.
21. In assessing patients you must:
(a) take a pertinent medical history, where clinically indicated perform a physical examination of patients, and/or order any relevant
tests or investigations;12
(b) reach a diagnosis by using a diagnostic system demonstrated by appropriate research methodologies to have a high level
of accuracy and proven benefits to patients. This may include taking into account previous assessments by other health
practitioners.
(c) advise patients of the evidence based and conventional treatment options, their risks, benefits and efficacy, as reflected by
current knowledge; and
(d) document all of the above in accordance with sound practice. Your notes must be such that any doctor or health professional
is able to understand the information you document (including the basis for your diagnosis and treatment) in order to provide
follow-up care to your patient.
22. In treating patients, you must:
(a) ensure that the treatment is safe;
(b) work within the scope(s) of practice you are registered in with the Council;
(c) have current knowledge and skills in your area of practice;
(d) be competent in the practices you employ;
(e) act honestly and in your patient’s best interests according to the fundamental ethics of the profession which includes managing
the patient’s expectations;
(f) provide sufficient evidence-based information to allow patients to make informed choices, as set out above;
(g) refer to or consult with others when patients request it, when you require assistance or when the standard of practice requires it.
(h) ensure that any advertising or promotional material about you and/or your services comply with Council’s standards on
advertising;13 and
(i) obtain informed consent for any proposed treatment.14
23. When you see a patient whose ongoing care is being provided by another practitioner, you must maintain contact with that
practitioner and must fully document CAM and other treatments provided to the patient. You must be available to answer any
queries that the other practitioner might have and you should provide access to your clinical notes if your patient, his/her general
practitioner, or any practitioner treating your patient requests a copy.15
24. In advancing knowledge including conducting clinical or innovative research into the use of CAM therapies and providing
treatments in areas of uncertainty where no treatment has proven efficacy, you must:
(a) follow nationally accepted guidelines for undertaking health and disability research, including obtaining approval for the research
from an approved ethics review board or committee;
(b) ensure that your patients are told the degree to which tests, treatments or remedies have been evaluated, and the degree of
certainty and predictability that exists about their efficacy and safety;
(c) be prepared to collaborate in the collection of information that can be appraised qualitatively or quantitatively, so that new
knowledge is created, to be shared with, and critically appraised by, the profession;16 and
(d) have your research peer reviewed as part of good professional practice.

 


Association with a CAM clinic, ther apy or device


25. Doctors who are associated with a CAM clinic, therapy or device, or who stand to gain financially from such an association must
adhere to Council’s standards.17
26. If you are associated with a CAM clinic, therapy or device, you must:
(a) ensure that any materials you publish accord with the standards outlined in this statement and other Council statements as well
as current New Zealand legislative standards.18
(b) disclose to your patient any financial or commercial interests you may have in the CAM clinic, therapy or device.

 

 

Related statements


Good medical practice
Good prescribing practice
You and your doctor
Information, choice of treatment and informed
consent
Doctors and health related commercial organisations
Statement on advertising
Maintenance and retention of patient records
New Zealand Medical Association’s Code of ethics for
the New Zealand medical profession
The New Zealand Code of Health and Disability
Services Consumers’ Rights
The Health Information Privacy Code 1994

 


November 2017
This statement is scheduled for review by November 2022. Legislative changes may make this statement
obsolete before this review date. The contents of this statement supersede any inconsistencies in earlier
versions of the statement.

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