Clinical integration of complementary and alternative medical (CAM) therapies, such
as acupuncture and traditional oriental medicine, chiropractic, herbal medicine, massage
therapy, and “mind-body” therapies, into conventional health care raises important
legal and risk management issues. Understanding which CAM therapies patients use is
legally prudent, as conventional treatment advice may interact with patients’ own
efforts toward self-care. In addition, nephrologists may limit potential liability
for medical malpractice by classifying any given therapy as follows: (1) the medical
evidence supports both safety and efficacy—recommend; (2) the medical evidence supports
safety, but evidence regarding efficacy is inconclusive—accept but monitor; (3) the
medical evidence supports efficacy, but evidence regarding safety is inconclusive—accept
but monitor; and (4) the medical evidence indicates either serious risk or inefficacy—avoid
and discourage. Applying this framework whether a therapy is labeled “conventional”
or “CAM” is consistent with the key recommendation of the recent report by the Institute
of Medicine at the National Academy of Sciences on Complementary and Alternative Medicine,
namely, to apply the same principles and standards of evidence of treatment effectiveness
to all treatments. Liability risk management also includes going beyond legal and
ethical informed consent requirements by engaging the patient in shared decision making
concerning all material treatment options, including CAM therapies, if supported by
evidence. Physicians further should familiarize themselves with documentation standards
suggested by the Federation of State Medical Board Guidelines and whether these are
applicable in their state or home institution. These steps aim to enable nephrologists
to respond to patient interest in CAM therapies in a way that is clinically responsible,
ethically appropriate, and legally defensible.
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Article Info
Footnotes
Supported by grants from the Greenwall Foundation and the Rudolph Steiner Foundation.
Identification
Copyright
© 2005 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
