Natural Medicine Clinic Publications

Collaboration: Your Medical Doctor and your Naturopathic Doctor Talking to Each Other

By Nancy Aagenes, ND

Maybe you want to see a naturopathic doctor first for all your medical needs. Maybe you have an established relationship with a medical doctor you trust and want to be your primary provider. In either case a day comes when you need the other kind of doctor. Even if you are my established ongoing patient, I don't want you to call me first if you are in a car accident. Conversely, if the drug controlling your blood pressure has troublesome side effects or stops working, it might be interesting to visit with a naturopathic doctor to find alternatives or ways of coping with the unwanted effects of the drug.

Any thoughtful person recognizes that the best medicine would involve a careful blending of all options. As a patient, you are left to ask these questions insistently. Ask your naturopathic doctor: How do you decide when I need conventional care? How will you help me get it? Ask your medical doctor: Are you comfortable talking with my naturopathic doctor? Will you communicate directly to her any serious concerns? I regard these as essential considerations in the relationship of doctor and patient.

Communication between your conventional and alternative providers is not always necessary. It becomes necessary when any one of the triad-you, the naturopathic physician or the medical doctor-needs additional information. Anytime you are confused by what two physicians are telling you it might be useful for them to discuss differences so that each can better explain to you.

A quick call to get a missing piece or clarification makes my advice to a patient more knowledgeable. Also, I do not expect that patients can reliably communicate something they don't fully understand. In very rare instances I will accompany a patient to visit another physician. I only do this by prearrangement and have found Helena physicians remarkably welcoming.

In Helena, we are small enough that creating collaboration is easier. Whether carpenter or doctor, in a town this size we behave with integrity in our work life, or are quickly found out. We know each other as doctors because we frequently have patients in common and are stumbling over each other daily. Establishing the relationship becomes practical and useful. Helena is just the right size to let our doctors be national leaders in integrating care that best serves our patients.

My consistent experience is that the moment direct communication occurs, your care is better. You must be willing to tell us what you are doing with the other and give us written permission to talk to each other by signing a records release. Then, if I never even talk to your medical doctor, but send her a note or request her records, you get more informed care. Coordinated treatment is more possible when your medical doctor consistently sends me her office notes.

When doctors are in conflict about a critical medical decision, unconditionally require that your doctors communicate with each other. Never let them play tug of war with you as the rope. They will not always agree, but it happens more often than you would imagine once the conversation begins.

Agreement between your doctors is not the goal. Doctors in the same specialty area have vociferous differences. It would be absurd to expect doctors operating from different philosophical and educational biases to agree. Many variables drop away when the conversation is focused on an individual patient. You have every right to expect that your personal circumstance will be intelligently and practically discussed in light of your own choices and values.

Ultimately medical decisions are yours. The best doctors do not use persuasion or fear to coerce a decision they favor. They have every obligation to fully inform your decision and to respectfully consider with you the consequences of your preferences. With the same diagnosis, two individuals may have different values and circumstances that lead to different choices. Good physicians resonate with their patient's uniqueness.

Here's an example. A patient comes with gallstones presenting in an emergent and painful way. My normal course is to immediately suggest referral for surgical consultation. Most patients are relieved and want that.

Early in my practice years two patients gave me the courage for alternatives. One was a man who flat out did not want surgery. The other was a woman on a very limited income with no insurance. She was willing to try something else, anything else, rather than incur the cost. For these two patients I developed a treatment plan that worked. In both cases they got out of pain quickly and we were able to use dietary and supplement plans that gradually dissolved the gallstones.

That's the rub. For the naturopathic protocol to work, consistent compliance is required for at least six months. Can you change your diet and consistently take pills for a six-month period? Are you willing to make that commitment? If not, do the surgery now. Don't wait until the condition becomes a greater surgical risk. If you chose naturopathic therapy, develop with both doctors an early warning plan so that surgery does not become an emergency.

I understand that it's tough for the conventional physician to support the patient's choice for naturopathic care in this situation. First, there is no reason that we can expect her to know what the naturopathic therapy is. Second, a gallstone untreated, moving into the common bile duct is a more complicated, painful and dangerous concern. We can't expect the medical doctor to have confidence in a therapy she has no experience with.

Ultimately though, a treatment choice is not the decision of either doctor. The patient must decide what risk they are willing to live with. I am critical of naturopathic doctors who discourage a patient's choice for surgery. I am critical of conventional doctors who use fear and ignorance of alternatives to manipulate a patient's choice.

The job here is for both physicians to fully inform the patient about the consequences of their decision and to communicate with each other any information that creates a threshold of safety for the patient. Years ago I had a patient who was also a long time friend opt for a chemo therapy that had only a seven percent chance of being useful. I was heartsick she was making that choice. I called a venerable naturopathic doctor most experienced in treating breast cancer. I asked him how to convince my patient not to do this. "Oh, Nancy," said Dr. Steve Austin, "your only job now is to shut up and support your patient's choice."

The best doctors encourage patients to seek all information and options-alternative and conventional. Even in situations when I expect a patient's medical doctor to disagree, I encourage the patient to get that advice, to learn everything they can from that doctor about the therapies that doctor knows best. I'm not as interested in a doctor's opinions about things they don't know. When a patient has no medical doctor, there are circumstances when I strongly encourage consultation with a conventional physician. None of us can give meaningful advice about things we haven't studied.