Relationships among older patients, CAM practitioners, and physicians: the advantages of qualitative inquiry

Older patients are increasingly likely to be under the simultaneous care of both physicians and alternative practitioners, often for treatment of the same condition. In the majority of cases, however, alternative care is not integrated with biomedical care; indeed, most patients do not inform their physicians of their concurrent use of complementary and alternative medicine (CAM). Because of the increased use of CAM in recent years, this is a critical juncture at which to study healthcare relationships in which the patient is treated by practitioners from different medical systems who are usually not in contact with and often not aware of one another. The purpose of this paper is to (a) review the limited literature that addresses healthcare relationships among patients, physicians, and alternative practitioners; (b) suggest that understanding all 3 sides of the patient-physician CAM practitioner triangle creates a more comprehensive and realistic view of current healthcare practices; and (c) propose that qualitative research methodologies can provide unique and essential understandings of these emerging healthcare relationship configurations. An ongoing qualitative research study of older women with breast cancer and their interactions with their physicians and alternative practitioners is described as an example.