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Excerpts of proceedings from The Southeast Permanente Medical Group's Spring CME Program held May 2002 in Georgia--edited transcript

Lee Jacobs, MD Moderator

Symposium on Complementary and Alternative Medicine: In the Era of Evidence-Based Medicine, What's a Physician to Do?

Introduction

Dr Jacobs: I want to welcome you all to this landmark morning for our [The Southeast Permanente] Medical Group. This session is noteworthy because this is the first time The Southeast Permanente Medical Group (TSPMG) has made a concerted effort to understand Complementary and Alternative Medicine (CAM) so that a dialogue can begin among the members of our organization. Just what does CAM include? How do we relate to our patients about complementary medicine? How do we integrate CAM into our practices and maintain an evidenced-based focus? These are the questions that this symposium will address.

First, I would like to emphasize that I really do want us to have a dialogue on this subject. Although many of us have strong opinions on the subject, I would ask that, today and in the future, we keep an open mind; listen to others so that we have all the facts to formulate opinions; and, finally, be ready to change our approach when evidence suggests a new direction.

Why is this Discussion Important to Physicians?

Although there are many reasons why we might benefit from understanding CAM, in my mind, two reasons stand above the others.

First, we want to maintain an open communication channel with our patients. We want them to be very comfortable in telling us what medications they are taking, because what they are taking or doing may have real clinical ramifications. However, we must be open and listen without prejudice; otherwise, they won't tell us! If patients don't feel comfortable, they won't tell us what they are taking and why, in turn, they might not be taking what we prescribed.

Second, we may not be offering patients all potentially beneficial therapeutic options. Both a fully informed physician and a fully informed patient are certainly essential if shared decision making is to exist.

Introducing Panel Experts

First, I would like to introduce Paul Wallace, MD, Executive Director of Kaiser Permanente's Care Management Institute (CMI), located in Oakland, California. Dr Wallace and CMI are doing absolutely cutting-edge work in evidence-based medicine and in promoting shared decision making. I continue to be impressed with the quality of their work, which I believe is now starting to be acknowledged in the medical community throughout the country. Dr Wallace will help us discuss CAM in the framework of evidence-based medicine.

Next, I would like to introduce Tieraona Low Dog, MD--a nationally renowned expert in the field and no stranger to Kaiser Permanente, as she is frequently invited to lecture on CAM. Dr Low Dog is from New Mexico and has been appointed to the White House Commission on Complementary and Alternative Medicine Policy.

Named by Time magazine as an Innovator of Alternative Medicine in 2001, she has spent the past 20 years working to integrate the use of botanical medicines into the current health care system. So we're thrilled to have Dr Low Dog here this morning to help our dialogue. I think that her national perspective and her understanding of the quality and uses of CAM will be extremely helpful.

Next, I want to welcome and introduce Lee Ballance, MD, a Permanente physician from the Kaiser Permanente Vallejo Medical Center in Northern California and Chief of Alternative Medicine at that facility. Yes, you heard me right: Imagine a medical group taking this subject seriously enough to have a department dedicated to it! We are all eager to hear about how CAM has been integrated into the physicians' practices in The Permanente Medical Group in Northern California.

Finally, moving from Northern California to the Northwest, I would like to introduce Charles Elder, MD, a physician from the Department of Internal Medicine in the Northwest Permanente Medical Group, where he is Director of Quality Assurance at Kaiser Permanente Sunnyside Medical Center. Dr Elder is a clinical investigator at Kaiser Permanente Center for Health Research, where he does research in mind-body techniques.

So, that is our panel of experts. Let's get started. I will ask the panel members to present some opening comments, and then the panel will entertain questions from the audience.

Let's start with Dr Wallace. To more Symposium >>

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