When Modalities Collide: Navigating the Crossroads of Western Medicine and Herbal Therapies
In last week’s blog, I discussed high-tech, futuristic models. This week, I want to take us back to basics, because that’s where some of our patients are going.
As the cost of healthcare rises and the level of trust in the overall healthcare system declines, we naturally see some patients turn to alternative modalities to keep them healthy and to treat disease. This, combined with access to information and herbal products at the touch of a smartphone, presents a patient safety challenge to clinicians that can’t be ignored.
Consider these three healthcare encounters:
Encounter 1 – Several years ago, I underwent an urgent hysterectomy. I don’t tolerate narcotics well, so I knew pain management might be an issue during my first postoperative days.
However, I knew my body and I had a plan.
I told my surgeon I planned to drink about a quart of strong chamomile tea each day following my surgery to help with pain. I also told her I planned to start drinking a strong infusion of stinging nettles three days a week for several weeks beginning about a week after my surgery. I asked her if my plan would pose any issues. Her response, “I’m familiar with those plants and see no issues. I’d still like to give you a prescription for a non-narcotic pain reliever in case you need it.”
Encounter 2 – Two winters ago, I took my daughter for her well-child visit. The nurse practitioner asked if she took any medications. “No, but she does take elderberry syrup and astragalus tea about four to five times a week.” She responded, “I’m not familiar with those. Why do you have her take them?” I explained that I give them to her to help support a healthy immune system, and she said, “OK, I guess I will have to familiarize myself with those in case I have other patients who are doing the same.”
Encounter 3 – My husband was seeing a new primary care physician for a routine visit. He shared this with me afterwards: “When the doctor was reviewing my medication list, he inquired why I was taking hawthorn berry tincture. I told him I take it for my heart. He then asked who told me to take it. I told him, ‘My wife.’ He laughed and said I could stop taking it, because he never heard of such a thing.”
Three different providers, three different responses.
My surgeon in encounter 1 was familiar with herbal therapies and was very supportive. She had an underlying concern that my teas might not be enough to manage my pain, but she wasn’t judgmental. She addressed her concern by offering me the prescription anyway just in case I needed it.
I was cool with encounter 2. The nurse practitioner wasn’t familiar with elderberry or astragalus. She tried to educate herself in the moment by asking me about them. I believed her when she said she was going to familiarize herself more with them. Learning is a lifelong process, and sometimes that means expanding your knowledge outside your comfort zone.
Encounter 3 was problematic. First, if it were up to me, I would have found a new physician. More importantly, the physician creates a scenario where his patients may keep valuable information from him. Many patients in this situation would not stop taking the herbs without a reasonable explanation from the doctor (which he didn’t provide). However, they may withhold such information from him in the future.
He lost an opportunity to provide the safest care for his patient.
And worse, risked making care more dangerous.
In the same way that certain drugs can interact with each other, herbs and drugs can have interactions too. For example, even common herbs like chamomile and garlic can interact with blood thinners and hawthorn berry may interact with some cardiac medications. And some herbs are contraindicated in certain conditions—you may not want your patient to take something like elderberry or astragalus if they have an autoimmune disease.
How might healthcare providers keep patients who don’t solely subscribe to western medicine practices safe?
Ask questions. A patient who is taking herb X because it’s being marketed as the latest and greatest, versus a patient who has informally studied what they are taking, versus a patient who is also working with a formally trained clinical herbalist, are three very different situations. Also, ask where your patient gets their products. While herbal therapies are not regulated by the Food and Drug Administration (FDA) in the same way drugs are, there are regulations around the manufacturing of herbal products—particularly regarding identification and contamination.
Develop relationships. Get to know the clinical herbalists in your community. Where are your patients getting advice? While it’s true that anyone in the United States can call themselves an herbalist, a reputable one will want to work in conjunction with the patient’s healthcare team and educate themselves in their practice. They will never pretend to diagnose your client, they will never tell their client to stop taking prescribed medications, and they should be quick to recognize when a patient needs to see a medical provider and will encourage them to do so.
Work together to help your
their client receive the best care.
Educate yourself. After informally studying herbs for more than a decade, I recently enrolled in a two-year study program with a well-known clinical herbalist. I was pleasantly surprised to find my fellow students included registered nurses, midlevel practitioners, and physicians. While this level of intensity may not be for everyone, familiarizing yourself with common herbs will only benefit your patients who use them. Being able to distinguish between someone telling you they take ginger for nausea (a common use for ginger) or taking something to treat Lyme disease or cure cancer (there isn’t an adequate herbal treatment for either) is critical.
Alternative therapies aren’t going away, and for some, they serve as the cornerstone of their healthcare. When we see different modalities as mutually beneficial instead of mutually exclusive, the patient wins.
Here is a short list (in alphabetical order) of some of my most used resources:
Adaptogens: Herbs for Strength, Stamina, and Stress Relief by David Winston
Bartram’s Encyclopedia of Herbal Medicine by Thomas Bartram
Herbal Therapeutics: Specific Indications for Herbal and Herbal Formulas by David Winston
Rosemary Gladstar’s Medicinal Herbs: A Beginner’s Guide by Rosemary Gladstar