A 33-year-old man comes to the office for a routine health maintenance visit. The patient states he wants to make sure he is taking care of his health after his father had a myocardial infarction a few months ago at the age of 61. He has been eating healthy and exercising 3 to 4 times a week. Past medical history is noncontributory, and the patient takes no medications. He shares that his aunt is an herbalist and recently gave him a supplement that is supposed to help prevent cardiovascular disease. The patient asks whether it is okay to start taking the supplement and provides a list of the ingredients, which includes herbs unfamiliar to the physician. Which of the following is the most appropriate response?

Question

A 33-year-old man comes to the office for a routine health maintenance visit.  The patient states he wants to make sure he is taking care of his health after his father had a myocardial infarction a few months ago at the age of 61.  He has been eating healthy and exercising 3 to 4 times a week.  Past medical history is noncontributory, and the patient takes no medications.  He shares that his aunt is an herbalist and recently gave him a supplement that is supposed to help prevent cardiovascular disease.  The patient asks whether it is okay to start taking the supplement and provides a list of the ingredients, which includes herbs unfamiliar to the physician.  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

This patient is concerned about cardiovascular health and is making a direct inquiry to the physician regarding alternative therapies with which the physician is unfamiliar. Such therapies are often safe and occasionally beneficial. However, nonstandard pharmaceutical products are relatively unregulated and often poorly studied and may carry risks due to the labeled agent or possible adulterants. When discussing complementary and alternative medical interventions, the physician should be honest, helpful, and nonjudgmental. The primary emphasis should be on developing a trusting physician-patient relationship conducive to sharing reliable, evidence-based information. If unfamiliar with the product in question, the physician should offer to obtain more information and follow up with the patient. Alternately, the physician may direct the patient to reliable information sources (eg, National Center for Complementary and Integrative Health), where the patient can obtain information directly. (Choices A and C) Discouraging a patient from using a therapy recommended by a family member without first learning the facts about the product may be seen as dismissive or insulting by the patient. The physician should understand the therapy in reasonable detail before giving guidance. (Choice D) Although many herbal supplements are benign, the physician should not assume safety without first obtaining reliable information about the product. A number of herbal agents (eg, ephedra, ma-huang) cause potentially severe cardiovascular toxicity. (Choice E) This response honestly presents the physician's lack of knowledge but avoids the patient's direct question and misses an opportunity to improve the patient's health and the physician-patient relationship. Educational objective: When discussing complementary and alternative medical interventions, the physician should be honest, helpful, and nonjudgmental, developing a trusting physician-patient relationship conducive to sharing evidence-based information. Physicians should obtain more information on unfamiliar products and follow up with the patient or direct the patient to reliable information sources. __________ References: Factors related to disclosure and nondisclosure of dietary supplements in primary care, integrative medicine, and naturopathic medicine. (http://www.ncbi.nlm.nih.gov/pubmed/32051918)

A 33-Year-Old Man Comes to the Office for a Routine