Complementary and Alternative Medicine Practitioners' Standard of Care: Responsibilities to Patients and Parents

Abstract

In this article we explain (1) the standard of care that health care providers must meet and (2) how these principles apply to complementary and alternative medicine practitioners. The scenario describes a 14-year-old boy who is experiencing back pain and whose chiropractor performed spinal manipulation but did not recognize or take steps to rule out serious underlying disease—in this case, testicular cancer—either initially or when the patient's condition continued to deteriorate despite treatment. We use chiropractic care for a patient with a sore back as an example, because back pain is such a common problem and chiropracty is a common treatment chosen by both adult and pediatric patients. The scenario illustrates the responsibilities that complementary and alternative medicine practitioners owe patients/parents, the potential for liability when deficient care harms patients, and the importance of ample formal pediatric training for practitioners who treat pediatric patients.

A Literature Review of Pediatric Spinal Manipulation and Chiropractic Manipulative Therapy: Evaluation of Consistent Use of Safety Terminology

“…12,13 After screening, 9 relevant articles were considered: 2 systematic reviews, 1,15 a recent literature review, 7 2 retrospective studies, 8,10 1 survey, 9 and 3 case studies. [16][17][18] Two case studies reported on the delayed diagnosis of children presenting to chiropractors 16,17 with one not specifying whether spinal manipulation did occur 17 ; the third case study reported a serious adverse reaction/event after spinal manipulation. 18 Three articles reported a methodology for classifying safety incidents.…”

Concluding Comments: Maximizing Good Patient Care and Minimizing Potential Liability When Considering Complementary and Alternative Medicine

“…2 We have suggested several concrete strategies for encouraging and optimizing open communication in other articles of this supplemental issue of Pediatrics. [3][4][5][6][7] …”

“…All health care providers, whether conventional or CAM, must be able to recognize limits to their own abilities and those of their profession and to refer appropriately. 7,17 …”

“…Patients, parents, and health care providers should understand (1) health care providers' individual roles and responsibilities, (2) decision-making processes, (3) policies about care provision, and (4) the care to be provided, all documented by appropriate record-keeping. 7,17,19 …”

“…5,6,17 Continuing education (eg, through educational programs, journal clubs, self-study) is important for ensuring that conventional and CAM practitioners learn about new developments and reported adverse events. 5,7 Educational programs tailored to the needs of different types of CAM and conventional practitioners should be developed through relevant educational institutions, regulatory bodies, or professional associations (eg, about routine childhood immunization). 3,17 Hospitals and health facilities should develop resources and policies that provide accurate and timely information to physicians and other health care providers about CAM therapies and products, as well as potential interactions with conventional treatment.…”