Assessing the Quality of Alternative Practicioners

Despite the uncertainties, if you’re willing to do your homework it’s possible to make smart choices. Here are ten questions to ask to help you assess the quality of alternative practitioners:

1. Do They Have Good Credentials? This is something you can often learn simply by making a phone call before your first visit. Ask about professional degrees, training, certification, licensure, membership in professional organizations and affiliation with reputable clinics and hospitals. Naturopaths, for example, are licensed to practice in Washington and Oregon but not in many others states. But some practitioners in states in which naturopathy is not recognized, get licensed in states that allow it just to prove their qualifications. For fields that aren’t yet licensed, such as Tibetan medicine, look for healers who have served long apprenticeships with qualified practitioners.
   One thing to keep in mind about credentials: Due to the boom in alternative medicine, many conventional physicians are entering the field hoping to cash in. Just because someone has an M.D. does not mean they’re well prepared to practice alternative medicine. A doctor who takes a few weekend courses in acupuncture or who reads a bit on herbs won’t posses the sophisticated understanding of someone who has spent years in the field. On the other hand, physicians do go through rigorous training. Those who do take the time to really learn about alternative practices may posess a unique ability to integrate therapies from both realms.
2. Are They Experienced? In addition to inquiring about credentials, ask how much experience a practitioner has both in general and specifically with people with problems like yours. For most areas of alternative medicine, the more years healers have under their belt, the more they’ll have seen and the better they’ll practice. For practitioners who employ therapies from multiple disciplines, as when an osteopath incorporates herbs and homeopathy into her practice, be sure to ask about experience in each realm.
3. Are They Insured? Everyone from yoga teachers, to massage therapists to acupuncturists should carry insurance in the rare event that the treatment causes harm. Ask if yours does and what the coverage limits are. It’s recommend that massage therapists, for example, carry coverage of $2 million for each incident and $6 million cumulatively--levels similar to those of many medical malpractice policies.
4. Are They Open To Other Healing Systems, Both Conventional And Alternative? If there’s anything that we can learn from the boom in alternative medicine, it’s that no one system has a lock on understanding of health or disease. Be wary of anyone who categorically dismisses other approaches. Be as skeptical of an alternative practitioner who ridicules all of conventional medicine as you would be of a standard doctor who disparages all of alternative medicine. Look for healers who are a combination of open-minded and skeptical. They should be willing to try any approach which seems reasonable and safe but not automatically favor every treatment or diagnostic test just because it’s labeled as alternative. Good alternative healers should also be willing to coordinate their services with conventional medical care for those patients who choose an integrative approach.
5. Do They Know When To Refer To Conventional Physicians For Testing Or Treatment? For all its shortcomings, there are some things, such as the care of accident victims or treating life-threatening infections that conventional medicine does extremely well. Similarly, people who develop unexplained weight loss or such worrisome neurologic symptoms as loss of sensation or weakness in part of their body should be evaluated using conventional diagnostic tests. “Look for practitioners who realize that their approach is wrong in some circumstances,” says David Reilly, a physician from Scotland’s Glasgow Homoeopathic [note: this is the British spelling] Hospital. “Sometimes what the patient needs is a surgeon.”
6. Are They Truly Holistic? One of the great strengths of alternative medicine is the holistic approach. But is a chiropractor who shuttles between four different exam rooms, insists on regular X-rays and spends only a few minutes with each patient really holistic even if he is open to alternative healing modalities? “The relationship is a huge piece of what’s therapeutic,” says Janet Quinn, R.N., Ph.D., an associate professor at the University of Colorado School of Nursing. Expect a visit that doesn’t feel rushed, in which the practitioner tries to get to know you as a person. “Trust your intuition here,” Quinn says. “If you feel like you’re being talked down to or coerced, you probably are.”
7. Do They Make You An Active Participant in Your Own Care? Alternative health care is, in the words of the New York based Tibetan medical doctor Eliot Tokar, “not a passive consumer activity.” The idea is not to go to your alternative doctor and leave with nothing more than a prescription for an alternative version of the proverbial magic bullet. “The goal of natural medicine is education,” Tokar says, primarily about behavior, lifestyle and dietary factors. “You should be looking for an alternative practitioner who gives you work to do in addition to whatever therapies they employ.”
8. Do They Oversell the Program? While herbs are much less likely to cause side effects than standard drug therapy, Suzanne Gordon’s alternative healers weren’t realistic about the potential for side effects from the remedies they prescribed. Watch out for people who oversell effectiveness, promising cures for everything, while minimizing the risks. Some approaches like homeopathy and acupuncture (assuming sterile disposable needles are used) are unlikely to cause serious side effects but other including herbs or more invasive techniques such as enemas or intravenous infusions can indeed cause problems.
9. Are They Willing To Discuss The Quality Of The Evidence? Is there support from scientific studies for the approach or does the practitioner only offer testimonials? Due to the lack of governmental support in the past, we can’t expect researchers to have documented the effectiveness of every alternative approach. Systems that have been around for hundreds if not thousands of years, such as acupuncture or ayurvedic medicine, and which appear to be safe, seem reasonable to try even if scientific proof for many of the treatments is lacking. The newer the approach and the higher the risk of side effects, the more you should look for evidence supporting the treatment. Practitioners should be willing to honestly assess how good the evidence is and tell you why they think it works and why they think it’s safe.
10. Do They Say The 3 Magic Words, “I Don’t Know?” Arrogance is one of the most dangerous characteristics for any health care professional. Of course, we want healers who give us hope and who believe they can help us but anyone who pretends to have all the answers may be dangerous. “Both patients and healers need to get more comfortable with ambiguity,” says Janet Quinn. “Our work is growing our consciousness so we can accept that we can’t know what’s going to happen.”

Part of what makes an alternative practitioner right for you depends on your level of medical sophistication and how much responsibility for you health care you’re willing to take on. The more you know about alternative therapies and about your health in general, the better you’ll be able to assess the knowledge and sophistication of your healers. If you’re less comfortable running the show yourself and don’t have the expertise to make sure your alternative practitioner isn’t missing something important, your best option may be to get second opinions from both other alternative healers and from conventional physicians. The reality is that in this transitional phase very few practitioners have a sophisticated understanding of both conventional and alternative medicine.

In recounting her story, Suzanne Gordon, looks back with some irritation at the practitioners who’d recommended natural approaches but never mentioned any possible down side. “Anyone prescribing these remedies has got to realize,” she says, “ that if they’re powerful enough to help you, they’re probably also powerful enough to cause harm.”

And since the same could be said of most alternative healers, it pays to choose yours carefully.

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