Keywords: Complementary and Alternative Medicine, Doctor-Patient Communication, Primary Care, Non-disclosure, Patient Safety.

Background:

The use of Complementary and Alternative Medicine (CAM) is prevalent globally, yet non-disclosure to General Practitioners (GPs) remains a significant safety concern regarding drug-herb interactions. While general prevalence is documented, the psychosocial drivers and systemic barriers leading patients to withhold this information in the primary care setting require further elucidation to improve clinical safety.

Research questions:

The primary objective of this study was to determine the prevalence of non-disclosure of CAM use among primary care patients and to identify the specific reasons and barriers preventing patients from informing their GPs.

Method:

Сonducted a cross-sectional study across 12 diverse urban and rural primary care practices. Adult patients (n=450) who reported using CAM in the past 12 months completed a structured questionnaire regarding disclosure habits. Logistic regression analysis was used to identify sociodemographic predictors of non-disclosure. Additionally, semi-structured interviews with a subset of patients (n=20) were analyzed using thematic analysis to explore underlying motivations, specifically focusing on the doctor-patient relationship and perceived relevance of CAM to conventional treatment.

Results:

Of the 450 CAM users, 48% (95% CI: 43.4–52.6%) did not disclose their use to their GP. The primary reasons cited for non-disclosure were the physician's failure to inquire (58%), the belief that CAM was irrelevant to their medical treatment (34%), and fear of a judgmental response (22%). Thematic analysis revealed a "don't ask, don't tell" culture. Younger age (OR 1.8, 95% CI: 1.2–2.6) and lower chronic disease burden (OR 2.1, 95% CI: 1.4–3.1) were significant independent predictors of non-disclosure.

Conclusions:

A significant proportion of patients withhold CAM information, largely due to a lack of proactive inquiry by GPs rather than active concealment. These findings suggest that GPs must initiate non-judgmental conversations about CAM to ensure patient safety. The results are robust given the mixed-methods design and applicable to general practice settings aiming to reduce adverse interaction risks.

Points for discussion:

How can GPs integrate CAM inquiries into routine history taking without significantly extending consultation time?

What educational interventions are required to reduce patient fear of judgment regarding alternative therapies?

The role of Electronic Health Records (EHR) in prompting physicians to ask about non-prescribed supplements.