Referrals and Coordination With Primary Care and Specialists

Why coordination matters

Different clinicians may not know what the others have recommended. That matters because some complementary approaches can have an effect on conventional medicine, as NCCIH puts it. [3] In cancer care, a systematic review of 21 studies found 20% to 77% of patients using complementary medicine did not tell their doctors, most often because the doctor did not ask, or the patient expected disapproval or thought it irrelevant. [4] A 2023 review of 30 articles (8,721 participants) found nondisclosure common and warned that the lack of dialogue raises the risk of adverse interactions with conventional cancer treatments. [5] Those reviews focused on cancer, and many included studies were small and from one center or region, so findings may not apply to every setting. [5]

What to share, and with whom

NCCIH's advice for patients:

• List every complementary practice you use on your patient history form. [3]
• Tell your providers at each visit, including over-the-counter medicines, prescriptions, and dietary and herbal supplements. [3]
• Do not wait to be asked. [3]
• Tell all your providers about the complementary approaches you use and about all practitioners treating you. [6]

For before-surgery and multi-medicine concerns, see integrative care with multiple medicines or before surgery and supplement and herb interactions.

How referrals can work in each direction

• From your doctor to a practitioner. NCCIH suggests first asking your doctor or other health care provider for names of practitioners in your area; a nearby hospital or medical school, professional organizations, state regulatory agencies or licensing boards may also help. [6] We do not list or recommend practitioners.
• From a practitioner to conventional care. NCCIH says naturopathic practitioners may, if appropriate, refer patients to conventional health care providers. [7] Ask early how a practitioner decides when to refer, and what they do if tests or symptoms need urgent attention.
• Between clinicians. NCCIH advises finding out whether the practitioner is willing to work together with your conventional health care providers. [6] Ask whether they will share notes or test results if you give permission.

What scope and title differences mean for coordination

Titles and licensing differ by place. NCCIH says licensed naturopathic doctors can diagnose, which may include history, exams, lab tests and imaging, while traditional naturopaths are not eligible for licensing. [7] The scope of practice varies by state. [7] In the US there is no standardized national system for credentialing complementary health practitioners. [8] In England, the NHS says other complementary therapists and herbal medicine practitioners do not need to be registered by law, and suggests choosing one registered with a professional organization accredited by the Professional Standards Authority. [2] A license or certificate is not a guarantee of being qualified. [8] Details by place are in how to verify a credential and scope of practice.

Cost and insurance

NCCIH advises not assuming that insurance covers a practitioner's services; contact your insurer and ask. [6] Ask whether tests ordered by a practitioner will be reviewed by your doctor, and who pays for repeat testing. See costs, packages and supplement sales.