Question 1 - November 2014
The percentage of patients who do not disclose their supplement usage to health care professionals could be as high as 60%. Does this concern you? Is there anything we can do to encourage our clients and patients to be more forthcoming with information about their supplement usage?
posted by Brady Jiter @ 9:11 AM
14 comments
14 Comments:
It is a problem that so many people aren't honest about their supplement use. There could be so many different interactions and some can be deadly. I think that as a Dietitian, we should explain to our clients the negatives of not being completely honest and forthcoming with the medications and supplements they're taking. We can also interject that food and medications can have interactions too and if they're taking more than 1 medication/supplement then they're at an even higher risk for problems. The more honest they can be, the more accurate and beneficial our education to them will be.
Yes, this concerns me since the prevalence of supplement use has risen. If they aren't being honest about supplement use they probably are not being honest about other health issues either. I think we have to build rapport with our patients by letting them know we need to know this information to help them, not to lecture or judge. Supplements not only have an impact on medication interactions but also lab values which can impact a diagnosis or diet. Being aware of new supplements known to cause medication interactions will be important education we will have to keep up with.
60% is a pretty concerning number, especially when you think about the number of medications being prescribed in our country. I wonder what the reason for not disclosing this may be, but whatever it is, we need to let our clients know that when they talk to us they can feel safe and trusting. Building rapport with clients before we begin asking questions may be helpful, if we have the time to do so. Also, it may help to have samples of some supplements during the counseling session to help jog their memory.
I also agree with Tina. Letting them know the reason behind why we are asking about supplements may help them to be more honest and forthcoming with their answers. Our clients should feel that we have their best interest at heart, and letting them know that we are concerned about interactions between supplements may make them feel that we really care about them.
I like the idea of making some sort of statement that taking more than 1 med/supplement puts you at risk for interaction. That might help draw out some more information. And definitely agree that building rapport with patients is key, for so many reasons. That will help them open up to us.
That is pretty concerning and it makes me wonder what their reasons may be for not disclosing that information. It may be because they feel that supplements must be safe since you can buy them anywhere and aren’t aware of the possible interactions and so they feel like this information doesn’t need to be shared. I can’t imagine they withhold that kind of information because they’re ashamed or anything like that. They may just need to be educated on possible interactions between medications and supplements. I agree that building rapport from the beginning is what’s important so that they feel comfortable telling us things. Like Haley mentioned, nobody wants to feel judged or lectured!
In my opinion, this is quite concerning as we don't want out patients to withhold information that could potentially influence our recommendations or the plan of care. To encourage our patients to be more forthcoming, I agree with what many have already said. Developing rapport and comfortability is just so very important and if we don't have that level of comfort, how could we expect the client to want to tell us in the ins and outs of their daily lives? I really like what Haley said about patients not wanting to be judged or lectured. That is so true. Sometimes I feel as though RDs may get a bad rap because clients assume that it's our job to tell them what NOT to do, as opposed to making recommendations for what they could do to better their overall health through diet. If we develop this rapport and comfortability, maybe they'll have a better understanding that we really are there to help and not to judge or to make a fool out of them and their habits.
We need to promise our clients that what happens in our discussion, stays in the room (I don't mean in terms of things like mandated reporting for abuse and things like that) and that we won't go around and gossip about their habits or even their ignorance about things like supplements and the possible dangers. If we are honest, and provide them with that comfortability, hopefully they'll be more honest and open to us.
Haley, I like how you point out that it's very important for us to stay aware of new supplements to enter the market. What really makes things difficult is that supplement manufacturers aren't required to provide the amounts of the ingredients in their product. They can claim it's a "proprietary blend" and don't want other supplement companies to rip off their product or it's exact chemical formulation. So we may know the ingredients (or the ingredients that are supposed to be in there...) but not the amounts. In my mind, the amount makes some difference. If it's a very small amount of an ingredient, well then maybe that won't make much of an impact. But if it's a large amount, it could be dangerous.
Take caffeine for example. At 25mg/serving, that's probably tolerated by some who are sensitive to caffeine or have medications that shouldn't be taken with caffeine. However, what if the product had 500mg/caffeine per serving and the user had no idea? Huge potential problem. Once again, regulation comes into play. For public safety, should manufacturers have to put all of this information on the label? That's the golden question.
Tina, I like your idea regarding using the 1 medication/supplement rule. That's a good baseline and may be good enough to kickstart a conversation about dietary supplements and their (potential) interactions with medications. Everyone has such great ideas. I'm really happy I'm doing research on supplementation. I think it's a topic that more RDs need to be aware of, no matter where they work. It'd also be a great subject for continuing education hours in our future careers.
Sammy, I do think there are probably some people who don’t report it because they think it’s safe not a big deal. But I think there might be a lot of people who aren’t interested in having their doctor judge them for what they are taking. Or they don’t want the doctor to tell them they shouldn’t be taking it because they don’t want to be told they should stop – and then reminded at future visits. I know I’ve avoided telling my doctors when I was supplementing with creatine because there are some nurses and doctors out there who still think it is dangerous, despite the research to the contrary. I’m sure there are others like me who just want to go about their business without the doctor interfering. (Not saying that’s good – just saying.)
Arthur, I think it depends on where we are when it comes to promising that “something stays in the room” if they tell us. If we are in a clinical setting and we find a significant interaction after they've shared info with us, we should probably be noting that and making sure doctors and nurses know. Those might be the very people they don't want to know about it.
Yes, this concerns me. Supplements have recently grown in popularity, and new and strange supplements are always emerging. Supplements impact nutrition status so patients should especially disclose this information to RDs. Supplements can also interact with prescription medications, so it is important that patients make their doctors aware of any supplement usage. To encourage clients and patients to be more forthcoming about their supplement usage, I would just let the patient know that RDs are there to help them. RDs are not the food or supplement police, and our job is not to judge people, but to give them advice and recommendations to improve their health. If someone discloses their supplement usage, then they could be warned about any potential harmful affects and could hopefully prevent any from occurring. If we make patients aware that being truthful about their supplement usage can better allow medical professionals to help them, then this may make patients more likely to disclose their usage.
Susan,
I like your idea of having samples of supplements during counseling sessions to help clients remember anything they consume. Since there are so many new and different types of supplements on the market now, having samples could be very helpful for clients to recognize any products they use. This would also be helpful since some supplements have strange names (black cohosh and dong quay?!) that can be difficult to remember. Even just having a list of supplements and asking the client if they use anything on the list could make them more likely to disclose their supplement usage.
I would be interested to find out what percentage of individuals who take supplements have drug/supplement interactions and how concerning the signs and symptoms of this are. It is concerning though. I think I would tell people what I consider to be a supplement. After they answer "do you take a supplement" with "no".. maybe making a further statement such as did you know a supplement includes tums and a multivitamin and seeing if they change their answer. You could also tell them the reason you are asking, I think this encourages more honesty and total understanding of the big picture.
I agree, building that rapport is key. Maybe if they don't tell us in the first session they will trust us by the second or third and tell us. I think its also important to remember that people probably aren't hiding these things from physicians/RD's on purpose. They probably just don't realize what a supplement is or feel like its not important.
Yes, it is very concerning. I like Susan's idea of having samples, and Caroline's idea of having a list. I think as Jessica said, we need to make sure the patient understands all of the items that can be included in the supplement category. Patients don't always realize what they are taking is considered a supplement and could potentially interact with other medications or supplements they may be taking. I also think they may be so anxious about being asked a lot of questions, they may not think of everything they are taking. In addition, some of the responsibility may fall on person asking the question. At my most recent visit, they asked me about the prescription medications I take, but did not ask if I was taking any other vitamins, minerals, supplements, or over the counter drugs.
I believe it's important to not make the client feel judged like Haley said. I also like people mentioning having samples in the office just to spark people's memory or disucssion of what they're taking. Jeanne has a point that we can't just assume the client knows what they're doing is wrong so we can't be quick to reprimand them. We just have to investigate and discuss their interactions.
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