Background: To assess physicians' attitudes regarding the legitimacy of complementary and alternative medicine (CAM) in medical practice, as well as factors that affect referral or prescription of a complementary therapy.Methods: Questionnaires were mailed to 380 physicians on staff at a local hospital in a mid-sized southeastern city in the United States; 138 were completed, for a 38% response rate.Results: Physicians in practice for less than 10 years were significantly more likely to accept most CAM therapies as legitimate than those in practice greater than 10 years. Nearly two-thirds of the physicians surveyed (65%, n = 88) had prescribed or referred for at least one complementary therapy. More than one-third of the physicians (34.8%, n = 48) had personally utilized at least one of these therapies, and personal experience resulted in a higher level of acceptance of CAM as legitimate medical therapy.Conclusions: It is likely that more positive attitudes regarding complementary therapies among more recently trained physicians is related to increased exposure during training and an increased awareness within the medical community of patient utilization of CAM. Despite a relatively positive attitude toward some CAM therapies, patients continue to use alternative medicine without notifying their primary care physicians. Unsupervised use of these therapies is potentially harmful and reflects a deficiency in the doctor-patient relationship. Open communication between physicians and their patients will continue to be hindered until physicians become knowledgeable in this area.

This was a study of physicians' narratives regarding their medical experiences with children with persistent medically unexplained physical illness. The goal was to better understand those attitudes and beliefs that are involved in the construction of meaning regarding the child's symptoms of illness or pain. The study also sought to learn more about physicians' early life experiences with health and illness and their potential to shape diagnostic thinking and treatment. Ten physician participants were interviewed using an open-ended, semistructured interview methodology. Interviews were analyzed using an alternative narrative approach described by Mishler (1986, 1991) to identify key themes within and across interviews for comparative analysis. The subjective experience and dynamic discourse between interviewer and participant were also analyzed (Mishler, 1991; Paget, 1983). Four key themes emerged: (1) the experience of certainty and uncertainty; (2) physician search for restitution; (3) the path to truth and the construction of the physician's illness narrative; and (4) the parallel anxiety between physician and parent. Findings suggested a "stages of training" model or developmental career theme associated with the ways in which physicians make meaning of persistent medically unexplained illness or pain in the child. Implications for diagnosis and treatment include the possibility that the nature of the relationship between physicians and parents-- particularly the ability to negotiate trust, intimacy, and power--may lead to a hidden and collaborative meaning making of symptoms that occurs in exclusion, of the child, Certain early life experiences of the physician may also be brought to bear in the medical encounter with parent and child. Physicians would benefit from training in neutrality and negotiation of therapeutic goals with parents of sick children, as well as training to enhance self-awareness and understanding of the ways in which alliances and conflicts with patients and parents may occur as a result of family of origin issues.