You are resident in an academic family medicine teaching unit. Ms. P is a 50 year old woman whom you receive as a new patient. She states she is “pretty healthy,” and joined the practice at her daughter’s insistence. She has no significant formal past medical history. She endorses a several year history of fatigue, but states that her homeopath, whom she sees monthly, has it “mostly under control” with a number of remedies. She provides you with a list of the preparations, but you do not recognize them, are not trained in researching the homeopathic literature, and cannot find any applicable primary biomedical research.
When you ask her what condition the tinctures are for, she says her homeopath has told her it relates to her fatigue and pain, but that he has never discussed the underlying cause. You explain that you respect her right to use complementary and alternative medicine, but that it is important that you understand what she is taking, and what the indications are. Accordingly, you obtain her permission to speak with her homeopath to clarify her existing treatments.
Her physical exam and review of systems are unremarkable. Nevertheless, because she has been taking unfamiliar medications for nonspecific symptoms and has not seen a physician for a long period of time, you order a complete blood count, serum creatinine...