Practising Outside of Established Conventional Medicine

Note: a glossary of terms can be found at the end of this document. Glossary terms are indicated in teal with a “^G” throughout this document.

1. Practising outside of established conventional medicine includes practices that are not included in widely accepted clinical practice guidelines and can include complementary and alternative medicine and emerging therapies.
2. For the purposes of this standard, the following definitions apply:
   1. “Conventional medicine” refers to the type of treatment, diagnostic analysis and conceptualization of disease or ailment that is considered “mainstream” medicine. This type of medicine is generally provided in hospitals and specialty or primary care practices. It is sometimes also referred to as “evidence^G-based.”
   2. “Complementary and alternative medicine” (hereafter referred to as “CAM”) refers to healthcare approaches developed outside of mainstream or conventional medicine that are used for specific conditions or overall well-being[1].
      1. “Complementary” refers to a non-conventional practice used in conjunction with mainstream conventional medicine.
      2. “Alternative” refers to a non-conventional complementary therapy used in the absence of mainstream conventional medicine.
      3. Off-label use^G of Schedule 1 or Schedule 2 drugs is not considered CAM.
   3. “Emerging therapies” refers to therapies developed within mainstream medicine with support from clinical research but currently lacking in rigorous, peer-reviewed evidence to support their use.
3. A regulated member who offers a therapy that is outside of conventional medicine to a patient must:
   1. practise in a manner that is informed by current best-available medical evidence and upholds their professional, ethical and legal obligations;
   2. always act within the scope of their practice based on their qualifications, skill, knowledge and level of competence; and
   3. respect the autonomy of the patient in making decisions about their health care, including choosing a therapy that is outside of conventional medicine instead of, or in addition to, conventional medicine.
4. All patient assessments and diagnoses must be consistent with the standards of conventional medicine and be informed by current best-available evidence. A regulated member must:
   1. offer a conventional medical approach before offering any therapy outside of conventional medicine;
   2. conduct a clinical assessment of the patient that includes taking an appropriate patient history and performing/ordering any necessary diagnostic tests, investigations or procedures that are required to establish a conventional diagnosis;
   3. offer therapeutic options that are informed by current best-available evidence prior to offering therapies outside of established conventional medicine; and
   4. counsel the patient, to the best of their ability and knowledge, about the risks and benefits of any diagnostic testing/investigation or therapeutic procedure so the patient can give informed consent^G.
5. A regulated member must document the details of the consent process, including rationale for providing therapy outside of conventional medicine as explained to the patient, in the patient’s record.
6. A regulated member is not obligated to make a referral that, in their opinion, is unlikely to provide a clinical benefit.
7. A regulated member conducting clinical research into the use of a therapy outside of conventional medicine must comply with the Human Health Research standard of practice.
8. A regulated member must not:
   1. delay the use of conventional therapy, or replace its use with therapy outside of conventional medicine, except at the direction of the patient;
   2. exploit the emotions, vulnerability or finances of a patient for personal gain; or
   3. recommend therapeutic options that have been proven to be ineffective through rigorous, peer-reviewed evidence.

Glossary

Evidence: rigorous, peer-reviewed clinical research that supports a claim and/or service.

Off-label use: refers to any use of a medication beyond what Health Canada has reviewed and authorized to be marketed in Canada and as indicated on the product label. (From Canadian Agency for Drugs and Technology in Health)

Informed consent: permission for something to happen or agreement to do something; a regulated member must obtain a patient’s consent in accordance with the Informed Consent standard of practice. For more information, please refer to the Informed Consent for Adults and Informed Consent for Minors Advice to the Profession documents.