The medication list your doctor’s office hands you asks about prescriptions, over-the-counter drugs and supplements. It almost never asks whether someone puts needles in your back every Tuesday, adjusts your neck once a month, or works deep pressure into a leg that was radiated last spring.
Plenty of people never mention those things. In one well-studied group of breast cancer survivors, fewer than half of the women who saw a chiropractor told their physician about it. And the conversation they skipped isn’t the one people usually picture. A supplement’s risk is chemical: what the product does to a drug or an organ. A hands-on practice’s risk is mostly mechanical. It’s force on a bone that may be thinner than it looks, a needle in someone whose blood clots slowly, pressure on tissue weakened by treatment, or a trance-like state in someone with a psychiatric history.
So the useful question is what your body can safely take right now, and who knows the parts of your history that answer it. This article covers how often people mention practices and why they don’t, the specific safety questions as named bodies have stated them, the places where no guideline exists, who is supposed to start the conversation, and what hospitals that offer these services do differently. Supplements raise the chemical version of these questions, which the library treats in its piece on supplement disclosure.
How often people mention a practice, and why they don’t
Hard numbers on disclosing practices, as opposed to products, are scarce. The best practice-by-practice figures come from one narrow group.
Gordon Saxe and colleagues at the University of California San Diego surveyed women in the Women’s Healthy Eating and Living Study, a trial of diet after breast cancer. In interviews conducted in 2003 and 2004, 300 women who had seen an acupuncturist, chiropractor, homeopath or naturopath for cancer-related reasons reported whether they had told their physician. The results, published in Integrative Cancer Therapies in 2008, varied sharply by practice:
- Naturopathy: 85 percent told their physician
- Homeopathy: 74 percent
- Acupuncture: 71 percent
- Chiropractic: 47 percent
Two-thirds of the women disclosed every practice they used, and 28 percent disclosed none. The authors suggested a reason for the chiropractic gap. By their account, most of the women seeing a chiropractor also went for problems such as low back pain that had nothing to do with their cancer, and may simply have considered it irrelevant.
Hold those numbers loosely. These were highly educated women enrolled in a diet study, asked only about cancer-related use. The figures describe that group, not American patients at large. In reviewing earlier work, the same authors noted that published disclosure rates had ranged anywhere from 23 to 90 percent, depending on who was asked, how and about what. A single headline rate for this behavior doesn’t exist.
The best evidence on reasons is older and broader. In a national survey of 831 adults who used both conventional and complementary care in 1997, published in the Annals of Internal Medicine in 2001, a team led by Eisenberg at Beth Israel Deaconess Medical Center in Boston found that 63 to 72 percent had not told their medical doctor about at least one therapy. That survey mixed products and practices together. The reasons people gave are what still matter:
- It wasn’t important for the doctor to know: 61 percent
- The doctor never asked: 60 percent
- It was none of the doctor’s business: 31 percent
- The doctor wouldn’t understand: 20 percent
Only 14 percent expected disapproval, and 79 percent of the whole sample felt that combining the two kinds of care worked better than either alone. The authors read their data as showing that people worried less about a doctor’s disapproval than about a doctor’s inability to understand or fit the therapy into their care.
The two leading reasons are beliefs about relevance and about whose job it is to raise the subject. The chiropractic gap in the cancer study fits that pattern exactly.
The questions are about force, needles and timing
For a practice, what a clinician needs to know is physical: what is being done to your body, where, how hard and how often. What the practitioner needs from your medical side is just as physical: the state of your bones, your blood and your treatment.
Manipulation and the state of your bones and blood
The World Health Organization’s 2005 guidelines on basic training and safety in chiropractic sort the conditions that matter into two tiers. Absolute contraindications, meaning manipulation of the affected area shouldn’t be done, include an acute fracture and internal fixation or stabilization hardware.
Relative contraindications are subtler. The guidelines say bone demineralization, the loss of mineral seen in osteoporosis, calls for caution and is a relative contraindication at the affected area. They say the same about bleeding risk from anticoagulant therapy or certain blood disorders. Relative doesn’t mean forbidden. It means the practitioner needs to know, and may change the technique or the target.
Picture a 68-year-old woman with osteoporosis who takes a daily anticoagulant for an irregular heartbeat and books a chiropractor for back pain. Under the WHO framework, both conditions are relative contraindications, which call for caution at the affected area. Both are facts the chiropractor should have before choosing a technique, and neither appears on any form unless she mentions it.
That gives each side a concrete job. A chiropractor or other manual therapist needs to hear about a recent fracture, a bone density diagnosis, surgical hardware and any blood thinner. Your prescribing clinician needs to hear that someone is applying thrust to your spine if they’ve diagnosed osteoporosis or started you on an anticoagulant. Neck manipulation carries its own question about artery tears, a debate that sits with this library’s spinal manipulation coverage.
Needles and blood thinners
The worry is intuitive: a needle in someone whose blood doesn’t clot normally. The published evidence is thin.
A systematic review by Michael McCulloch and colleagues, published in The Permanente Journal with a 2015 volume date, found 11 relevant reports: two randomized trials, four case series and five case reports. Seven reported well enough to assess, covering 384 anticoagulated patients and 3,974 treatments. Across them, there was one moderate bleeding event: a large hip hematoma, a collection of blood in the tissue, managed by reversing warfarin with vitamin K and stopping warfarin after its medical justification was re-examined.
The paper’s summary converts that into a percentage that doesn’t match its own arithmetic. One in 3,974 is about 0.025 percent. The count is the number to rely on. The authors concluded acupuncture appears safe in anticoagulated patients, with a condition attached: appropriate needling location and depth.
A second study adds the newer pills. Researchers at the stroke center of Kyung Hee University’s Korean Medicine Hospital reviewed records of 316 patients and 10,177 acupuncture sessions in 2017. Brief bleeding that stopped within 30 seconds occurred at a rate of 3.9 percent among people taking newer oral anticoagulants, 5.6 percent among those on antiplatelet drugs and 5.1 percent among those on neither. No major bleeding was found. It was one hospital, looking backward, which limits how far it travels.
The practical point is the condition in that conclusion. Location and depth are choices the acupuncturist makes, and they can only make them well if they know about the blood thinner. Any change to the blood thinner itself is a decision for the clinician who prescribed it, never something to arrange around an appointment.
Massage and acupuncture during cancer treatment
The National Center for Complementary and Integrative Health, in its cancer guidance last updated in October 2021, says massage therapists may need to use less pressure than usual in areas made sensitive by cancer or its treatment. It also stresses that acupuncturists treating people with cancer must follow strict sterile procedures, because chemotherapy and radiation weaken the immune system.
So the practitioner needs your treatment calendar: what kind of treatment, when, and where on your body radiation was aimed. The same NCCIH page tells patients to inform their providers about complementary approaches even when the reason has nothing to do with cancer. That sentence answers the chiropractic gap in the Saxe study directly.
Where no guideline exists
Two questions come up often and lack a guideline-level answer. Saying so is more useful than inventing one.
Cupping and bleeding risk. No guideline or professional-body statement was found naming anticoagulants or bleeding disorders as a contraindication to cupping. A 2023 systematic review of 22 cupping studies in musculoskeletal and sports care, led by Ayman Mohamed at the University of Illinois, called the incidence of adverse events very low. Most of those studies used dry cupping, though, and trials of that size aren’t built to catch rare problems in people on blood thinners. The honest move is to raise it as a question: is this cupping dry, or wet, which deliberately breaks the skin, and does the practitioner know about your medication?
Hypnosis and psychiatric history. No guideline-level statement was found either. A 1996 report of ten cases in a German anesthesia journal says hypnosis is contraindicated in psychotic disorders, major depression and hallucinogen abuse, but that is one author’s opinion. A hospital program described below screens out patients with active psychosis, severe behavioral health symptoms or substance use before its sessions, which is an operating rule, not a guideline. NCCIH describes hypnosis as safe when practiced by a trained, experienced, licensed health care provider. If you have a psychiatric history, both the hypnotist and your mental health clinician should know about the other.
Who is supposed to ask
The professional record on this is thinner than you might expect.
In 1997, the American Medical Association’s Council on Scientific Affairs issued a report recommending that physicians routinely question patients about alternative or unconventional therapies. That recommendation is known here through a 1999 clinical newsletter summary, not the report itself, and the current text of any AMA policy on it wasn’t verified.
No guidance from the American Academy of Family Physicians or the American College of Physicians telling clinicians to ask about complementary practices turned up in the research for this article. That’s a reportable absence, not proof that none exists.
Federal patient guidance puts the job on you. NCCIH’s chronic pain page, last updated in January 2023, tells readers to check with their providers that an approach is safe and to mention any product or practice they’re considering. Its general advice on choosing a practitioner says to tell all your providers about every complementary approach you use, and to find out whether a practitioner is willing to work with your conventional providers. That second check is easy to skip and tells you a good deal about how a practitioner sees the relationship.
One state pushes from the other side. Colorado’s 2013 law requires unlicensed complementary practitioners to give clients a written disclosure that includes a line urging clients to talk over whatever the practitioner recommends with their other health care providers. It’s a rare case of the law making the practitioner prompt the conversation. What else those state forms must contain gets a full reading in the article on consent outside medicine.
The default, then, is that nobody is obligated to ask. If the subject comes up, it’s usually because the patient raised it.
The Saxe team, writing from inside a cancer study, put duties on both professions. Practitioners, they wrote, need a fuller understanding of their methods’ limits and of how care should change during conventional treatment. Physicians need to show more respect for patients’ choices and actively invite disclosure. Neither duty is written into any rule found for this article, but together they describe the conversation that works.
When the hospital offers it
Some hospitals remove the disclosure problem by putting the practice inside the medical record.
NYU Langone Health’s Department of Integrative Health has run a bedside consult service at Tisch Hospital and the Kimmel Pavilion in Manhattan since 1992. A 2025 paper by Emma Millon and colleagues, published in Global Advances in Integrative Medicine and Health, describes how it works. An attending physician, physician assistant, nurse practitioner or nurse orders the service in the electronic health record, at no cost to the patient. Thirteen nurses trained in several modalities respond, usually within 48 hours. They offer Reiki, light-touch massage, aromatherapy, meditation, focused breathing and guided imagery to roughly 200 patients a month.
Between September 2022 and February 2024, 3,491 hospitalized patients were referred and 2,530 of them received at least one session, with a median wait of four days. Patients with active psychosis, severe behavioral health symptoms or substance use were screened out.
Because the order sits in the chart, the practice is documented where the care team works. The paper also found who got left out. Men, Asian American patients and patients who didn’t prefer English all had significantly lower odds of being referred, after adjustment, and men were less likely to complete a session once referred. A service built into the record still depends on someone thinking to order it.
Clinicians were surveyed too. In a pilot study of 46 clinicians at an academic medical center, published by the same NYU team in late 2025, 56 percent said they had discussed the benefits of these services with patients. Barriers included limited awareness and thin staffing on evenings and weekends, and one proposed fix was automatic referral prompts in the health record. Even where the service is free and on site, only a little over half of the clinicians surveyed reported bringing it up.
Outpatient systems show a different pattern. At Kaiser Permanente Colorado’s Center for Complementary Medicine, 27,225 patients sought chiropractic, acupuncture or massage between 2007 and 2014, according to a 2017 Permanente Journal report by Tracy McCubbin and colleagues. Chiropractic made up 66.9 percent of the services, acupuncture 18.1 percent and massage 15.0 percent. More than a third of patients referred themselves. Most had already seen a physician for the same problem, and 60 percent had received medication for it. Even inside an integrated system, then, a third of patients arrived on their own decision, and most were already under a physician’s care or taking medication for the same complaint. That is exactly the situation in which the physical details matter.
What each side needs to hear
The useful disclosure is specific. Saying you see a chiropractor tells a clinician almost nothing about what is happening to your spine. These two short lists are a starting point.
Tell your clinician:
- The practice by name and the actual technique, such as high-velocity neck adjustment versus soft-tissue work, or wet versus dry cupping
- Where on your body, how often and for how long
- Who does it, and whether that person holds a state license
- What you’re hoping it helps, and anything unusual you’ve noticed afterward, like bruising, swelling, dizziness or new pain
Tell your practitioner:
- Any blood thinner or antiplatelet drug
- A bone density diagnosis, recent fracture, recent surgery or implanted hardware
- Current cancer treatment, its schedule, and where radiation was aimed
- Psychiatric history or a current mental health crisis, before hypnosis or deep relaxation work
Preparing for the appointment itself, and deciding on treatment together, are covered in other articles in this section. This list is only about the physical facts each side is missing.
When it shouldn’t wait for the next session
Some changes are worth telling both sides about before your next appointment, not after:
- Starting or switching a blood thinner
- A new fracture, a new osteoporosis diagnosis, or surgery
- Starting chemotherapy or radiation
Some situations call for prompt medical attention. Bruising or swelling that keeps spreading after needling, especially if you take an anticoagulant, belongs with the clinician who prescribed it; the one moderate bleed in the McCulloch review was exactly that kind of hematoma. The American Heart Association and American Stroke Association note that a cervical artery dissection may first show up as a one-sided headache or pain at the back of the neck. If that appears around the time of neck treatment, it warrants prompt medical assessment. The Centers for Disease Control and Prevention lists sudden numbness or weakness on one side, sudden confusion or trouble speaking, sudden trouble seeing, loss of balance and a sudden severe headache as stroke signs that call for 911 right away, whatever came before them.
The Takeaway
Name the practice and describe what physically happens. For a supplement, the bottle is the disclosure. For a practice, the disclosure is the technique: where, how hard and how often.
Then carry the other half back. The person adjusting, needling or pressing on you can only respect a blood thinner, a fragile bone or a radiation field if they know it’s there, and the disclosure research suggests the most common reason information doesn’t travel is that the patient didn’t think it mattered.
Sources
- Integrative Cancer Therapies. “Saxe GA, Madlensky L, Kealey S, Wu DP, Freeman KL, Pierce JP. "Disclosure to physicians of CAM use by breast cancer patients: findings from the Women's Healthy Eating and Living Study." Integr Cancer Ther, 2008. PubMed. DOI: 10.1177/1534735408323081.” pubmed.ncbi.nlm.nih.gov
- Annals of Internal Medicine. “Eisenberg DM, Kessler RC, Van Rompay MI, Kaptchuk TJ, Wilkey SA, Appel S, Davis RB. "Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey." Ann Intern Med, 2001. PubMed. DOI: 10.7326/0003-4819-135-5-200109040-00011.” pubmed.ncbi.nlm.nih.gov
- World Health Organization (English edition hosted by the World Federation of Chiropractic). “WHO guidelines on basic training and safety in chiropractic, 2005 (contraindications, sections 2.1, 3.2, 3.3).” wfc.org
- The Permanente Journal. “McCulloch M, Nachat A, Schwartz J, Casella-Gordon V, Cook J. "Acupuncture safety in patients receiving anticoagulants: a systematic review." Perm J, 2015. PubMed. DOI: 10.7812/TPP/14-057.” pubmed.ncbi.nlm.nih.gov
- Evidence-Based Complementary and Alternative Medicine. “Kwon S, Jung WS, Yang S, et al. "Safety of Acupuncture in Patients Taking Newer Oral Anticoagulants: A Retrospective Chart Review Study." Evid Based Complement Alternat Med, 2018. PubMed. DOI: 10.1155/2018/8042198.” pubmed.ncbi.nlm.nih.gov
- National Center for Complementary and Integrative Health, National Institutes of Health. “Cancer and Complementary Health Approaches: What You Need To Know (content Last Updated October 2021).” nccih.nih.gov
- Journal of Back and Musculoskeletal Rehabilitation. “Mohamed AA, Zhang X, Jan YK. "Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: A systematic and evidence-based review." J Back Musculoskelet Rehabil, 2023. PubMed. DOI: 10.3233/BMR-210242.” pubmed.ncbi.nlm.nih.gov
- Der Anaesthesist. “Schulz-Stübner S. "Hypnosis: a side effect-free alternative to medical sedation in regional anesthesia" (German, English abstract). Anaesthesist, 1996. PubMed. DOI: 10.1007/s001010050331.” pubmed.ncbi.nlm.nih.gov
- Clinician.com (newsletter archive, July 1, 1999). “AMA: Know patients' alternative therapy use (summary of AMA Council on Scientific Affairs Report 12-A-97).” clinician.com
- National Center for Complementary and Integrative Health, National Institutes of Health. “Chronic Pain and Complementary Health Approaches: Usefulness and Safety (content Last Updated January 2023).” nccih.nih.gov
- National Center for Complementary and Integrative Health, National Institutes of Health. “6 Things To Know When Selecting a Complementary Health Practitioner (undated).” nccih.nih.gov
- Colorado Legislative Council Staff (fiscal note hosted by StateBillInfo). “Final Fiscal Note, SB13-215, Alternative Health Care Practitioners, July 1, 2013.” statebillinfo.com
- Global Advances in Integrative Medicine and Health. “Millon EM, Shang A, DeMarco KA. "Characteristics of Hospitalized Patients Referred for Complementary and Integrative Health Services at a Large Metropolitan Academic Medical Center." Glob Adv Integr Med Health, 2025. PubMed. DOI: 10.1177/27536130251388991.” pubmed.ncbi.nlm.nih.gov
- Journal of Integrative and Complementary Medicine. “Millon EM, Shang A, Bass B, et al. "A Mixed-Methods Pilot Study on Clinicians' Attitudes and Utilization of Complementary and Integrative Health Services for Patient Care at an Academic Medical Center." J Integr Complement Med, 2025. PubMed. DOI: 10.1177/27683605251406896.” pubmed.ncbi.nlm.nih.gov
- The Permanente Journal. “McCubbin T, Kempe KL, Beck A. "Complementary and Alternative Medicine in an Integrated Health Care Delivery System: Users of Chiropractic, Acupuncture, and Massage Services." Perm J, 2017. PubMed. DOI: 10.7812/TPP/16-172.” pubmed.ncbi.nlm.nih.gov
- Stroke. “Biller J, Sacco RL, et al. "Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association." Stroke, 2014 (online August 7, 2014). PubMed. DOI: 10.1161/STR.0000000000000016.” pubmed.ncbi.nlm.nih.gov
- Centers for Disease Control and Prevention. “Signs and Symptoms of Stroke (last reviewed May 19, 2026).” cdc.gov