Objective - To document the frequency of conversations about alternative medicine during primary care consultations for back pain in diverse settings.

Design - ''Exit interview'' type patient survey.

Settings - General practices in Seattle, Washington; rural Israel; and Birmingham, England.

Patients - A convenience sample of 218 adults completing a doctor visit for back pain.

Main outcome measures - Frequencies of doctor-patient discussions of alternative medicine.

Results - Alternative medicine was discussed in a minority of visits (US site 40%, Israel site 37%, UK site 14%, p < 0.05). At each site, patients initiated at least half of the discussions. Users were five to six times more likely to discuss alternative medicine with their doctor than non-users (p < 0.05 for comparison at each site). The percentage of patients who used alternative medicine but left the consultation without discussing it was similar at all sites (US site 17%, Israel site 23%, UK site 15%).

Conclusions - Discussions of alternative medicine occurred in a minority of consultations for back pain although the rate varied considerably by site. Discussions were initiated primarily by patients who use it.