Background
: Alternative medicine is defined as a non-orthodox therapeutic practices including chiropractic, acupuncture, herbal medicine, faith spiritual therapy or as all sorts of medical care that do not follow the medical community standards. Patients do not think of modern medicine as the absolute solution to their health problems and they will sometimes ask for complementary therapy and in want of referral to alternative practitioner. We have investigated the primary physician's attitude and behavior towards alternative medicine.

Methods : Randomly selected 770 practitioners, in primary care practice in Seoul, were questioned from July to September in 1996 about the attitude to wards alternative medicine, the reasons and symptoms when referring, and experience in alternative medicine practice.

Results : 150 questionnaires were returned and among them 139 completed one(18.1%) were analyzed. Among 770 doctors, 35(25.2%) have refereed patients to alternative practitioner before and more referrals were made when they worked together closely or had some prior training. The belief of special effect of alternative medicine on certain disease was the first reason to refer. Other reasons were for herbal medicine, acupunture, and chiropractics in the order of sequence. The standard way to learn alternative medicine was to attend seminars available through certain institutions. On referral either chronic pain or musculoskeletal disease were the most chief complaints or main diseases of patients. 15 doctors(10.8%) had some experience in practicing an alternative approach and the patient subjects were more likely to be women, and there was increased tendency to be working with another doctor, and to have been trained for such practice. The items used by alternative practitioners were acupuncture, herbs in the order of sequence.
Conclusions：Alternative medicine is accepted somewhat by primary physicians in Seoul although the rate of referral and practice is lower than 54% compared to 16% in Canada.

Research Background : It is well-known that there are significant differences in clinic blood pres-sure (CBP) and ambulatory blood pressure (ABP) among many hypertensive patients. These differen-ces are called the "white-coat effect"(WCE). There have been studies to find a method of predicting the WCE and to investigate a correlation between the WCE and anxiety of paients. However, anxiety scales adopted in the former studies were fount to be inadequate to measure the anxiety which patients experience in clinics. In this study we developed a new scale, called the "white-coat anxiety scale"(WCAS), which can effectively measure the anxiety of hypertensive partients in clinics and help to find a method of predicting white-coat hypertension in the future.
Methouds: The WCAS was developed on the basis of te test anxiety scale and the manifest anxiety scale, whose validity and reliability have been proved. First, a test questionnaire was made with professional advices of a psychiatrist, a preventive medicine staff, and a professor of education. Patient anxiety symptoms were classified into three categories : autonomic hyperactivity, motor ten-sion, and cognitive symptom. Twelve questions were made in each category to make the test question-naire of 36 questions. Second, after a pre-test, a final questionnaire was made by rejecting two ques-tion, whose internal consistencies were found to be poor, in each category. The final questionnaire of 30 questions was checked with the test-retest correlation method. Third, a survey was actually done on hypertensive patients whose 24 hours ABP's were monitered either in department of family medicine, a university hospital of in a general hospital. Finally, based on the survey, the correlation between the WCE and WCAS was evaluated. The WCE was determined by subtracting the CBP value with the aerage value of 24 hours ABP.

Results : The study subjects were composed of 15 patients in departiment of family medicine, a university hospital and 25 patients in a general hospital. They consisted of 23 male and 17 female patients, and their average age was 50.6 years. The internal consistency of the WCAS was estimated to be 0.87, and the correlation of the test-retest results was found to be 0.90. The correlation coefficients between the WCAS and the WCE were 0.48 for the daytime systoli lood pressure(SBP), 0.33 for the night-time DBP, and 0.45 for the mean DBP. These values show that the difference of the CBP from daytime blood pressure has a strong correlation with the WCAS. The correlation between the WCE and the WCAS was found to be similar for the SBP and the DBP. Among the patient anxiety symptoms, the cognitive symptom is not correlated wit the WCAS.

Conclusion : The newly developed WCAS has a high reliability and shows a strong correlation with the WCE. In order to introduce the new scale to a clinical use, more studies are required to find a cutoff value of the WCAS and to check the possibilities of predicting white coat hypertension with the WCAS.