Alternative therapists query NHS treatment
When a complementary medicine centre opens near the surgery you and your partners accept an invitation to tour the facilities but decline a request to refer suitable patients to them. This is partly because you do not feel comfortable about all the therapies on offer and partly because you only recommend patients to people whose professional reputation you know and trust. As the weeks go by, you notice patients are saying that therapists at the centre are questioning their NHS treatment in a way that implies criticism of the partners. You are treated to full details of the therapists' alternative views on the aetiology of various problems, and some patients have adopted unusual diets or requested unnecessary second opinions. This is both adding to your workload and affecting the practice's reputation.
Dr Simon Atkins
'Patients don't deserve to be in a petty game of piggy-in-the-middle'
It would be very easy for this situation to lead to 'pistols at dawn' if things are allowed to continue.
The professional competence of both parties has been called into question and it's no surprise that doctors and therapists have got the hump. But the people who are suffering the most are obviously the patients, who are already enduring unnecessary investigations and referrals as a result.
If we as doctors are having trouble understanding the patients' accounts of the alternative aetiologies of their conditions, think how confused the patients must be when we contradict them and present a different story altogether.
When communication breaks down like this then the priority is to get people talking again. The patients don't deserve to be the go-betweens in a petty game of piggy-in-the-middle.
It would therefore be a good idea to arrange a meeting either between the managers of both practices or between just a few doctors and therapists. A large meeting is unlikely to resolve anything and could end up in a 'my treatment's better than your treatment' slanging match.
Having an independent third party present to mediate would be vital; an agreed, time-limited, agenda will help too. This would ensure those who aren't able to attend can have their views aired and that the meeting doesn't last for ages. Hopefully, this strategy would produce some useful conclusions by the end.
It may be that, as a gesture of compromise, we are able to refer some of our patients to the therapists because of positive outcomes and good reports of their practice in the time the centre has been open. This may not be true across the board and they will need to accept that that may remain the case.
Likewise, we as GPs need to be more open to other interpretations of the causes of health and disease and respect our patients' right to see alternative therapists, even though we may be deeply sceptical.
Hopefully in this way and with some give and take on both sides, the situation may resolve without the need for a shoot-out.
Dr Nick Imm
'Some branches of complementary medicine seem to get away with any old hocus-pocus on the grounds it's natural'
I can't stop my patients visiting the complementary medicine centre any more than I can prevent them visiting McDonald's. It's a lifestyle choice they are free to make. But whereas most people are aware a burger and chips is not especially healthy, some branches of complementary medicine seem to get away with any old hocus-pocus on the grounds that it's natural and therefore good for you. At least McDonald's is regulated by the Food Standards Agency.
The staff at the centre may feel snubbed because we don't refer patients despite the tour of their premises, but their criticism of accepted medical advice is worrying and potentially dangerous.
If an alterative therapist has a novel opinion on the aetiology and treatment of a medical condition, that's fine. There is growing evidence for the efficacy of treatments such as St John's wort and glucosamine and I should keep an open mind. But I also know that herbal remedies can have side-effects and interactions too.
If I criticise my patients for following their new therapists' advice they may become defensive and decline to tell me when they stop or change treatments. I risk losing their trust. On the other hand, it's important they are aware of the lack of evidence for many alternative therapies both in terms of efficacy and safety.
A reasonable approach would be to encourage the therapists to act more responsibly. I'd discuss the situation with my colleagues and gather relevant evidence. Hopefully, we could arrange a meeting with the manager of the complementary medicine centre.
I'd ask if they felt qualified medically or morally to advise patients in this way. If they want to suggest stopping an established treatment or adopting an odd diet they must be aware of the potential risks their clients take.
Once this situation is put into perspective they may well be less keen to criticise.
Dr Lucy Free
'If criticism of us isn't justified, then as sure as eggs are eggs these charlatans will get their comeuppance'
Patients can and will suit themselves. They can choose to take conventional or alternative remedies, to use complementary therapies or to demand the ultimate high-tech treatment just reported in the papers.
All of these options are valid and appropriate for different patients, and generally speaking they have the right to decide what they feel is best for them. It would be a serious mistake to get involved in a mud-slinging competition with people who have fundamentally different beliefs, and an even bigger mistake to be bullied into referring patients to them.
Complementary therapies are just that: they are adjuncts to the traditional remedies of surgery or the contents of the BNF. Why should we resent people trying them? People will gravitate to what suits them, and we should be grateful our heartsink patients have an alternative ear to bend. Heaven knows how much time is saved by patients going elsewhere. We shouldn't be so defensive; after all, healthy competition is the basis of a free market economy, and anything that helps patients has to be a good thing.
The emphasis these days is on education; patients are encouraged to seek information from the internet, leaflets, libraries and self-help groups. We expect them to know smoking and fats are bad for them, and that exercise and fresh fruit are good. How then can we condemn people who have sought to help themselves, paying their own money, for alternative therapies?
In fact the practice is in a win-win situation here. If these criticisms of your conventional management are justified, then this may be the required stimulus to improve standards in the surgery by audit or postgraduate education.
And if they're not then as sure as eggs are eggs these charlatans will get their comeuppance. Fashion is fickle and the novelty of paying for a treatment that doesn't work will wear off, particularly in a small town. My advice would be to sit tight, to remain totally professional, to be non-judgmental about the 'competitors' and to wait for the tide to turn.