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The waiting game

Do I have to refer a patient for homeopathy?

Three experts advise a GP who is in two minds about referring a cancer patient for complementary medicine

A patient with disseminated malignancy has asked for referral to a hospital for integrated care with a view to homeopathy. I don’t believe homeopathy is an effective treatment or in her best interest. How should I respond?

Dr Simon Parton: Agree if the patient fully understands their condition

My first priority would be to establish the patient’s understanding of the diagnosis. What information has she received about conventional management options, prognosis and potential side-effects?

I would discuss my concerns with the patient about the risk of deviation from recognised and evidenced therapy while maintaining a relationship of trust and support. I would offer to share with her any published NICE guidance for her cancer, and review any literature she has on her proposed homeopathic treatment. I would offer to meet again in a few days to allow further discussion.

I would also direct her to charities such as Macmillan Support, Cancer Research UK and Breast Cancer Care who have information about supportive and complementary therapies that are safe and appropriate.

Having established that she fully understands her condition and her request is based on choice rather than a lack of understanding or capacity I would agree to her request and maintain regular reviews of progress. I would also suggest consultation with conventional oncology services so that there is an opportunity to discuss standard therapies with specialists and maintain an ongoing dialogue with conventional therapy teams so she could consider treatment at a later date. Because of the likely palliative nature of any therapy for disseminated disease, early information and referral to community palliative care services might be appropriate.

Whether she is reviewed in a traditional oncology service or an integrated homeopathic service she will need the ongoing support of her GP and it’s essential to maintain that relationship, especially when she approaches the end of life.

Dr Simon Parton is a GP in Lewisham and chair of Lewisham LMC 

Dr Pipin Singh: Make sure the patient knows the lack of evidence

It will be important to have a full understanding of the patient’s condition and prognosis. A curable metastatic condition may alter the advice that you give.

Establish what the patient already understands about her condition and prognosis. If she has capacity to make a decision, you have to respect her wishes. If she doesn’t understand her condition and you feel she lacks capacity, you may wish to offer further discussion with her next of kin or close relative. If there is no one else to discuss with, you may wish to consider a patient advocate.

Knowledge of homeopathy will vary from doctor to doctor, however as GPs it is important we respect patients’ health beliefs. Explore why the patient is requesting homeopathy. Does she have a fear of conventional treatments? Find out what the patient already knows about homeopathy. Is this something she or a family member or friend has used before with good outcome?

You should explain that homeopathy is not recommended by NICE or the NHS and does not have a robust evidence base. It is not routinely available on the NHS although a few doctors do offer homeopathic options for certain conditions. There is also no regulation of homeopathic practitioners.

Agreeing to a referral is acceptable as long as the patient has capacity and is fully informed of the pros and cons.

Dr Pipin Singh is a GP in Wallsend, Tyne and Wear

Dr Zaid al-Najjar: You needn’t refer but you must explore why she has asked

Whether you believe homeopathy is effective or not, it has a significant following and many GPs encounter situations like this.

In the first instance, it would be helpful to discuss your concerns with the patient, exploring why she feels conventional treatment might not satisfy her needs.

You do not have to make a referral if you do not believe it would be of clinical benefit or in the patient’s best interests, but it is important to consider Section 5d of the GMC’s consent guidance on patient treatment:

‘The doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient they do not have to provide it. But they should explain any other options that are available, including the option to seek a second opinion.’

Together, you may like to explore the possibility for mainstream therapies to be carried out alongside homeopathy, subject to the availability of funding and willingness of the specialists involved.

Ensure you record all discussions you have with the patient.

If you have concerns about the patient’s capacity to make an informed decision about her care, given the disseminated malignancy, you should contact your defence organisation.

Dr Zaid al-Najjar is a medicolegal adviser at the Medical Protection Society and a sessional GP in London

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Readers' comments (40)

  • Having studied Homeopathic Medicine, which can still be prescribed on FP10, my anecdotal feedback from patients is that they feel better and have fewer side-effects from their oncology treatments with homeopathy.

    There are robust outcome studies on Homeopathy as well as RCT's, although disease specific research is difficult to fund and challenging to perform.

    Quality research in URTI conditions indicates Homeopathic Medicines are a safe alternative in the face of antimicrobial resistance.

    The Faculty of Homeopathy has a responsible officer for revalidation.

    Research can be accessed at:

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  • I am pleasantly surprised to read what these 3 doctors say about a referral for homeopathic treatment. It is more reasonable and balanced than many people receive when requesting a referral by a GP.

    I have only three things to add. First, patient choice (a policy supported now by all main political parties) and is exactly what it says, it is the patient who should decide the treatment he or she wants. I welcome the remarks made by the 3 doctors about giving the patient information. The choice made should be an informed choice.

    Second, the vast majority of doctors are not homeopaths, their knowledge of homeopathy is limited, and they should be advising patients to talk to a suitably trained homeopath. There is, for example, good evidence for homeopathy and to say there is no 'evidential basis' is little more than the repetition of a mantra, and a demonstration of a lack of knowledge.

    The third point is that any referral should be seen as an opportunity for some joint working, and some 'integrated' medicine. It is a pity that the hostility of conventional medicine towards homeopathy has prevented this now for so many years.

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  • The opening question should not be 'do I have to' it should be 'might it benefit the patient in front of me' and 'is it likely to do harm'. And if you don't know the answers to these questions as with any other specialty you should ask advice from an expert. In this case clearly if there is good evidence based conventional therapy the patient must be strongly informed of this, but there is no good reason to deny complementary homeopathy. Medical homeopaths are registered with the faculty of homeopathy and now undergo monitoring of continuing professional development.

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  • There is also issue from the Montgomery case regarding patient informed consent to be considered.

    The Supreme Court has ruled:" ….patients are now widely regarded as persons holding rights, rather than as the passive recipients of the care of the medical profession."

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  • I agree with Gabriella that the question might have been couched in a more 'open and patient centred ' format but the fact that the question is being asked at all and being responded to in the way that it has by the three colleagues is very positive, showing an openness to consider a more integrated approach. If we were truly 'patient centred ' we would see the benefits to patients in enabling them to access both conventional and complementary treatment. I am glad to see that Andrew Sikorski has pointed out that it is incorrect to state that there is no evidence for the efficacy of Homeopathy and alongside the source he mentions I would add another I do also wonder how those who continue to perpetuate this myth square it with the fact that homeopathic medical treatment is used extensively in India for example. I would refer interested readers to the work of the Drs Banerji at where you will find some interesting information under ' research initiatives '. Finally, I would also like to make people aware of two charities which promote an integrative approach to cancer and

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  • What possible justification can there be for stil trying to advance these treatments?

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  • Betteridge's Law of Headlines applies, of course. No, no healthcare provider is required to refer a patient for blatant quackery.

    To refer a patient for a treatment like homeopathy, where there is no reason to think it should work, no way it can work, and no god evidence it does work, is the medical equivalent of a debt counsellor referring a client to Bernard Madoff.

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  • Andrew Sikorski's comment makes an important point: informed consent is indeed necessary.

    I wonder if the patient will still want homeopathy after they have been fully informed? I'd say that reading the NHS Choices page on homeopathy, or the Wikipedia article, would help the patient understand the reasons why people still believe in homeopathy despite the well-established fact that its potions are inert.

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  • Guy- this is a site intended for health professionals- and you are neither.

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  • Reality Shill Guy
    Guy of the Family Chapman, free man, skeptic, quackbuster, argumentative sod, railway modeller, @BromptonBicycle owner, married 25 years, dad to two great lads.

    Reading, UK

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