Forming connections in the homeopathic consultation

Classifying knowledge used in complementary medicine consultations: a qualitative systematic review

Background

Complementary Medicine (CM) is widely used internationally but there is limited understanding of the forms of knowledge CM practitioners use in their clinical practice and how they use this knowledge in interactions with patients. This review aims to synthesise the existing evidence on the forms of knowledge that are mobilised, and the role of this knowledge in the interactions between practitioners and patients during CM consultations. It considered a diverse range of CM practice areas to develop a classification of CM practitioners’ knowledge use in consultations.

Methods

Systematic searches of health and sociology databases were conducted using core concepts, including complementary and alternative medicine, practitioners, and knowledge. Articles were included where they reported on data from recorded CM practitioner and patient consultations and offered insights into the types and applications of knowledge used in these consultations. 16 unique studies were included in the review. Data were extracted, coded and analysed thematically.

Results

Results demonstrate that diverse sources of knowledge were mobilised by practitioners, predominantly derived from the patients themselves –their bodies and their narratives. This reflected principles of patient-centredness. The use of discipline specific forms of knowledge and references to biomedical sources illustrated ongoing efforts towards legitimacy for CM practice.

Conclusion

CM practitioners are navigating tensions between what some might see as competing, others as complementary, forms of knowledge. The classification system provides a useful tool for promoting critically reflective practice by CM practitioners, particularly in relation to self-assessment of knowledge translation and patient interactions.

A Population-Practice-Based Model to Understand How Yoga Impacts on Human Global Functioning: A Qualitative Study

Introduction:Research is increasingly demonstrating a range of benefits of practicing yoga, such as improved physical and mental health, social connectedness, and self-care. Mechanisms of action are less well understood, but may include both psychological and physiological changes. The aim of this study was to understand more about benefits and mechanisms of yoga practice, using qualitative data collected from a large-scale survey of yoga use in the United Kingdom. Methods: The mixed methods, cross-sectional online survey collected data on yoga use and perceived benefits from 2434 U.K. yoga practitioners. The qualitative survey element used open-ended questions to gain "real life" data regarding practice and perceived benefits. Data were analyzed thematically and deductively. A practice-based model describing yoga practice, mechanisms, and benefits, based on the Khalsa logic model of yoga, was developed to explain the data. Findings: Findings highlighted that a diverse range of yoga practices and nonspecific contextual factors related to practicing yoga, needed to be considered to understand how yoga was benefitting people. These practices encompassed both modern and traditional conceptions of yoga as a deeper lifestyle practice. Key mechanisms for change included improvements in physical strength and flexibility, stress regulation, resilience, equanimity, mind-body awareness, and spiritual/personal growth. These mechanisms resulted in diverse improvements in global health functioning, particularly physical and mental health and well-being. Conclusions: The Khalsa model provided a useful base upon which to guide the new population-practice-based model, to understand participants' "real life" experiences of yoga, how yoga is helping people and why. It provides important information for practitioners, teachers, and those delivering yoga interventions as to the range of skills and potential benefits of yoga practice. In addition, findings indicate directions for future research, by highlighting key yoga mechanisms that researchers may choose to focus on in future studies.

Experiences of language barriers by homoeopathy student interns providing health services at the University of Johannesburg

Background

South Africa is a multilingual society, and therefore, the likelihood of healthcare providers (HCPs), including students training to be HCPs, encountering language barriers with patients is high.

Aim

To explore and describe the experiences of homoeopathy student interns regarding language barriers in the delivery of health services and to provide guidance towards overcoming language barriers in homoeopathic practice at the University of Johannesburg (UJ).

Setting

The interviews and focus group discussions were conducted in English and at a private location that was convenient for the participants in Johannesburg, Gauteng.

Methods

This qualitative study used a phenomenological approach. Ten individual interviews were conducted with registered homoeopathy student interns (HSIs) from the UJ. The central question: ‘What has your experience been regarding language barriers between you and your patients at the UJ Homoeopathy clinics?’ was asked and responses were recorded and transcribed for later analysis. The interview results were presented to a focus group for discussion to validate findings that arose from the analysis and to provide an opportunity to add any insight, comment or recommendations that were not expressed in individual interviews and verification of emergent themes.

Results

Participants described how language barriers create challenges in understanding between patients and HSIs. Descriptions of the experiences of the intrapersonal and interpersonal effects that are associated with language barriers were provided. Participants also described the influence of language barriers on the various aspects of the health service process. Finally, participants described the mitigation of language barriers through various strategies.

Conclusion

Participants reported their experiences of language barriers as challenging. Language barriers were found to adversely affect the various aspects of the health service process as well as the practitioner’s personal feelings and the patient–practitioner relationship. Language acquisition and awareness modules introduced early on in the syllabus is a proposed solution to the mitigation of language barriers.

The Bell Tolls for Homeopathy: Time for Change in the Training and Practice of North American Naturopathic Physicians

North American naturopathic medicine is a distinct form of practice that is woven into the larger fabric of integrative medicine; in a number of US states and Canadian provinces, naturopathic doctors enjoy a wide scope of practice, including the ability to make diagnoses, order tests, use medical technology, write prescription drugs, and perform minor surgeries. However, the basic premise of naturopathic medicine and its guiding principles-considering the whole person and supporting healthy lifestyle behaviors-is the unifying approach in clinical practice. In the 1970s, homeopathy-considered in many circles to be a hypothesis-driven, fringe form of alternative medicine-became embedded into the training and practice of North American naturopathic doctors. Since the earliest days of its theory (circa 1800), homeopathy has escaped, and continues to escape, biological plausibility; however, the persistence of this modality (and the insistence by both its consumers and practitioners that it provides benefit) speaks to the role of expectations, beliefs, values, agency, context effects, and the placebo-at-large. It is our contention that the progression of professional naturopathic medicine in the 21st century requires a major transition in how it approaches the subject of homeopathy. We propose that students should be encouraged to critically analyze the tenets of homeopathy, its lesser known history, and the idea of homeopathy as a biomedicine that simply awaits untold chemicophysical mechanisms. Furthermore, the modality of homeopathy should be incorporated into the larger context of placebo studies, narrative medicine, ethics, and psychotherapeutic techniques.

A gentle ethical defence of homeopathy

Recent discourses about the legitimacy of homeopathy have focused on its scientific plausibility, mechanism of action, and evidence base. These, frequently, conclude not only that homeopathy is scientifically baseless, but that it is "unethical." They have also diminished patients' perspectives, values, and preferences. We contend that these critics confuse epistemic questions with questions of ethics, misconstrue the moral status of homeopaths, and have an impoverished idea of ethics-one that fails to account either for the moral worth of care and of relationships or for the perspectives, values, and preferences of patients. Utilitarian critics, in particular, endeavour to present an objective evaluation-a type of moral calculus-quantifying the utilities and disutilities of homeopathy as a justification for the exclusion of homeopathy from research and health care. But these critiques are built upon a narrow formulation of evidence and care and a diminished episteme that excludes the values and preferences of researchers, homeopaths, and patients engaged in the practice of homeopathy. We suggest that homeopathy is ethical as it fulfils the needs and expectations of many patients; may be practiced safely and prudentially; values care and the virtues of the therapeutic relationship; and provides important benefits for patients.

Towards improving the reporting quality of clinical case reports in complementary medicine: assessing and illustrating the need for guideline development

BACKGROUND

Case reports have had a varying level of recognition as a source of evidence throughout the history of medicine. In recent years, there has been a revival of interest in clinical case reports in both conventional and complementary medicine. There is a need to further improve the reporting quality of clinical case reports of different Complementary and Alternative Medicine (CAM) therapies.

OBJECTIVES

To provide an overview of the different objectives for clinical case reports, identify those that are most relevant for CAM, and to develop a conceptual framework for purpose orientated clinical case reporting guidelines for CAM therapies. To practically illustrate the chosen approach by developing a clinical case reporting guideline for homeopathic cases.

METHODS

The various objectives of clinical case reports were described by Prof. Milos Jenicek, and the potential relevance of these objectives for CAM were discussed and graded by a mixed panel of experts. A conceptual framework for developing clinical case reporting guidelines for CAM treatments with specific objectives is proposed. The aim is to integrate both 'generic' and 'CAM therapy specific' quality items. This framework has been practically applied to the development of a reporting guideline for clinical case reports in homoeopathy which will be reported in a second article.

RESULTS

An overview is given of the clinical case reporting literature. The conceptual framework for the development of purpose orientated CAM clinical case reporting guidelines is presented. This framework is based on alignment with the recently published 'generic' CARE guideline for reporting of clinical case reports, whilst addressing the CAM specific elements at the same time.

CONCLUSIONS

The scope and importance of clinical case reporting guideline development in CAM is illustrated. A conceptual framework for developing CAM specific clinical case reporting guidelines was established. It has been implemented using homoeopathy as an illustration, and this will be reported in a separate article. Further improvements in clinical case reporting in CAM will greatly contribute to CAM research and education, as well as to improved patient care.

The role of health care communication in the development of complementary and integrative medicine

In recent years, complementary medicine (CM) approaches are integrated within a growing number of health care services worldwide. Implementation of CM within primary, secondary and tertiary settings of health care requires attention to a variety of communication challenges. In this special issue of Patient Education and Counseling 23 articles are presented about the patient-provider communication on complementary approaches, and the implementation and integration of CM in health care. Parallel to CM integration in the clinical arena, this special issue emphasizes the importance of two complementary axes: in medical education and in research, particularly on management of chronic illness and life-threatening diseases. The three legs of the integrative stool--research, education, and clinical practice--are perceived in the light of open, non-judgmental patient-health care provider-CM practitioner communication and a patient-centered bio-psycho-social-cultural-spiritual agenda.