A grounded theory study of homeopathic practitioners' perceptions and experiences of 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.

Homeopathy in the 21st Century, and Comparisons with Hahnemann

BACKGROUND

 Homeopathy has survived the test of time over more than 200 years and has been accepted by many consumers and practitioners across the world as being an important constituent of health care. It continues to provide successful outcomes in a wide range of conditions using traditional and newer approaches to practice and is expanding into integrated health care. This article discusses modern developments in homeopathic theory, homeopharmaceutics, homeotherapeutics, and patient access. It also considers how Hahnemann might have responded to these changes.

COMMENTARY

 Theoretical explanations for homeopathic mechanisms of action are complex and can involve ideas that conflict with established thinking amongst non-homeopaths. The use of different pharmacopoeial standards in the manufacture of remedies and variations in nomenclature continues to cause confusion for practitioners and patients. It also causes problems for manufacturers in providing the documentation required by national regulatory authorities to support licensing applications. Interaction with these bodies and other stakeholders is vital, to ensure the continued availability of a full range of homeopathic medicines. The incorporation of a homeopathic section within the European Pharmacopoeia (Ph. Eur.), which is used by many countries globally, is a positive development in promoting the standardisation of remedies. With increasing reliance now on evidence-based medicine, scientifically trained colleagues and sceptics have cast doubt on the validity of the observational studies that form much of the homeopathic evidence base.

RECOMMENDATIONS

 The homeopathy community should engage as fully as possible in robust research to validate homeopathic practices, thus ensuring the viability of homeopathy in the future. There is an ongoing need for homeopathic practitioners to review their procedures regularly and take account of changes in patient demographics and lifestyle, and in modern methods of health care delivery. Colleagues should also be aware of patients' emerging abilities to critically assess treatment options and to judge outcomes. Future opportunities exist for homeopathy in new concepts of integrated health care that includes a range of other therapies, as well as in veterinary and environmental health. There is also the possibility of homeopathy joining social care services to improve accessibility to health care by making it available in a range of different community settings.

CONCLUSION

 Hahnemann would likely have been unimpressed by the less positive contemporary influences on homeopathic practice.

The Intersection Between Models of Health and How Healing Transpires: A Metaethnographic Synthesis of Complementary Medicine Practitioners' Perceptions

Introduction: This metaethnography provides an interpretative synthesis of complementary medicine (CM) practitioners' perceptions toward their health model and the healing process. CM is commonly described on the basis of its distinction from biomedicine with limited research available on CM practitioners' understanding of what the essence of their practice is and how healing transpires as a result. This is despite the significant patronage of CM and high rates of couse with biomedical services. Materials and Methods: An extensive and systematic search of the literature was conducted across seven databases (AMED, SINAHL, Medline, PsycINFO, PUBMED, Science Direct, and Scopus) with no date, language, or region restrictions applied. The basis for the search was MeSH terms and keywords relating to (1) CM practitioners, (2) perceptions, and (3) healing. A screening process was conducted and articles were identified for inclusion based on their addressing the research question. These articles were then quality appraised. A seven-stage metaethnographic framework was utilized to assist with identifying and interpreting the themes within the data. Results: Following the screening process, merely 10 qualitative studies were identified, which represented practitioner views across 22 CM professions. CM practitioners believe they provide a distinct model of care informed by a traditional shared holistic and vitalistic philosophy. Nonspecific factors, such as an augmented therapeutic relationship, empathy, and patient empowerment, are actively and deliberately incorporated into the treatment process alongside specific interventions and afforded equal valued. Conclusions: This metaethnographic synthesis brings together the perceptions of CM practitioners on how healing transpires within the CM clinical setting. In a context of medical pluralism and aspirational integrative health care, this synthesis highlights the understanding and approach CM practitioners bring to health management and may assist in further defining CM philosophy and practice, and the positioning of CM in the contemporary health care landscape.

Understanding the Traditional Chinese Medicine (TCM) consultation: Why do patients adhere to treatment?

BACKGROUND

and purpose: Adherence is an issue that affects Complementary and Alternative Medicine (CAM) and conventional medicine practitioners, whereby approximately half of the patients do not take their medicines or remedies as prescribed. The consultation is an opportune area where practitioners can have an impact on patient adherence to treatment. As such, research was undertaken to explore this in depth within one CAM. The aim of the study was to understand the Traditional Chinese Medicine (TCM) consultation process that occurs in relation to adherence and develop a consultation model health professionals can use.

MATERIALS AND METHODS

A classical grounded theory approach was employed to semi-structured interviews of TCM practitioners and patients along with observations of their consultations. Sampling was theoretical and by snowball in the United Kingdom. NVivo 11 was used to assist with analysis of the transcribed interviews and observations.

RESULTS

Seven TCM practitioners and twenty-eight patients were recruited. TCM practitioners built a therapeutic relationship through the consultation by enabling patients to feel comfortable, valued as individuals which incorporated feeling understood and known, as well as supported in the management of their health. Fundamentally, patients needed to feel cared for and have trust in their TCM practitioner for the therapeutic relationship to be established. This motivated patients to continue with treatment.

CONCLUSION

The TCM Consultation Model for Adherence was developed to conceptualise the consultation process that occurs in relation to adherence. It can be used to encourage patient persistence with treatment by TCM practitioners and potentially other health professionals.

"Placebo effect is probably what we refer to as patient healing power": A qualitative pilot study examining how Norwegian complementary therapists reflect on their practice

BACKGROUND

Complementary therapists spend considerable time with their patients, especially in the first consultation. The communication between patients and their therapists is important for raising consciousness and activation of the patient's self-healing power. Thus, the aims in this study were to delineate what complementary therapists regard as essential in patient consultations, their view of the healing process, and how the therapists understand the placebo effect and its position in the healing process.

METHODS

Semi-structured individual interviews (n = 4), focus group interview (n = 1) and participant observation were conducted among four different complementary therapists in a Norwegian community. The text data was transcribed verbatim and the analysis of the material was conducted according to conventional and direct content analysis. Some codes were predefined and others were defined during the analysis.

RESULTS

The pilot study showed that the implemented methods seems feasible and fit well with the aims of this study. Complementary therapists (chiropractor, naprapath (musculoskeletal therapist), acupuncturist and acupuncturist/homeopath) representing four different complementary modalities participated. A combination of the conversation and examination during the first consultation formed the basis for the therapist's choice of treatment. A successful consultation was characterized by a fruitful relationship between the therapist and the patient. Moreover, the therapist needs to be humble and show the patient respect. Patients' positive beliefs and expectations about the treatment play a significant role in the healing process. The more hope the therapist can bring about, the more easily the patient can start believing that it is possible to get well.

CONCLUSION

This was a pilot study. Therefore the findings should be appreciated as limited and preliminary. Therapists' and patients' mutual understanding and treatment goals were essential for a successful consultation. The therapists emphasized their professional skills and therapeutic competence as important when building fruitful relationships with their patients. Exerting authority and making the patient feel confident were essential factors for a successful healing process. The complementary therapists understood the placebo effect as the patient's self-healing power, resulting from establishing trust and belief in the treatment process.

Informing the homeopathic practice for Turkish pharmacists: reviewing the example of Portuguese community pharmacies

INTRODUCTION

Alternative and complementary therapy systems, such as homeopathy, have long been used around the world. Since 1995 homeopathy has been officially recognized in Europe as a system of medicine or a medical specialty. Portuguese community pharmacists have long-standing experience with homeopathic products. By contrast, healthcare professionals in Turkey are less experienced with homeopathic practice although there is a new regulatory setting in place. There are a limited number of studies addressing pharmacists' role within the homeopathic system.

AIM

To investigate the attitudes (knowledge, feelings and behaviour) of experienced Portuguese pharmacy practitioners who deal with homeopathy, and thus to inform Turkish pharmacy practice and policy on homeopathy-related success factors.

METHODS

A qualitative cross-sectional design was followed, using semi-structured and face-to-face individual interviews with purposively selected Portuguese pharmacists experienced with homeopathic medicines. Audio-recordings were transcribed verbatim and the transcriptions imported into QSR NVivo v10 software for qualitative coding and analysis. Using a thematic content approach, the extracted codes were grouped and indexed by recurrent themes through a reflective procedure and constant comparison.

RESULTS & DISCUSSION

Six general themes emerged, the most relevant being participants' feelings of gratitude for the ability to work in homeopathy; other themes were a helpful regulatory body, clear practice boundaries, scientific support and product quality assurance. Specialized homeopathic education was considered the most important factor for success. This was related to patients' positive perceptions and acceptance, suggesting an increase in public awareness through the pharmacy network.

CONCLUSIONS

Portuguese pharmacists' attitudes towards their homeopathic practices highlighted the key elements for success in a field that is usually distant from traditional pharmaceutical education and practice. The present findings provide guidance for Turkish pharmacists willing to expand their professional scope and to embrace complementary medicines.

Damning with faint praise: how homoeopaths talk about conventional medicine with their patients

Homoeopathy is one of the most widely used forms of complementary medicine in the West. However, its methods and philosophical underpinnings are basically polarized in relation to those of conventional medicine. Many homoeopathic patients choose to continue using conventional medicine while they receive homoeopathy, but from a homoeopathic perspective, these treatments are often regarded as undesirable or even damaging. This article will utilize the principles of conversation analysis (CA) to explore points in homoeopathic consultations where practitioners address their patients' use of conventional medications. It will be suggested that approaches which display a degree of incorporation are preferred to those which imply categorical rejection. By not emphasizing the underlying tensions between conventional and homoeopathic paradigms, and displaying an adaptive and inclusive approach, homoeopathy essentially sets itself up as a parallel (i.e. equal) system, rather than one that is purely in opposition to the dominant medical model.