Models of Medicine Flashcards
what part of the Kleinman’s model do CAMs fall into?
Complementary and Alternative medicine falls into the
popular sector (info about CAM is passed on by lay-public)
folk sector
professional sector (in some clinics in hospitals, complementary and alternative medicine are used e.g. in cancer centres)
of the Kleinman’s model
what are the definitions for CAMs?
Complementary medicine: when a non-mainstream practice is used together with conventional medicine. E.g. cancer patient receiving acupuncture alongside chemotherapy
Alternative: when a non-mainstream practice is used instead of conventional medicine e.g. cancer patient refuses chemotherapy and relies on complementary medicine.
There is an overlap. Sometimes an alternative medicine can be used in a complementary setting.
Complementary & Alternative medicine (CAM) – a group of therapeutic & diagnostic disciplines that exist largely outside the institutions where conventional healthcare is taught and provided.
Medical students should be aware of the range of CAMs, why patients use them and how this might affect other types of treatment that patients are receiving.
what is Integrative medicine?
where both patients & HCPs are onboard with the use conventional & complementary treatments
what is Pluralism?
a system where more than one route of treatment is offered in healthcare to the patient i.e. GP would offer both an orthodox treatment route and an alternative treatment route for the patient to decide.
how many people use CAMs?
what is the most used CAM?
50% of people use CAMs
Average referral rate of patients to CAMS by a doctor is 39%
Over the counter usage of CAMS (e.g. herbal preparations) is greater than therapist usage as OTC is easier access, cheaper and more convenient (no appointments)
Acupuncture was the most used CAM followed by homeopathy and relaxation therapy.
what patients use CAMs the most?
Higher rates of use of CAMs among patients which chronic and difficult to manage diseases e.g. cancer, HIV MS, etc.
Some cancer patients use CAMS to alleviate side effects of cancer treatment e.g. nausea.
This may be because orthodox medicine will come to a limit on how much it can help patients. The symptoms may still however be problematic so patients look elsewhere to help relieve symptoms.
what are the 5 groups of complementary therapies?
Mind-body medicine – techniques designed to enhance the mind’s capacity to affect bodily function & symptoms i.e. meditation & prayer
Manipulative & body-based practices – movement of one or more body parts i.e. chiropractic, osteopathy and massage
Alterative medical systems – built on complete systems of theoretical principles & practice i.e. homeopathy & traditional Chinese medicine
Natural products - e.g use of natural substances e.g. herbal products etc.
Energy medicine – medicine that effects the energy fields that supposedly surround and penetrate the human body e.g. bioelectromagnetic-based therapies, Reiki, therapeutic touch.
how did the House of Lords classified CAM therapies in 2002?
Most popular therapies with most evidence are in G1. Popularity and evidence base decreases as you go down
Group 1 (i.e. acupuncture, chiropractic, osteopathy, homoeopathy, herbal medicine e.g. St John’s Wort) – have a diagnostic approach i.e. take a history to develop a management plan specific for you.
Group 2 (i.e. aromatherapy, hypnotherapy & meditation) – these are most commonly used to complement conventional medicine, don’t have diagnostic skills
Group 3a (i.e. traditional and herbal Chinese medicine), philosophical approach.
Group 3b (i.e. dowsing and iridology) – no evidence for these
what are some examples of CAMs?
- Homeopathy: very controversial as nobody can explain how it works. The idea homeopathy is based on is let like be cured by like e.g. taking a small quantity of something that if you would take a large quantity for you would give you the symptoms you are experiencing can help cure you.
Used within the NHS, we have homeopathic hospitals and clinics. - Alexander techniques: suggest that body symptoms and problems can come from incorrect posture. They look at the way you sit and stand and will try to correct this to treat your symptoms. Used by actors and musicians
- Hypnotherapy – is an accepted treatment, NICE guidelines recommend it for refractory irritable bowel.
- Dowsing – moving a two-pronged twig around the body. When twig quivers that is the site of the problem is.
- Iridology – attempting to diagnose where a problem might be in a patient by looking at the colour of a patient’s iris
- Traditional Chinese medicine: evidence on this is low as there are not many research papers in English about it.
Homeopathy and herbal medicine are very popular as you can buy them over the counter.
are CAMs recommended by doctors?
It is important to know that although the evidence base for a lot of CAMs are lacking there are a few CAMs which have been recommended by NICE such as the Alexander technique for Parkinson’s disease, ginger and acupressure for reducing morning sickness in pregnancy etc. because they have proven effective.
what demographic uses CAMs the most?
female gender (menopause- treat low-lying symptoms i.e hot flushes, fatigue, joint pains)
middle-aged
higher socio-economic groups
higher level of education
regional differences (greater use in South England)
Ethnicity – no research 🡪 common assumption that different cultures prefer different treatments I.e. their own
Individuals usually have poorer self-reported health, people who feel orthodox medicine can’t control symptoms so they go to complementary therapists
what are the 4 different patterns of complementary medicine usage?
Earnest seekers – have a chronic health problem for which they have tried many therapies for, one therapy being CAMS
Stable users – either use one type of therapy for most/all healthcare problems or use a range of therapies for one main problem they are suffering from
Eclectic users – choose & use different therapies for different problems
One-off users – discontinue complementary therapy after limited use
It is important for doctors to know what kind of user a patient is to see if it is appropriate to recommend CAM or not.
what factors are causing growth of CAM?
Dissatisfaction with orthodox medicine
- i.e. orthodox limit
- long waiting times for appointments
- short appt times (they want longer care)
- serious adverse effects
- high tech, low touch
Postmodern philosophy rejection – People feel CAMS fits more with the way they look at life, they prefer natural products and are concerned about side effects of modern medicine
Widespread availability of healthcare information has made it easier to access to CAMs.
Increase in consumerism (patient choice)
Importance of individual responsibility for health propels CAMS
what are the positive reasons for the use of CAMs?
Accessibility – available over the counter or appt waiting times are quick (spending does not go down in times of money stress as people see it is important)
high touch, low technology (people like this)
have more control over your treatment
philosophical congruence 🡪 therapies fit with how you see the world
pleasant therapeutic experience 🡪 although generally because therapist wants patient to return & spend more money
perceived effectiveness & safety
Good patient-therapist relationship 🡪 i.e. enough time available for treatment, on equal terms, therapists more polite, longer appt times
Non-invasive nature (not true for acupuncture or when herbal medicine interacts with orthodox medicine)
affluence – people have money to use
what are the negative reasons for orthodox medicine that cause people to use CAMS?
dissatisfaction with some aspects of orthodox medicine:
- ineffective for certain conditions
- serious adverse effects
- poor dr-patient relationship
- insufficient time with dr
- long waiting lists
- high tech, low touch
- rejection of science & technology
rejection of the ‘establishment’ – the NHS
desperation - some people will do anything to find a cure to relieve their symptoms & may turn to complementary medicine if orthodox doesn’t work or is limited
