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Homeopathy in general practice
The ten-minute appointment system is not incompatible with homeopathic prescribing, explains Tim Robinson
In essence my life as a GP homeopath is no different to any other regular GP. I go to work, make a few diagnoses, prescribe some medicines and graft my way through two long surgeries. But as a GP homeopath, there are a number of subtle differences to that of a non-homeopathic GP. These differences relate to each of the above, namely the diagnoses, prescriptions and the grind!
I have been working full time in a country three-doctor practice for almost 20 years. After about five years in post I began to feel restless. I needed a new challenge within my medical world. I loved my job but somehow I wanted to improve on it. I was aware of certain gaps in the conventional practice of a GP. There were many conditions that conventional medicine did not treat very well or not at all. I kept on being asked by patients for an alternative to chemicals. There were many patients who seemed to be stuck in a state of ill health, on heaps of tablets, constantly at the surgery or being investigated over and over again in the hospitals.
There seemed to be many of these unfortunate patients with the unkind label of “heart sink” cases. I found myself wondering what could be done about these. I also wondered how I could address my restlessness!
Introduction to homeopathy
I had been aware of homeopathy since my school days; my dear mother used to send me medicines for sore throats and indigestion. Subsequently as a medical student I used to buy my own remedies at Ainsworths pharmacy which was not far from my medical school. A number of years later, by that time married and in my GP partnership, my wife developed leg cramps in pregnancy. I was advised by Ainsworths to give her Cuprum metallicum which cured the cramps. This all happened at around my five year restless phase.
And then I received a flyer for the introductory course at the Bristol Homeopathic Hospital and the rest is history. Homeopathy has been an integral part of my life since then, fulfilling the challenge and providing the stimulation that I had been looking for, as well as benefiting my patients in so many ways.
The provision of a homeopathic service in routine general practice is very straightforward. As with all consultations the patient presents their particular problem or set of symptoms from which I make a diagnosis and decide upon a management plan for the case. If I consider homeopathic treatment is an appropriate, safe and valid alternative I offer my patient the choice at that point. I usually point out that we homeopaths don’t know how it works but years of homeopathic experience support its effectiveness. When I am offering the homeopathic choice I back it up with the fact that it won’t do any harm and if it doesn’t work we still have conventional medicine to fall back upon. Patients are usually receptive to this and grateful for the choice.
Homeopathic prescribing is perfectly possible within the standard ten minute GP consultation time. The prescription is usually based upon one of a number of possible prescribing strategies. For example some specific conditions respond to specific medicines, such as Arnica for bruising or Cocculus for car-sickness. I may also prescribe on “local” features of a condition – ones that are individual to the case, for example joint pains that are better for heat and movement (Rhus tox rather than Bryonia).
I also prescribe on what’s known as the isopathic principle. This is similar to the principle of immunisation in which a small dose of the causative agent is given to the patient. In conventional immunisation this stimulates antibody production; in homeopathy this stimulates a healing response, the mechanism of which we don’t understand. An example of this is with hay fever treatment in which pollen is given in homeopathic form to prevent the hay fever symptoms.
Once I have arrived at a diagnosis and the patient has chosen to be treated homeopathically I then make up the medicine on the spot. Having provided a homeopathic service over the years I have accumulated a large supply of liquid potencies of the medicines. I simply add two drops to a small phial of pills (kindly pre-filled by my dispensing manager), print off a label and hand it to my patient. I also print off a homeopathic medicine instruction sheet. This contains practical information on how to take the medicine as well as cautions, general advice and background information about homeopathy. I then ask the patient to make a follow-up appointment four weeks later.
This process is easily achievable within the ten minute consultation. There are times though in which the patient’s condition is more complex and requires a full, “whole person” constitutional case assessment. This requires an hour in consultation which, of course, is not feasible in the GP setting. I have got around this over the years by arranging a double appointment at the start of a surgery but ask the patient to attend 40 minutes before this; thus I have managed to create the hour needed for the constitutional consultation. If this is not possible I am able to refer to a homeopathic consultant colleague in one of the five NHS homeopathic hospitals, a service that remains accessible to all GPs and consultants within the health service.
Conditions I treat homeopathically
Over the years I have found homeopathy very useful in general practice. It has extended my ability to care for my patients. There are so many situations in which it is useful. When I audited my use of homeopathy over one year within the surgery, I found that I had prescribed for 86 different conditions or situations.
Homeopathy can be used in nearly all the problems that I would be using conventional treatment for – indeed I say to my patients that I feel lucky that I have two dispensaries, one of conventional drugs and the other of homeopathic medicines. And so for patients who don’t want conventional medicine, homeopathy is a valid and effective substitute for problems in all the systems: respiratory (catarrh, asthma, flu), digestive (indigestion, irritable bowel syndrome, constipation), joint, hormonal, skin (eczema) as well as anxiety, bereavement, panic attacks and recurrent migraine.
Homeopathy is also really useful in situations in which conventional medicine is ineffective or non-existent such as bruising, chilblains, leg cramps, growing pains, glandular fever, teething, infantile colic, childhood night terrors and bed-wetting. It is also valuable in situations where conventional medicine may be unsafe or contraindicated such as in pregnancy or the elderly who can’t take anti-inflammatory drugs because of a past history of indigestion.
GP colleagues enquiring about homeopathy usually ask me, “What’s it good for and how could it help my practice?” There are many examples such as those that I’ve mentioned above but there are also situations in which all GPs like to avoid conventional medicine.
For example in those women who can’t take HRT, homeopathy can be a useful treatment for menopausal sweats and flushes. All physicians are constantly trying to reduce antibiotic prescribing; homeopathy can be very effective in treating ear infection, tonsillitis, recurrent sinusitis. Homeopathy is also excellent for treating cold sore sufferers thus reducing the prescriptions for antiviral drugs.
Along with all of these benefits I also believe that patients appreciate the holistic approach to healthcare. I like to think that our practice is viewed as broad-minded and prepared to work outside the narrow confines of the “medical box”. I feel that this helps to strengthen the working relationship between the doctors and patients, which assists the overall healing process.
Benefits to the NHS
I believe that GP homeopathy also brings benefits to the NHS as a whole. Patients who receive homeopathic medicines are therefore not receiving the more expensive conventional medicines. Thus there is an immediate saving on the strained NHS drug budget. Factor into this other disadvantages of conventional drug treatment such as side-effects, illnesses as a result of conventional drugs and drug interactions, and further savings are made to the NHS budget.
As well as this, patients who are treated successfully with homeopathy may not require referral onto the hospital service. This saves valuable appointments for patients who are more in need of those appointments. The patients receive immediate treatment rather than having to wait anxiously, in a state of distress and discomfort, for a hospital consultation.
Thus far I have concentrated upon all the benefits that homeopathy brings to the patients in particular and the NHS in general. There are other benefits besides these relating to the homeopathic GP him or herself. One of the main motivations for me in my involvement with homeopathy was the need for a challenge and further stimulation in my medical practice.
There is a well-recognised phenomenon called “burn-out” which can occur in any profession and medicine is no exception. The professional loses interest, enthusiasm and enjoyment in their chosen field. We are all in danger of falling victim to “burn-out”. Homeopathy provided me with all the anti-burn-out tools, namely interest, enthusiasm and enjoyment, and continues to do so.
As well as this I have found that homeopathy has been a tremendous help in further developing and refining my consultation skills. My ability to connect to patients within the consultation has been enhanced. I like to think that this has made me a more effective and efficient doctor. It has provided me with a deeper interest and insight into the dynamics of the consultation, its objectives and most importantly, the underlying or initiating factor behind the patient’s problem. I liken my role to that of a private detective for health issues – an Inspector Morse or Sherlock Holmes even! The heart-sink patients that I referred to earlier have now become a challenge; every one of them has a story to tell and there is a reason for their chronic problem. The homeopathic approach, the medicine and the enjoyment of the consultation gives me the chance to unravel the problems or at least clarify and simplify their management. Perhaps this is why I would consider that I have very few true heart-sinkers on my list. The net effect of my combined role of GP and homeopath is that my job satisfaction, enjoyment of work and life have all been enhanced.
Countering the critics
We are all aware of the savaging homeopathy has been receiving. Our critics discredit homeopathy by saying that patients improve (yes they admit they do improve) because of long and repeated consultations. As I have described, my homeopathic consultations are mostly seen within standard ten-minute GP appointments. Thus the additional psychotherapeutic effect that can be gained from long consultations does not apply in this situation.
My homeopathic prescribing audit that I mentioned earlier demonstrated many interesting facts apart from the amazing scope and range of conditions that homeopathy can be prescribed for. It also showed that over that 12-month period I prescribed homeopathy in nine per cent of my total GP consultations. I assessed the outcomes from the homeopathic treatments by scoring the degree of improvement. I was pleased to find that 78 per cent of those patients treated noted an improvement.
These results support my use of homeopathy within my NHS general practice. It was also pleasing to find that this improvement result was of the same magnitude as other outcome studies performed in homeopathic hospital outpatient clinics.
Despite the consistency between these independent studies’ outcomes, the sceptics are still unconvinced. They keep bleating their mantra of “Homeopathy can’t work as there’s nothing in it”, in spite of the fact that there are plenty of other studies that demonstrate that it does work; these support anecdotal cases of its effectiveness in babies, children, cats and dogs! We openly admit that the medicines are so dilute there are none of the original molecules left in it but how do you explain that these same medicines have a measurable effect in laboratory experiments with white blood cells, rat intestine and allergy response blood components?
The sceptics also claim that patients improve (yes they still state that they improve!) because we only treat conditions that get better on their own with no treatment. Those of us who have been treating patients with homeopathy for long enough will know that we successfully treat many long-term conditions that have shown no sign of improvement over long periods of time.
We are also accused of deliberately misleading our patients; as I described earlier, I ensure I tell my patients that we don’t understand how homeopathy works and leave it to them to decide between conventional and homeopathic treatment.
My final annoyance with the sceptics is that they accuse us of being dangerous and treating inappropriately by discouraging childhood immunisation and recommending homeopathic vaccination against malaria. Members of the Faculty of Homeopathy operate within very clear policy guidelines which advocate medical immunisation and condemn homeopathic malaria vaccination.
Not only do the sceptics aim to discredit homeopathy, they also hope to close the NHS homeopathic hospitals in order to save £9 million annually. When you consider that the total NHS budget is fast approaching £100 billion, this represents a very small saving on the NHS budget. In actual fact this is a very short-sighted saving; if funding for homeopathy was withdrawn from those patients who are treated successfully, they would then have to be absorbed by the conventional, overstretched hospital service and treated with much more expensive allopathic medicines.
During these troubled times for homeopathy we are indeed fortunate that there is a body of patients who remain unflinching in their belief in homeopathy and recognise the bleating of the sceptics as totally unfounded. Their first-hand experience of homeopathy’s effectiveness and personal recommendations to family and friends makes them valuable allies against those blinkered, disbelieving sceptics.
In an ideal world there would be even greater provision of homeopathic treatment in the GP setting. I know that it would bring great benefits to patients, ease the NHS drug bill and pressure on hospital services, enhance the enjoyment and effectiveness of my fellow general practitioners; the quality of life of all parties involved would be enhanced. This is certainly my experience having been providing homeopathy in my GP setting over the last 13 years.
Dr Tim Robinson MBBS MRCGP DRCOG MFHom is a GP in Beaminster, Dorset and a lecturer at Bristol Homeopathic Hospital.