Diagnoses and visit length in complementary and mainstream medicine

Abstract

BackgroundThe demand for complementary medicine (CM) is growing worldwide and so is the supply. So far, there is not much insight in the activities in Dutch CM practices nor in how these activities differ from mainstream general practice. Comparisons on diagnoses and visit length can offer an impression of how Dutch CM practices operate.MethodsThree groups of regularly trained physicians specialized in CM participated in this study: 16 homeopathic physicians, 13 physician acupuncturists and 11 naturopathy physicians. Every CM physician was asked to include a maximum of 75 new patients within a period of six months. For each patient an inclusion registration form had to be completed and the activities during a maximum of five repeat visits were subsequently registered. Registrations included patient characteristics, diagnoses and visit length. These data could be compared with similar data from general practitioners (GPs) participating in the second Dutch national study in general practice (DNSGP-2). Differences between CM practices and between CM and mainstream GP data were tested using multilevel regression analysis.ResultsThe CM physicians registered activities in a total of 5919 visits in 1839 patients. In all types of CM practices general problems (as coded in the ICPC) were diagnosed more often than in mainstream general practice, especially fatigue, allergic reactions and infections. Psychological problems and problems with the nervous system were also diagnosed more frequently. In addition, each type of CM physician encountered specific health problems: in acupuncture problems with the musculoskeletal system prevailed, in homeopathy skin problems and in naturopathy gastrointestinal problems. Comparisons in visit length revealed that CM physicians spent at least twice as much time with patients compared to mainstream GPs.ConclusionsCM physicians differed from mainstream GPs in diagnoses, partly related to general and partly to specific diagnoses. Between CM practices differences were found on specific domains of complaints. Visit length was much longer in CM practices compared to mainstream GP visits, and such ample time may be one of the attractive features of CM for patients.

The role of global traditional and complementary systems of medicine in the treatment of mental health disorders

“…Every definition notes that CAM therapies are not part of conventional biomedicine, though the exact phrasing differs and some authors note the intrinsic relativism of any such criterion 1,10 . Indeed, the boundary between conventional medicine and CAM is increasingly muddy as medical schools, general practitioners and hospitals worldwide have introduced CAM therapies alongside mainstream biomedical therapy 16,17,18 , and official regulatory bodies acknowledge and licence selected CAM practices 1 . Definitions which note that CAM satisfies a demand not met by conventional biomedicine usefully explain the complementary function of CAM in society, but still depend unsatisfactorily on the ill-defined shortcomings of biomedicine.…”

“…Repeatedly, CAM users report that using both forms of care together is more useful than either alone 74,75,76 . However, CAM users do complain about the quality of the doctor-patient relationship during the brief consultations typical of conventional medicine 18,77 . In addition to more satisfying consultations, the philosophies behind CAM have a persuasive appeal which users find compelling 19,78 .…”

Integrative paediatrics: a Dutch experience

“…Up to 30–40% of children visiting regular paediatric outpatient clinics make use of CAM 1,2 . The types of CAM most frequently used by children are homeopathy, phytotherapy and manual therapies, which are generally offered by CAM practitioners that practise CAM mostly outside the world of mainstream medicine 1,3 . CAM use is often unsupervised since the majority of parents seldom discuss the use of CAM with their general physician or paediatrician 1,4 …”

“…1,2 The types of CAM most frequently used by children are homeopathy, phytotherapy and manual therapies, which are generally offered by CAM practitioners that practise CAM mostly outside the world of mainstream medicine. 1,3 CAM use is often unsupervised since the majority of parents seldom discuss the use of CAM with their general physician or paediatrician. 1,4 Last year discussions took place within the Royal Dutch Medical Association (RDMA) about the health risks associated with the limited evidence base of CAM interventions.…”

Placer, transformación y tratamiento: uso de las medicinas alternativas para problemas emocionales en la Ciudad de México

“…those related to emotional problems stand out from the rest. The international literature suggests a high use of these practices for the treatment of mental and emotional problems (Collinge et al, 2005;Weze et al, 2006;Rodrigues-Neto et al, 2008;Russinova et al, 2009;Heiligers et al, 2010) particularly to attend depres-sion and anxiety (Kessler et al, 2001;Gallagher et al, 2001). In Mexico, surveys have reported that a significant percentage of the population with emotional disorders use CAM.…”