A registrar survival guide ... referral to complementary medicine

Do you know your autogenic training from your cranio-sacral therapy?

When would Devil's Claw three times a day be beneficial? (It is not in a prescription formulary, I've checked).

These and a plethora of other questions are awaiting you in primary care.

Today, with consumer-driven health delivery, how people access healthcare and what type of healthcare it is varies wildly. Therefore, a working knowledge of complementary and alternative medicine (CAM) is essential.

Whatever your views on this area of healthcare, some patients are vocally passionate about it. Equally some people are sceptical.

In these cash-strapped times, funding of therapies without a good evidence base is coming under scrutiny.

Accessing complementary medicine
Whether or not you can access CAM will be dependent on your primary care organisation. Your area may already have some services in place. There is evidence for certain CAMs, such as acupuncture, so referral might be easier.

Where to refer to
If you want to refer a patient to complementary medicine but are unsure where to go, consult The NHS Directory of Complementary and Alternative Practitioners at www.nhsdirectory.org

Appeal
If your referral has been declined on the NHS but you believe the CAM to be essential to the health of your patient, appealing the decision is possible. Be prepared to give a convincing argument.

Giving your opinion
A patient may ask you to suggest a practitioner or for your opinion on a particular therapy. Obviously, mumbling about RCTs and meta-analyses might not be helpful, so if in doubt, find out and get back to the patient.

Most importantly, be open minded.

  • Contributed by Dr Syed Haque, a GP registrar in East Anglia
Essentials checklist
  • An open mind.
  • Knowledge of complementary therapies and the evidence base for each.
  • An ability to listen to patients' beliefs about complementary medicine and have a frank discussion regarding access for unproven modalities.

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