Tuesday, 15 May 2012

Informed Consent and Homeopathy

Conventional medicine (ConMed) usually fails to provide patients with sufficient information about the effectiveness and safety of their treatments, and so fails to provide patients with a situation in which they can give their 'informed consent' to medical treatment. So what information should Homeopaths give to patients to ensure they are able to give their 'informed consent'. As 'the Black Duck' said, in response to my previous blog:

          "Perhaps you might like to tell us how homeopaths tackle the tricky issue of informed consent? Do you set out some of the controversial aspects of homeopathy, the current lack of understanding of how homeopathy might work, and so on? Do you allow patients to make their own informed decisions on the back of this information, or do you make that decision for them?
Most new Homeopathy patients fit into one of two categories. Some arrive at an early stage of their illness because they have already decided that they do not want to go through the ConMed route of drug-based treatment. Others have gone through the NHS-ConMed route, some for many years, and found that their health has not improved, or has gradually declined. In neither category can the Homeopath take for granted that the patient knows enough about their illness, and its treatment by Homeopathy, to ensure that they can make an 'informed choice' about it.

What do you know about homeopathy?
This opening gambit is probably a sensible one in any initial Homeopathy interview as it will ascertain just where the patient is in terms of his/her knowledge and understanding. And it is always important to start from this point rather to make any assumptions. Increasingly, I am finding that potential patients have already done considerable research into Homeopathy, and/or have heard about it from former patients who have been treated successfully. But nevertheless the question remains important. What patients say in response to it will determine what the Homeopath needs to say to enable them to made an 'informed choice' about proceeding with Homeopathy.

How does homeopathy work?
The Black Duck feels that this is important. Actually, for most patients, it is not important! Indeed, it is probably not important for patients who seek help from any medical discipline. Patients know that they are ill, and that they want to get better. Most conventional doctors would be hard-pressed to explain how their drugs are supposed to work! And it is not my experience that patients want to sit through a long, philosophical lecture on the working mechanism of any particular medical therapy!

So I usually keep the explanation (or answer) to this question quite brief, mentioning the homeopathic principle of 'treating like with like', and briefly describing 'remedy pictures', and 'symptoms of illness', and the importance in Homeopathy of matching the two together. If patients want to ask further questions about this (and most don't) I will try to provide them with answers, based on my understanding.

However, one important point should be made in response to this question. This concerns the nature of the healing process, and how this will be driven by the body, and not by the homeopathic remedy. All the remedy does is to seek to assist the body to do so - it will not do so in its own right. Remedies are not 'wonder cures', all they do is to 'nudge' the body towards its self-healing task.

In addition, every patient should be told that Homeopathy works best when it is used as part of a 'holistic' strategy, which stresses the importance of good diet, exercise, and other life-style factors. 

Primarily, most patients want to know about two things. Is homeopathy an effective treatment for their condition or illness? And how safe is it?

I usually begin with the latter - safety. I tell them that homeopathy is safe, and will not cause 'side-effects', 'adverse reactions', or indeed, cause disease or death. To support this, I will give a brief description of how remedies are made - by serial dilution and succussion. I may then tell them about the 'mass suicide' demonstrations undertaken by 'homeopathy denialists', like 'the Black Duck', in order to show that remedies cannot harm patients in the same way as Big Pharma drugs. I will then affirm that if, together, we arrive at the wrong remedy it will do absolutely no good whatsoever - but likewise it will do no harm!

It is then quite easy to move on to discuss effectiveness. I have always felt it important to tell patients that in order to be effective, a correct or 'similar' remedy has to be found. If such a remedy is found there will be some measure of improvement in the condition or illness. If it is not there will be no improvement. At this stage I always feel that it is important to manage expectations. There are no guarantees. This is especially important, perhaps, when a patient has arrived after homeopathy has cured or successfully treated a friend or relative (the source of most new referrals).

The Working Partnership
This quickly introduces another vital piece of information the patient needs to know about homeopathy, that the treatment process needs to be a partnership, and that it is not an 'expert-client' relationship. Although the Homeopath may have all the training and knowledge needed to determine a remedy that is 'similar', he/she can only arrive at this if the patient is able to openly, honestly and with insight, explain and describe their symptoms. 

This means that the patient is a vital part of the process. Even the most skilled and experienced Homeopath has to depend on the patient for the treatment to be effective.

Normally I will also tell patients that I am likely to ask some strange, and sometime intimate questions, and that these questions will often appear to have little relationship to the illness or disease being treated (at least, not in conventional terms).

In my experience, Homeopathy works best when it is conducted within a professional relationship that is open, honest and transparent. And I know of no reason why the homeopath-patient relationship should be based on anything else!

It is always important for 'non-doctor' homeopaths, like myself, to explain that we are 'homeopaths' and not 'medical doctors' - that, for instance, we do not diagnose disease - that our skills are about matching the patients' symptoms of illness with remedies. I will usually tell patients that if they tell me anything that suggests that a formal diagnosis is necessary, or advisable, I will ask them to see their GP.

Do they wish to continue on the basis of this information?
At this point, I feel it is important for Homeopaths to ask the question - do they wish to continue? Often, this question is asked and answered during an initial telephone, or email enquiry. However, in my experience, few people who have bothered to ask these questions, when given these answers, have then decided to decline treatment. Most are content with the explanations given, and genuinely keen to proceed at this stage.

And in response to 'the Black Ducks' implied criticism, I don't know of any patient who has been forced to accept Homeopathy. Nor am I aware of any decision that I, or any other homeopath, 'make on behalf of patients'

Perhaps I can remind him that most patients who choose Homeopathy pay for it privately. This is quite different to the approach most patients find within the NHS: "you are ill, we are only going to offer you drug-based, ConMed treatment, and we are not going to tell you much about it"!

Providing the remedy.
I will always tell the patient about the remedy I would like them to take (I don't think I have ever told a patient to 'take a remedy' - I have always said 'I would like you to take this remedy'). Normally I will tell the patient what the remedy is, share some of the key symptom that it is known to deal with, and tell the patient why I feel this is important in their case. 

I will also tell the patient that if, after taking a remedy, the symptoms get worse (what we call an aggravation) to contact me in order to discuss the situation, and what to do about it.

Thereafter, the process of homeopathic treatment is concerned with the patient and homeopath working closely together, discussing changing symptoms, modifying the potency of remedies, and moving to other remedies when necessary.

Providing the patient with this information, honestly and openly, enables them to give their 'informed consent' to Homeopathic treatment. And as we have seen, Informed Consent is also important to the very process of providing patients with homeopathic treatment.  So it is not 'tricky' to do so, as 'the Black Duck' suggests. It is actually quite easy, and essential to the process of healing.

Of course, it is true that providing this information to patients is easier for homeopaths as we have nothing to hide. Our remedies do not cause 'adverse reactions', disease or death. Our treatments do not involve potentially dangerous chemicals, invasive surgical procedures, or dangerous X-Rays or Radiation.

Homeopathy works alongside the body, helping it to achieve what it usually does quite naturally - keeping us healthy. Homeopathy has an easy, straight-forward and honest message that most patients, when they hear it, will understand and readily accept.