Consumerism, reflexivity and the medical encounter.

Background Studies suggest that between 30% and 50% of the adult population in industrialized nations use some form of complementary and/or alternative medicine (CAM) to prevent or treat a variety of health-related problems. Method A comprehensive literature search identified 25 surveys conducted between 1982 and 1995 that examined the practices and beliefs of conventional physicians with regard to 5 of the more prominent CAM therapies: acupuncture, chiropractic, homeopathy, herbal medicine, and massage. Six studies were excluded owing to their methodological limitations. Results Across surveys, acupuncture had the highest rate of physician referral (43%) among the 5 CAM therapies, followed by chiropractic (40%) and massage (21%). Rates of CAM practice by conventional physicians varied from a low of 9% for homeopathy to a high of 19% for chiropractic and massage therapy. Approximately half of the surveyed physicians believed in the efficacy of acupuncture (51%), chiropractic (53%), and massage (48%), while fewer believed in the value of homeopathy (26%) and herbal approaches (13%). Conclusions This review suggests that large numbers of physicians are either referring to or practicing some of the more prominent and well-known forms of CAM and that many physicians believe that these therapies are useful or efficacious. These data vary considerably across surveys, most likely because of regional differences and sampling methods, suggesting the need for more rigorous surveys using national, representative samples. Finally, outcomes studies are needed so that physicians can make decisions about the use of CAM based on scientific evidence of efficacy rather than on regional economics and cultural norms.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/210591/ira80434.pdf

A review of the incorporation of complementary and alternative medicine by mainstream physicians.

Objectives To describe Victorian general practitioners' attitudes towards and use of a range of complementary therapies. Design A self-administered postal survey sent to a random sample of 800 general practitioners (GPs) in Victoria in July 1997. Participants 488 GPs (response rate, 64%). Main outcome measures GPs' knowledge; opinions about harmfulness and effectiveness; appropriateness for GPs to practise; perceived patient demand; need for undergraduate education; referral rates to complementary practitioners; and training in and practice of each therapy. Results Acupuncture, hypnosis and meditation are well accepted by the surveyed GPs, as over 80% have referred patients patients to practitioners of these therapies and nearly half have considered using them. General practitioners have trained in various therapies--meditation (34%), acupuncture (23%), vitamin and mineral therapy (23%), hypnosis (20%), herbal medicine (12%), chiropractic (8%), naturopathy (6%), homoeopathy (5%), spiritual healing (5%), osteopathy (4%), aroma-therapy (4%), and reflexology (2%). A quarter to a third were interested in training in chiropractic, herbal medicine, naturopathy and vitamin and mineral therapy. General practitioners appear to underestimate their patients' use of complementary therapies. Conclusions There is evidence in Australia of widespread acceptance of acupuncture, meditation, hypnosis and chiropractic by GPs and lesser acceptance of the other therapies. These findings generate an urgent need for evidence of these therapies' effectiveness.

Complementary therapies: have they become accepted in general practice?

Objectives.To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services offered by hospitals.Methods.A literature review and information search was conducted to determine which insurers had special policies for CAM and which hospitals were offering CAM. Telephone interviews were conducted with a definitive sample of 18 insurers and a representative subsample of seven hospitals.Results.A majority of the insurers interviewed offered some coverage for the following: nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. Twelve insurers said that market demand was their primary motivation for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness based on consumer interest, demonstrable clinical efficacy, and state mandates. Some hospitals are also responding to consumer i...

Current trends in the integration and reimbursement of complementary and alternative medicine by managed care, insurance carriers, and hospital providers.

Over the past two to three decades there has been vigorous debate in the sociological literature as well as in popular forums concerning the changing social position and status of the medical profession and the extent to which consumerism has entered the doctor-patient relationship. Few qualitative socio- logical inquiries, however, have directly sought the views of medical practitioners themselves on these issues. To address this hiatus, this article discusses the findings from an empirical study using semi-structured indepth interviews with 20 doctors living and working in Sydney about their views on the contemporary status ofthe medical profession and their experiences of medical practice. Three major aspects are discussed: the extent to which the social position of doctors has changed, the impact of consumerism on medical practice and the qualities ofa 'good' doctor. The implications of these data for theorising the nature of contemporary medical practice, power and professional status is explored, with particular reference to the insights offered by Foucauldian theory.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-9566.1997.tb00414.x

Doctors on the medical profession

Disenchantment with allopathic medicine has coincided with an upsurge in recent years in Australians consulting alternative therapists about their health care needs. Two major government studies have provided valuable independent evidence about the sociodemographic characteristics of users of alternative therapies and about their attitudes to health and medical care. However, the focus of these inquiries was predominantly on the users of chiropractic and osteopathy, just two of the modalities which make up this diverse field. To investigate, among other things, who consults alternative practitioners, how they come to choose a particular therapist, and whether, and on what basis, they have abandoned cosmopolitan medical care or use a combination of alternative and allopathic medicine, we conducted a cross-sectional survey of 289 patients of eight Sydney practices providing a range of alternative modalities. Findings indicate that far from being representative of the Australian community, the majority of our sample population came from a very select group, with a narrow range of socioeconomic backgrounds. The health risk behaviour of those surveyed was also significantly different from that exhibited by the population in general.

Choosing alternative therapy: an exploratory study of sociodemographic characteristics and motives of patients resident in Sydney

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Choosing alternative therapy: an exploratory study of sociodemographic characteristics and motives of patients resident in Sydney