Medical homoeopathyBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7139.2 (Published 18 April 1998) Cite this as: BMJ 1998;316:S2-7139
Does allopathy have all the answers? General practitioner Kathy Ryan thought not. She describes the training and practice opportunities for doctors in a specialty with big plans for the the future
- Kathy Ryan, general practitioner and clinical assistant in homoeopathic medicine,
When I give a talk on homoeopathy my first acetate reads, “Homoeopathy for sceptics; By an ex-sceptic.” When, as a senior house officer, I heard that an acquaintance had got involved with homoeopathy my response was, “how unwise and unsound.” But the realisation of the limitations of conventional medicine starts to dawn fairly early, usually as a student, when, as the patient leaves, the registrar says exasperatedly over his shoulder, “She's mad.” Sometimes this is justified, but the truth of the matter is that the patient has needs which traditional medicine cannot address. Such patients are commonplace. They have symptoms we cannot explain: one quarter of GP consultations, and half of outpatient attendances are with people with unexplained physical symptoms(1); they have symptoms which add up to a diagnosis, but there is little treatment; they have a ‘proper' illness which should respond to our medication but doesn't; they don't like our drugs or have side effects from them; they say funny things like, “I haven't been right since I had that D&C…” and so on. What does one do with such patients? It was exactly this frustration which led me to start looking at complementary medicine.
Homoeopathy does not have all the answers, but audits of homoeopathic treatment show that around 70% of patients have a moderate to major improvement. It remains controversial, but there is evidence to support its use.(2)–(4)
Combining in practice
Integrating homoeopathy into general practice, rather than pursuing it as a career in itself, is straightforward. All homoeopathic medicines may be prescribed on an FP10, in addition to, or as an alternative to, conventional strategies. Hospital doctors must get the approval of the hospital's therapeutics committee. This has already happened, for example, on renal units, where the patients obviously have more problems with the side effects of conventional medication.
Integration with conventional practice
Wider therapeutic repertoire
Safe holistic approach
Stimulus of like minded colleagues
Increased patient satisfaction
Income from teaching and private work
Increased overall job satisfaction
Variable reactions from colleagues
Can feel isolated if no other medical homoeopaths locally
Frustration in wishing to use homoeopathy more, but lacking the time
Time, money, and energy required to learn it
Chronic conditions in general practice are less straightforward. Sometimes quick and accurate decisions about homoeopathic medicine are possible, but usually an individualised prescription is required. This means that not only is the patient's presenting complaint taken into account, but also any coexisting symptoms, history, and general characteristics. For example, two women,different in some respects (one fussy, insecure, sensitive to cold, the other worn out, weepy, and having lost affection for her husband) but with similar symptoms of irritable bowel syndrome would receive different homoeopathic treatment. The amount of detail required takes time to gather, and it is likely that a longer than usual consultation will be needed to ensure one has the full picture. There may be payoffs. Further visits for the same condition will be avoided, as may referral to secondary care.(5) Homoeopathic medicines are very cheap, and safer than many orthodox drugs. Finally, and importantly, the vast majority of patients are pleased to be offered the option of homoeopathy.
There are opportunities in both the NHS and private sectors. There are five NHS homoeopathy units in the UK; in London, Glasgow, Liverpool, Bristol, and Tunbridge Wells. They are each run by one or more consultants, with support from associate specialists, clinical assistants, registrars and SHOs. Each centre has a programme of education, audit and research. In addition, there is a network of specialist NHS homoeopathy clinics scattered around Scotland. Entry is either at clinical assistant or senior house officer level. For the former the MFHom is preferred, while for the latter a year or two of general experience is expected. Senior house officer appointments are more usually for twelve months rather than six.
After completing one of the accredited courses and finishing vocational or general professional training, one can take the Membership of the Faculty of Homoeopathy exam which has written and clinical parts. Practitioners who want to integrate homoeopathy into their conventional medical practice, but not take referrals, can study to be a licensed associate (LFHom), a primary health care certificate which requires a year's study.
Courses are available in Oxford, London, Glasgow, and Bristol. They offer a series of short modular courses held over three or four years. The students are mostly general practitioners, with a number of vets, pharmacists, dentists, and nurses. Glasgow's introductory course is the most popular of any postgraduate medical course in the UK. In Scotland, 20% of general practitioners have undertaken basic training in homoeopathy.
The Faculty of Homoeopathy is working on a curriculum and training pathway which, it is hoped, will prove acceptable to the Joint Committee on Higher Medical Training and the Specialist Training Authority. The eventual creation of a CCST equivalent in medical homoeo-pathy is planned. As it stands a register of specialist homoeopathic medical practitioners will come into being on 1 May this year. To be on this list, one will be required to have completed an approved programme of training post MFHom. The vision is to eventually have a consultant medical homoeopath attached to every hospital.
Private sector work
In the private sector, some doctors join an established homoeopathic practice or complementary medicine clinic. Others set up on their own. Either way, leaving the security of an NHS post to attempt to make a living entirely from private homoeopathy is a daunting task. Most doctors, once reasonably experienced, start seeing paying customers on a part time basis. Taking money directly from patients requires some getting used to. The ‘going rate' to charge is variable: newcomers might ask around £45 per hour; well known practitioners may charge well over £100. It is said to take around two years to build a practice, and even those who are successful will often have rooms in more than one place.
The advantages of joining somewhere which is already established are that the infrastructure is there and the patients are found for you; the disadvantages are that the clinic will take up to 50% of the fee and that you are not your own boss.
Striking out alone has some obvious difficulties, with the need for premises and staff, advertising, pensions, unpaid holidays, isolation, developing a clientele, charging enough for the clinical work to cover cancellations and the cost of medical defence subscriptions. The latter rate is that of a conventional low risk specialty, which can be a substantial amount.
Whether a private enterprise takes off or not will depend on a number of factors. Some of these are the local competition (check the Yellow Pages), the proximity of NHS homoeopathy, the general economic climate and the flair of the individual doctor.
A full time career in homoeopathy
Ability to deal with complex cases and develop a subspecialist interest
Good income potential in private practice
Little or no out of hours work
Plenty of time to spend with patients
At forefront of growth industry of complementary therapies
Difficulty getting established in private practice
Few NHS opportunities
No current route to become an NHS consultant for GPs
May be a lone consultant
NHS homoeopathy fairly time constrained
The total national activity in homoeopathy is unknown. It has been estimated that in the region of 750,000 consultations take place per annum with doctors using homoeopathy.(6) Just look in any Yellow Pages and there will be a list of non-medically qualified homoeopaths, who are presumably seeing at least some patients. There is currently no formal regulation to discern the degree of training and standard of practice of these individuals, which is clearly unsatisfactory. It would be preferable if more of the demand for homoeopathy was met by the medical profession.
Internationally, the profile of homoeopathy is variable. In Japan, for example, although other forms of complementary medicine are very commonly used, homoeopathy is virtually unknown. In India, in contrast, it has a long and strong tradition. Closer to home, in France, Germany, Belgium, and Norway, homoeopathy is more popular than in the UK. In France, for example, it is estimated that around 10,000 doctors use it, having studied it during their state funded medical training.(7)
I am a better, and happier, doctor for my involvement with homoeopathic medicine, and I know I am not alone in this sentiment; in the controversy over homoeopathy, this broader aspect of increased job satisfaction should be given due regard.