Complementary medicine and the patient

doi:10.1136/bmj.319.7223.1486

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Catherine Zollman,
Andrew Vickers

In surveys of users of complementary medicine, about 80% are satisfied with the treatment they received. Interestingly, this is not always dependent on an improvement in their presenting complaint. For example, in one UK survey of cancer patients, changes attributed to complementary medicine included being emotionally stronger, less anxious, and more hopeful about the future even if the cancer remained unchanged.

Increasing availability of and demand for complementary medicine is evidence of its popularity. The question is whether this represents a passing fashion or a deeper need for change within the healthcare system

Satisfaction may influence further use of complementary medicine: a Community Health Council survey found that over two thirds of complementary medicine users returned for further courses of treatment and that over 90% thought that they might use complementary medicine in the future. What is it that patients find worth while and what does this tell us about their expectations of healthcare services in general?

Attraction of complementary medicine

The specific effects of particular therapies obviously account for a proportion of patient satisfaction, but surveys and qualitative research show that many patients also value some of the general attributes of complementary medicine. These may include the relationship with their practitioner, the ways in which illness is explained, and the environment in which they receive treatment. When these augment the therapeutic outcome of treatment, they contribute to what is sometimes called “the placebo effect.” None of these is unique to complementary medicine, but many are facilitated by the private, non-institutional settings in which most complementary practitioners work. The relative therapeutic importance of specific and non-specific attributes obviously depends on individual patients and practitioners, but some complementary practitioners may be better than their conventional colleagues at using and maximising “the placebo effect.”