Re: Should medical students be taught alternative medicine?
We are final year medical students at Warwick Medical School. This debate was brought to our attention a couple of weeks ago when we attended a two day course on alternative therapies, a compulsory part of the final year at Warwick. We disagreed with some of the aspects of the argument put forward by our peer at Cambridge and so wanted to express our viewpoint on the discussion.
The debate as to the use of alternative medicine is an important one, and it cuts to a key conflict present in modern-day medical practice: the clash of evidence- and values-based medicine.
Basing treatment options on evidence-based medicine is integral to modern medical practice and is a central theme in the GMC document Good Medical Practice, which states doctors must “provide effective treatments based on the best available evidence” 1. The National Institute for Health and Care Excellence (NICE) is often key in developing guidelines for treatment based on evidence of efficacy. Some alternative therapies have been included in NICE guidelines for the treatment of certain conditions, for example depression and lower back pain. Other areas of the medical curriculum are founded on treatments recommended by NICE, and so we feel that such alternative therapies should be no different.
Values-based medicine is founded on the principle that all patients have different views and priorities regarding their health and the treatment they are willing to receive. Addressing the values of a patient before making a joint decision on treatment enhances the doctor-patient relationship.
The popularity of alternative medicines increases the relevance of developing an awareness of alternative therapies during medical school. In the GMC document Tomorrow’s Doctors, there is an expectation that future doctors should “demonstrate awareness that many patients use complementary and alternative therapies, and awareness of the existence and range of these therapies, why patients use them, and how this might affect other types of treatment that patients are receiving” 2. A good doctor should acknowledge the alternative therapies available and use evidence to help their patient to make an informed decision.
We agree that the stage of medical school at which alternative medicine is discussed is relevant to the debate. If we expect our medical students to have a balanced and informed view then we should give them the skills to analyse evidence and opinion prior to tackling such issues. A good medical student should have a healthy cynicism for what is taught, irrespective of the topic. However, medical schools also have a responsibility to ensure that the material is taught in a balanced manner. We suggest that teaching this material at a later stage of the course is likely to increase the ability of students to question those teaching.
In the article published it is claimed that the guidance given in two GMC documents is in contradiction 3, although we believe the pieces are consistent. The GMC simply guides that doctors should be equipped with the knowledge and skills to advise patients on the effectiveness and likely benefit of treatments. We feel that this differs from the notion of promoting such treatments, when there is no evidence base; thus allowing clinicians to fulfill the principle of providing “effective treatments based on the best available evidence”. We suggest that the role of the clinician should be to assess the evidence base competently, thus avoiding any potentially dangerous adverse effects, and to relay this to the patient in a non-judgmental manner, allowing them to make an informed decision. Finally, the clinician should support a patient if a treatment helps alleviate their symptoms. In this way, we as future doctors will follow the key principle to medical practice, also recommended by the GMC, to “make the care of your patient your first concern” 1.
1. General Medical Council (2013). Good Medical Practice.
2. General Medical Council (2009). Tomorrow’s Doctors
3. Cork, N and Williams, G. Should medical students be taught alternative medicine? BMJ 2014;348:g2417
Competing interests: No competing interests