It is common to talk about integrating complementary and conventional
therapies. The assumptions being that the practitioners are keen to be
part of the NHS, and that limited availability within the NHS produces
inequity in healthcare provision. The questions then are which therapies
should be integrated and how should they be integrated? Complementary
therapies are currently delivered within the NHS through a variety of
models including primary care, hospitals, and by conventional healthcare
staff who have completed additional training and extended their skills
(Fulder 1996, Coates and Jobst 1998). The extent to which different models
have been compared and contrasted, however, is somewhat limited and the
most appropriate mechanisms for delivering complementary therapies within
the NHS have not yet been established.
Furthermore, there are diverse definitions of 'integration'. For
example one definition might be to place the patient at the centre of a
package of care that combines different but appropriate therapeutic
modalities, delivered within the context of their own theoretical
perspectives. Another definition is that 'integration' is simply about
taking the best bits of complementary and alternative medicine and placing
them in the NHS. But if we have limited research evidence about the
effectiveness of the 'best bits', and have not fully explored the
fundamental underpinnings, similarities and differences of conceptually
diverse therapies, how can we 'integrate' appropriately? There are no
simple answers to this. What may be missing from the debate about
complementary therapy and its integration into orthodox healthcare is
dialogue about the fundamental principles of complementary therapies. What
do the common principles within complementary therapies have to offer?'
How different and diverse are they? How do they contrast with conventional
Western medicine? But also can they provide a deeper understanding of
human nature, health and illness? And can they enhance our ability to
provide a therapeutic context for our conventional health care?
Two issues need to be explicit. The first is that any attempt to
integrate a complementary therapy should be clear about the therapeutic
approach, parameters, context, strengths and weakness of the initiative
when reporting the outcomes. The second is to continue to facilitate
dialogue about the fundamental principles of complementary therapies.
So how can we consider these issues when planning the education of
healthcare practitioners? The 'familiarisation' courses suggested by the
Select Committee may quickly become a feature of all pre-registration
medical and nursing training. However there is a danger that such courses
will only skim the surface and fail to do justice to some of the
therapies. Yet perhaps at this level, the best we can do is to present an
overview of a range of complementary therapies, raise awareness about
safety, regulation and evidence, and talk of the challenges the different
philosophical perspectives present. In contrast, at the post-registration
level, different professional disciplines can come together to learn new
therapeutic techniques, whilst exploring and debating the contribution of
different philosophical perspectives.
The integration of complementary and alternative approaches within
conventional healthcare, and the development of multi-disciplinary
education that incorporates such therapeutic approaches will require
careful planning. The context and cultural development of complementary
and alternative approaches, requires further dialogue and debate. If these
issues are neglected as we hurry to incorporate different 'techniques'
into our conventional practice, we may simply be left with additional
tools that we are ill equipped to use.
References
Coates J.R. & Jobst K.A. (eds) (1998) Integrated Healthcare: A
Way Forward for the Next Five Years? The Journal of Alternative and
Complementary Medicine 4(2), 209-247.
Fulder S. (1996) The Handbook of Alternative and Complementary
Medicine. Oxford University Press.
Dr Janet Richardson
Chairman of the Research Council for Complementary Medicine
And Director of Integrated Health Development, Oxford Brookes University
Rapid Response:
Integrate what?
It is common to talk about integrating complementary and conventional
therapies. The assumptions being that the practitioners are keen to be
part of the NHS, and that limited availability within the NHS produces
inequity in healthcare provision. The questions then are which therapies
should be integrated and how should they be integrated? Complementary
therapies are currently delivered within the NHS through a variety of
models including primary care, hospitals, and by conventional healthcare
staff who have completed additional training and extended their skills
(Fulder 1996, Coates and Jobst 1998). The extent to which different models
have been compared and contrasted, however, is somewhat limited and the
most appropriate mechanisms for delivering complementary therapies within
the NHS have not yet been established.
Furthermore, there are diverse definitions of 'integration'. For
example one definition might be to place the patient at the centre of a
package of care that combines different but appropriate therapeutic
modalities, delivered within the context of their own theoretical
perspectives. Another definition is that 'integration' is simply about
taking the best bits of complementary and alternative medicine and placing
them in the NHS. But if we have limited research evidence about the
effectiveness of the 'best bits', and have not fully explored the
fundamental underpinnings, similarities and differences of conceptually
diverse therapies, how can we 'integrate' appropriately? There are no
simple answers to this. What may be missing from the debate about
complementary therapy and its integration into orthodox healthcare is
dialogue about the fundamental principles of complementary therapies. What
do the common principles within complementary therapies have to offer?'
How different and diverse are they? How do they contrast with conventional
Western medicine? But also can they provide a deeper understanding of
human nature, health and illness? And can they enhance our ability to
provide a therapeutic context for our conventional health care?
Two issues need to be explicit. The first is that any attempt to
integrate a complementary therapy should be clear about the therapeutic
approach, parameters, context, strengths and weakness of the initiative
when reporting the outcomes. The second is to continue to facilitate
dialogue about the fundamental principles of complementary therapies.
So how can we consider these issues when planning the education of
healthcare practitioners? The 'familiarisation' courses suggested by the
Select Committee may quickly become a feature of all pre-registration
medical and nursing training. However there is a danger that such courses
will only skim the surface and fail to do justice to some of the
therapies. Yet perhaps at this level, the best we can do is to present an
overview of a range of complementary therapies, raise awareness about
safety, regulation and evidence, and talk of the challenges the different
philosophical perspectives present. In contrast, at the post-registration
level, different professional disciplines can come together to learn new
therapeutic techniques, whilst exploring and debating the contribution of
different philosophical perspectives.
The integration of complementary and alternative approaches within
conventional healthcare, and the development of multi-disciplinary
education that incorporates such therapeutic approaches will require
careful planning. The context and cultural development of complementary
and alternative approaches, requires further dialogue and debate. If these
issues are neglected as we hurry to incorporate different 'techniques'
into our conventional practice, we may simply be left with additional
tools that we are ill equipped to use.
References
Coates J.R. & Jobst K.A. (eds) (1998) Integrated Healthcare: A
Way Forward for the Next Five Years? The Journal of Alternative and
Complementary Medicine 4(2), 209-247.
Fulder S. (1996) The Handbook of Alternative and Complementary
Medicine. Oxford University Press.
Dr Janet Richardson
Chairman of the Research Council for Complementary Medicine
And Director of Integrated Health Development, Oxford Brookes University
janet.richardson@brookes.ac.uk
www.rccm.org.uk
Competing interests: No competing interests