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[Complementary and alternative medicine in practice - the diagnostic-therapeutic process from the perspective of
Berthold Musselmann1, Joachim Szecsenyi, Stefanie Joos
1Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Deutschland. dr.musselmann@t-online.de
Background:
Complementary and alternative medicine (CAM) is widely used in general practices in Germany. This study aimed to explore the diagnostic-therapeutic process and relevant factors regarding the use of CAM from the perspective of general practitioners (GPs).
Methods:
Within a qualitative approach 3 focus groups with a convenience sample of 17 GPs were conducted. Group discussions were analysed by qualitative content analysis.
Results:
GPs view the diagnostic-therapeutic process in CAM as complex and less dependent on the methods used than on approach-independent factors. On the basis of the focus group transcripts, 4 main categories were identified that play a major role when CAM is used in primary care: patient factors, physician factors, relationship factors and generic factors of CAM. 'Constitution', 'expectation', and 'personal (life) concepts' were mentioned as relevant patient factors, 'empathy', 'respect' and 'authenticity' as relevant physician factors. At the level of the doctor-patient-relationship, 'time', 'confidence', 'matching', 'balance of power' and 'rituals' seem to play a major role.
Discussion:
From the perspective of the GPs the diagnostic-therapeutic process can be considered as a cyclic process in which patient, physician and relationship elements as well as generic CAM factors are closely interweaved. According to this conception, CAM can be used for a wide range of health problems in primary care. Sufficient time and a trustful doctor-patient-relationship are, however, essential for the use of CAM. Due to the increasing economical pressure there is a risk that CAM is processualised, i.e. split into single processes and uncoupled from the doctor-patient-relationship. This would jeopardise efficacy of CAM in everyday practice.
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