Background: The aim of this study was to investigate how general practitioners react when their cancer patients show interest in complementary medicine, and how their reaction is related to their knowledge in the field.
Methods: We conducted semi-structured interviews with 10 German general practitioners. Interviewees came from 5 different federal states and varied in terms of urban/rural setting, single/joint practice, additional certifications, gender and length of professional experience. Interviews were electronically recorded, transcribed and then analysed using qualitative content analysis according to Mayring.
Results: General practitioners feel largely responsible for providing information on complementary medicine to their cancer patients. However, uncertainty and a lack of knowledge concerning CAM lead mainly to reactive responses to patients' needs, and the general practitioners base their recommendations on personal experiences and attitudes. They wish to support their cancer patients and thus, in order to keep their patients' hopes up and maintain a trusting relationship, sometimes support complementary medicine, regardless of their own convictions.
Conclusion: Although general practitioners see themselves as an important source of information on complementary medicine for their cancer patients, they also speak of their uncertainties and lack of knowledge. General practitioners would profit from training in complementary medicine enabling them to discuss this topic with their cancer patients in a proactive, open and honest manner.
Background: Treatment of female infertility has been growing globally in recent years. In spite of improvements in medical strategies and the improved outcomes for infertile couples, treatment attempts remain largely unsuccessful. A growing number of patients pursue complementary and alternative medicine treatment options like Ayurveda that offers a variety of inpatient and outpatient treatments for infertility.
Case report: A case of a 38 year-old woman with infertility of unknown origin is presented. She received 18 conventional fertility treatments in 5 different fertility centers and 3 different countries. After several complications, the patient quitted conventional treatment and admitted to an Ayurvedic outpatient clinic where she received a complex Ayurvedic treatment, which included botanicals, dietary and lifestyle advice, manual therapy, yoga, and spiritual elements. The patient then became pregnant and gave birth to a healthy boy in 2012.
Conclusions: Ayurveda may be a useful complementary option in the case of futile conventional treatment attempts in female infertility. Nevertheless, the evidence base for Ayurvedic interventions remains weak and requires well-designed clinical trials. This case raises some questions, such as whether the exposure to a large number of assisted reproduction procedures can lead to more health problems than health benefits. The Ayurvedic approach to fertility strives first to improve the health of the patient leading to a higher likelihood of pregnancy. As this is a case report, we are not able to exclude temporal factors stimulating the pregnancy. However, the chronology suggests that this approach might have been an important factor in the eventual pregnancy.
Even though homeopathy is regarded as a harmless intervention, homeopathic practice may not be entirely risk-free. Risk in homeopathy can be divided into direct and indirect risk. Direct risk refers to traditional adverse effects of an intervention; indirect risk is related to adverse effects in a treatment context, e.g. the practitioner. Available data suggest that the risk profile of homeopathic remedies in ultra-molecular potencies is minor, but there is a potential for indirect risk related to homeopathic practice. The concept of 'homeopathic aggravation' which is unique for homeopathy may impose a particular risk as it allows the health status of the patients to deteriorate before there is a possible improvement. In that respect it is imperative to distinguish homeopathic aggravations from adverse effects. In a general risk evaluation of the homeopathic treatment it may be useful to assess the patient's symptoms in accordance with the natural course of disease and to evaluate any negative deviation from the normal curve as a possible adverse effect of the treatment. It is imperative that more emphasis is placed on patient safety during the education in homeopathy, and that students are trained to identify serious and red flag situations.
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