Tuesday, November 5, 2013

Patient Advocacy: Providing Access to Alternative Treatment


  • Healthcare is never provided in a vacuum - it is always embedded in a cultural context
Have you ever wondered…

  • Why patients from one community often reject one form of medical treatment, but readily accept another?
  • Why some patients follow their doctor’s advice, while others do not?
  • Why some people prefer alternative healers for some form of illnesses (e.g. insomnia, indigestion etc.) but not for others (e.g. diabetes and high blood pressure)?
  • Why one ethnic group has a higher incidence of certain diseases (e.g. diabetes, hepatitis C etc.) compared with another? 
  • Why some women abruptly change their diet patterns during pregnancy or breastfeeding in ways which may be harmful to the health of their child?
  • Why are some conditions such as obesity regarded as “diseases” in one 
  • culture but not in another?
The answer is because every culture has a different world view about the body and health - and
we all unconsciously absorb this view and look at our health through this prism. Healthcare
is never provided in a vacuum, it is always embedded in a cultural context. In a perfect world,
both doctor and patient would share the same prism, leading to optimal health outcomes.
However, it is when the doctor and patient have differing worldviews that a conflict arises.
Dissatisfaction with the modern doctor’s obsession with technical minutiae and his desire to
“treat” lab reports and scan images leads a number of patients (especially among the minorities
and economically weaker sections) to seek alternative treatment options. Not only do they
find these more cost-effective, they are also more aligned with their personal perspective on
health. This has led to the increasing popularity of alternate systems of medical care.
Western medicine doctors are often not comfortable with these alternative options
because they do not understand them. They feel that these have not been adequately studied; that
they have not been subjected to controlled clinical trials to prove their efficacy; that their scientific
basis is unproven; and that a lot of alternative medicine practitioners are quacks who prey on
the patient’s gullibility. This often leads to conflict, where the patient seeks an alternative medicine
doctor, without informing his doctor that he is doing so. This kind of hide and seek confuses the
patient and his doctor – and leads to poor health outcomes. It’s far better that the doctor should seek the help of a patient-advocate, who can then refer the patient to reliable providers of alternative treatments and complementary medicine.
Using integrative medicine, advocates help patients combine the best of both the worlds –
Western Allopathy with homeopathy or Ayurveda, depending upon the patient’s preferences.

Typically, an integrative approach is based on the following principles:
  • Our body has the ability to cure itself
  • Healing practices must be individualized, because every patient is unique
  • People are responsible for their own health. Patient-advocates can only guide them in choosing a set of therapies that might work the best for them
  • Healing must aim for a balancing of mind, body and spirit
Let me illustrate this point with the following example:
A 45-year-old patient was once diagnosed with a cyst on the left side of his neck that biopsy
showed was cancer. The patient rejected the diagnosis and over time the cyst grew in size
and eventually turned into an inoperable tumour that had spread to his jugular vein. The
oncologist knew that chemotherapy and radiation offered the only ray of hope, but since the
patient was still in a state of denial, the doctor arranged for a consultation with a patientadvocate.
Along with accompanying him for his chemotherapy and radiotherapy sessions, she
also arranged meetings with a yoga therapist; and had the patient attend meditation classes.
The combination of therapies worked. Everybody watched as a robust person, who had got
reduced to a skeleton and could no longer swallow because the radiation had destroyed his
oesophagus, started regaining his health bit by bit. Then the day dawned when this patient
tested negative – the cancer had disappeared. Earlier, he had been given eight months to live.
It has been over three years now and this patient is still alive and kicking and lives his life to
the fullest.
Integrative medicine has many streams, including:
Osteopathic Medicine: Osteopaths believe in the healing power of the body and in rebuilding
its strength.
Functional Medicine: One of its basic principles is of biochemical individuality, i.e. treatments should
vary based on genetic and environmental factors.
Traditional Chinese Medicine (TCM): includes approaches such as acupuncture, and ancient herbal

Ayurvedic Medicine: combines herbal therapy with strict dietary recommendations.

Naturopathic Medicine: Naturopathic doctors (NDs) combine diet, exercise and lifestyle changes
in their treatment approach..

Homeopathic Medicine: This therapeutic method was developed by the German physician Samuel Christian Hahnemann at the end of the 18th century.

QUIZ TIME: Is Your Patient Ready For Alternate Care?
As a patient-advocate, before you offer alternate therapy for the patient,
ask her …
  • What do you hope to gain out of this therapy?
  • Would you like to talk to a patient about their experiences with these therapies?
  • Would you like to do more research more about this therapy?
  • Are you aware of the side effects of this therapy?
  • Will this treatment interfere with the other treatments that you are taking?
A patient who responds satisfactorily to these questions makes for an ideal candidate for
alternate therapies.

The above is an extract from Dr.Aniruddha Malpani's book : Patient Advocacy - Giving Voice to Patients
The book launch will take place on Saturday, 16 November 2013 at Hall of Harmony, Nehru Center, Worl, Mumbai - 400018 during the 4th Annual Putting Patients First Conference.

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