Sunday, 18 January 2015

NHS Doctors And Herbalists

Herbalists are not doctors and it's a criminal offence to claim to be a doctor unless you really are one.  This is slightly muddied by the fact that you might have a PhD instead of an MD, but clearly if you're calling yourself "Dr Smith" and practicing as a herbalist when your doctorate is actually in Mesopotamian potsherds, it could be said that you're not behaving with much integrity.  This is about medical doctors.

Nonetheless doctors and herbalists often do have a lot in common, although many herbalists tend to be ex-pharmacists rather than doctors.  I can't speak for other herbalists but I have no personal dispute with doctors and I hope they haven't with me.  It would in any case be unprofessional to engage in such a slanging match, not to mention disrespectful.  Picture a doctor spending long hours on a night shift attending to patients, having to fill in reams of paperwork, or just not being able to do her job properly because of the way the organisation she works for is structured.  She could be forgiven, to say the least, to think about all the alternative and complementary practitioners tucked up in bed as a violent patients takes a swing at her at three in the morning or she has to tell someone her child has died.  It's not an enviable job.

In this country, we have the NHS, and I'm not about to criticise them, but comparing herbalists to doctors here usually means comparing privately practicing herbalists to doctors working for the NHS.  Due to circumstances outside the NHS itself, GPs have to abide by certain rules which means consultations must be extremely brief and only one problem can be presented at a time.  This has a number of knock-on effects.  Whereas doctors often become extremely skilled at rapid diagnosis and planning, the time available to perform physical examinations is very limited.  Consequently it must be very easy to become de-skilled in such areas, and this means referrals for investigations, for that reason or through simple lack of time.  Investigations cost money and can create further problems.  For example, a barium enema uses very strong X-rays meaning that most of the torso is exposed to ionising radiation to a considerable degree over a considerable period of time, with all the risks that entails.  Such investigations can also be very expensive.  On the other hand, a longer period of time spent with a doctor examining the abdomen and having taken a history focussed on gastrointestinal matters would usually reveal the probable cause, and more invasive investigations can produce false positives and false negatives in any case.

I regularly spend several hours with a patient.  I'm able to do this because I get paid for it directly by the patient and because the demand for my services is limited, but it does mean I'm able to build up a very detailed picture of their health and they get listened to, I hope, and perhaps head off problems which would otherwise become very serious and need a lot more resource-hungry intervention.

This is where it gets complicated though.  This picture of waylaid doctors versus laid-back CAM people (and I must remember to say at some point why I'm not sure herbalism is CAM at all incidentally, not to the detriment of Complementary and Alternative Medicine, she adds hastily!) suggests a change in orthodox health services where the GPs spend more time with patients and perform physical examination and the like more often.  This clearly would mean fewer radical and more expensive interventions later and more crucially less suffering and greater quality of life, but the question arises of what the break-even point would be.  Clearly a GP can't be regularly expected to spend an entire day with a patient and it would not be a sensible use of resources to do that.  At some point, though, there must be an optimal solution to the problem.

In the real world, what usually happens with herbal consultations is that patients are already seeing a doctor and taking pure-ish medicines (I should come back to that too).  We actually work with that situation all the time.  Consequently our task involves caution with prescribing herbs which may interact with those medicines, and it is of course at best a decision between the patient and the doctor what they do with that kind of medication.

If it did turn out that herbalists became part of the NHS at some point, I suspect what would happen is that we would no longer be able to devote so much attention to the patient as we currently do.  This leaves me with a quandary because it means I am in a way committed to private medicine when I don't want to be.  I don't really know what to do about that.