Tuesday, 21 October 2008

Enforced Quackery

My girlfriend is a second year medical student at a UK university (naming no names, as she seems to think she'll be punished if this gets out...) She does a module called "Medicine in Society", she has 11 full days observing real-life medical practitioners at work, more than half of her patient contact for the year. This year, she will be doing her placement at the Greenwich Natural Health Centre. Yes, it is as bad as it sounds.

Among other things, they offer "Holistic Aromatherapy", "Homeopathy", "Cranial Osteopathy", "Cranio-sacral therapy" (on reading the blurb on the website, I honestly can't see any difference between these particular two brands of woo) , and the Reiki Healing. Even when some of the treatments sound as though they might be sensible (Pyschotherapy, Relationship Counselling...) it turns out that some of the practitioners are the same people who do the Reiki healing. Although, to be fair, some of them do seem to be qualified psyhotherapists (not, note, qualified pychiatrists).

There doesn't appear to be a single person on the staff at GNH who is a qualified medical doctor (I haven't looked through the entire list, I'm willing to be corrected on this) and one woman proudly offers her qualifications as "BA Hons", "DipTch", which unless I'm mistaken is just a Bachelor's degree (in an unspecified (arts) subject) and a teaching diploma.

Anyway, that's enough trashing the place - obviously, it's a hotbed for woo, and they don't really buy into the whole "evidence-based medicine" thing. Fair enough, there's a time and a place for that sort of thing, as Ben Goldacre points out in his new book, there are probably more important things to worry about, but this is where the story gets silly.

On hearing that she was going to be sent to woo-central, and not really liking the idea, my girlfriend decided to ring up the School and ask if she could possibly be transferred to a placement where they did actual medicine. She was told in no uncertain terms that she could not, and that if she didn't attend all eleven days of woo-school, she couldn't possibly pass her second year. An extract from this conversation apparently went:

My Girlfriend: "But there's absolutely no evidence that any of it works, it's not based in science."
Office Lady: "That's a fair point, but..."

"but..."? But what? What "but..." could possibly justify forcing someone to waste 11 days and (approximately) £1000 of tuition fees on learning about treatments that can't possibly work? Possibly the scariest part about this is that the other twenty or so medical students who were sent on the same placement don't seem to have objected at all.

Anyway, today is day one of her placement. She's promised to take copious notes, and I'm going to write about them here.


HolfordWatch said...

This is very interesting and your future posts on this might be quite eye-opening.

Ros67 said...

I imagine your girlfriend is feeling pretty frustrated if half of her clinical contact time in her second year is spent in this manner, especially if she is itching to get going learning medicine on real patients rather than studying cholesterol metabolism and the anatomy of the brachial plexus. However, one of the things doctors are constantly criticized for is confining our treatments to the medical model, rather than taking a more holistic approach. When qualified you have to treat people with a huge variety of belief systems which may not tally with yours. I'm not saying she should jack in medicine and become a reiki therapist, or even that reiki 'works'- I'd be fascinated to read a good randomised controlled trial on it! But as a doctor, a huge amount of what we do is done via the nature of our relationship with our patients, rather than just the tablets we prescribe. And the more effective you can make those relationships by considering your patients' very different points of view, the more effective a doctor you will be.
I'd advise your girlfriend to use the time to find out what made the clients she sees during this attachment go for alternative therapy rather than taking a more traditional route to treatment. And then take that into account when she becomes a doctor herself- she will be a better one for it.
Unfortunately, once qualified, the opportunities for this kind of experience vanish- which is when we would probably appreciate it more.
All the very best to her anyway- and tell her to hang on- she will be at the business end of it all much quicker than she thinks!
Dr Ros Wood MBBS (Sheffield), MRCPsych
PS Just for info- psychotherapy is a talking treatment, psychiatry is the medical specialty involved with mental health. They are quite different things, although some psychiatrists choose to do extra training (like me)in order to specialise in psychotherapy. A well qualified accredited psychotherapist certainly does not need a medical degree to be effective. There are different branches of psychotherapy however, and some have a larger evidence base than others. It is worth doing your research before picking one.

mugsandmoney said...

I'm tempted to say that she gave in too easily; it sounds like she has been chucked into this situation as a way of "ticking the box" for the med school - i.e. the basis was political, rather than academic.

according to a (nameless) medical school website, each SSM should develop:
* a special appreciation of the areas studied
* insights into scientific method and research discipline
* a questioning and self-critical approach to medicine.
If it's not doing that, then your girlie is being let down by the system. Does she have a personal mentor?

If she was feeling militant, she probably could have appealed to the GMC or something like that.

Anyway, assuming she doens't go over to the dark side, it will be an "interesting experience" for her.