Complementary Health Care

BACKGROUND

Many practitioners offer complementary health care as part of the services available to their patients. For some practitioners it constitutes the bulk of their work. For others, a single modality such as acupuncture is available as an adjunct to their routine practice. Patients are likely to perceive them to be 'doctors who offer complementary health care' rather than 'complementary health practitioners who happen to be doctors'.

The term complementary health care covers a wide range of modalities such as acupuncture and Traditional Chinese Medicine. For the Board's purposes, the important distinction is between proved and unproved care; rather than between conventional medicine and complementary health care.

There is a paucity of scientific evidence about complementary health care. Some modalities can be shown to be beneficial. Others are potentially harmful.

Harm, when associated with complementary health care may take the form of;

  • Direct harm, which results in adverse patient outcome.
  • Indirect harm, which results in a delay of appropriate treatment or in unreasonable expectations that discourage patients and their families from accepting and dealing effectively with their medical condition;
  • Economic harm, as a result of expenditure on harmless, but inefficacious treatment or products.

All complementary health care may cause indirect harm. An example of a modality causing direct harm is the use of herbal remedies in circumstances where the active ingredients are poorly identified and understood. Modalities that cause direct or indirect harm are of great concern to the Board, given its public protection role.

Economic harm is important to the Board because of the ethical aspects of providing patients with unnecessary and ineffective care.

POLICY

  1. Medical practitioners who offer complementary health care are accountable to the NSW Medical Board for the full range of conventional and complementary health services that they provide.
  2. The Board's Code of Conduct; Good Medical Practice applies to all aspects of a registered medical practitioner's practice. In particular, practitioners providing complementary health care must ensure that they;
  • have demonstrable current knowledge and skills in their area of practice;
  • act honestly and only in their patient's best interests;
  • provide patients with sufficient information to allow them to make informed choices at all stages of their assessment, investigation and treatment;
  • are honest in relation to financial and commercial matters. Section 36 of the Medical Practice Act, as amended also provides guidance in relation to pecuniary interest and accepting or offering a benefit for a referral or recommendation.
  • keep medical records that comply with regulatory standards;
  • assess patients by;

    (a) taking a pertinent history and performing an appropriate physical examination, sufficient to make, or confirm, a generally recognised diagnosis, meeting the standard of practice generally expected of the profession;

    (b) investigating when necessary, ensuring that patients are not denied access to generally recognised investigation modalities;

    (c) reaching a diagnosis that reasonable medical practitioners would reach, supported by the information available;

  • treat patient by;

    (a) advising them of any conventional treatment options, their risks, benefits and efficacy, as reflected by current knowledge;

    (b) providing an honest account of the risks, benefits and efficacy of a recommended treatment.

  1. A doctor who recommends an unproved treatment rather than one with proved effectiveness must have broad professional support in doing so, as well as the patient's fully informed consent; or must be prepared to argue, with evidence, that the treatment is safe and that the patient will not be harmed in any way by withholding conventional therapy.

December 2004