Patch Adams dreams revolutionary medicine and in a way his vision consummates the vision of Medical Marriage, but it is so radical that it is divorced from almost all current practices.

Fifty or so people attended this work-shop which started with a critique of current systems—specifically their lack of fun. Miserable doctors, sapped of creativity, fail to cure miserable patients, who just repeat the miserable cycle. Costs spiral and then dehumanisation becomes the norm as the profit motive (or “efficiency”) takes precedence. The demands of malpractice insurers help to drive the spiral on.

Next came some of Dr Adams’s personal history from traumatic teenage years, to social activist, to orthodox medical student who would spend an hour a day deliberately telephoning wrong numbers just to improve his approach with strangers. He spoke of the realisation he had that the doctor-patient relationship (redefined as friendship) is at the very core of good medicine. He spoke too of his rejection of the current systems that hinder friendship—out went fees (and patient donations), out went clinics, and out went malpractice insurance from his idea of medicine.

The next 11 years found him and some of his colleagues living together in a large house along with their patients. During this time they practiced medicine in the manner they wanted it to be: they made friends, did not allow violent people to remain with them, got patients to help each other, and demanded everyone have fun.

Important lessons were learned, such as seeing mental illness as extreme self-centredness; seeing the common traits of boredom, loneliness and fear in all of his patients; and the importance of mutual respect, self-esteem and vision.

This experience led to plans for the Gesundheit Institute—a hospital in a community—which is currently being built. Its central aim is to get healers closer to patients by bringing them into the community and inviting friends and family. Consultations, with the possibility of lasting as long as they need to, even hours, will be held in whatever environment the patient feels most at home. Each patient will be assigned one orthodox and one complementary practitioner in addition to a student and whatever help can be enlisted from the patients and community members. The goal is to create medical solutions through a cross-fertilisation of ideas.

—from notes by Guy Riggs

Aspects of Malpractice Insurance

•Value to the public and the practitioners.

Although it is understood that most complementary therapy is not harmful to the public, professional indemnity insurance nevertheless provides a comfort cushion in the rare event that something does go wrong. Even with the best training available and a conscientious, experienced therapist, it must be admitted that no one is perfect or infallible!

In the challenges of a busy practice many demands can be made by patients, colleagues, staff, and personal and professional relationships and there could also be stresses around housekeeping and financial pressures, which can all conspire to bring periods of burn-out, clouded judgement, or inability to diagnose correctly.

It must be understood that policies exist to protect the therapist, not only when mistakes are made, but also against allegations made, which need to be defended, whether true or not. The legal costs to clear a therapist’s name and reputation can financially cripple an individual and there are stories of this happening. Whilst no financial help can stop the personal trauma that such situations can cause, therapists do appreciate the support of sound wording in their insurance policies and sympathetic claims counselling from both the intermediary and insurer’s claims staff and solicitors.

Not enough thought is given to the quality and scope of wording in the insurance document, or to the philosophy and  experience of the team servicing the therapist.

As insurance tends to be considered a necessary evil, many therapists have tended in the past to get it as cheaply and painlessly as possible. Now, they listen much more to information about what they are buying, as the whole question of professional indemnity insurance is part of a wider issue to do with professionalism, public exposure, and the need to improve standards and trainings.

Many health centres and other institutions require to see proof of valid insurance before therapists are allowed to practise, and this reinforces the position of insurance as provider of some degree of security for the public as to bona fides therapists. (No school, no matter how well-respected, can guarantee the on-going performance of its graduates.)

• What insurance generally will and will not cover.

A person seeking compensation for negligence must establish that the defendant owed them a duty of care, and that there was a breach of that duty, and that harm (capable of financial compensation) of which the patient complains, was caused by that breach of duty of care. There is usually no difficulty in establishing that the defendant owes a duty of care.

Inherent in professional indemnity insurance is the principle of accountability and responsibility, because the patient normally places him or herself in the care of the practitioner. Whilst accountability and responsibility can be exercised in the choice of training course and code of conduct etc, it should also apply when choosing a policy to protect livelihood and patient.

The widest wordings indemnify the assured against all sums which they can become legally liable to pay as damages arising out of any bodily injury, mental/emotional injury, illness, disease or death of any patient caused by a negligent act, error or omission in or about the conduct of occupation or business as stated, plus Good Samaritan acts etc.

They can be extended to cover professional indemnity, financial loss, breach of confidentiality, libel and slander etc.

Commonly found are “public liability with treatment risk” policies, which mainly cover the “business” and what goes on in the therapy room, usually for injury or damage. Some public liability policies do not even cover treating medical or chronic conditions!

Some policies have exclusions on sexual impropriety or AIDS, and some have warranties regarding sterilisation of instruments.

Because there have been so few claims, there have been very few case histories to test some of these wordings. However, legal opinion validates the true professional indemnity wording and advises against the public liability solution.

Any therapy not mentioned on a proposal form or renewal declaration, would not be covered, nor would criminal activity or any material not disclosed on the proposal form.

There is usually an excess to be paid. Some policies include all cover within the indemnity limit selected, and some give legal costs and expenses on top.

Apart from the above kinds of coverage, many professional organisations have their own “block” insurance schemes, and many do not fully appreciate the scope or inadequacies of the policies they have, although these policies do give a corporate image and premium benefits to members.

Implications for the General Practitioner

• The view of defence unions regarding referral and supervision.

It has to be understood that defence unions are not insurance companies— they only give discretionary cover. As a benefit of membership they provide defence and defence costs—but there is no policy or contract of insurance between the union and practitioner. As it is, most day to day events are covered, but there is no formal statement as to what these may be in contractual form.

My research so far has produced the following results: (i) a letter from MDDUS stating that they “are discussing their position in relation to many of the aspects [I] have raised and are not in a position to give a definitive answer to most of [my] questions,” (ii) Medical Defence Union still have not responded (iii) Medical Protection Society state that a doctor has to abide by common law, but cannot comment on how he can establish standards for referral.

It is difficult for the defence unions because they do not have an insurance contract, and their defence goes hand in hand with the status and membership of their body.

I found the booklets produced by the UK Central Council for Nursing to be much more useful, as they describe implications between doctor and nurse, and practice nurses and other medical auxiliaries. Leaflets such as “Code of Professional Conduct”, “Standards for Records and Record Keeping”, “Exercising Accountability”, “Confidentiality” and “Medico-Legal Aspects of Practice Nursing” all give valuable insights and guidelines as to what could well become officially accepted standards for complementary practitioners.

Cover is available for the GP who wishes to refer patients to complementary practitioners outside of the defence unions.

• Doctors’ awareness of complementary therapists ’ insurance.

I would suggest that the GP check not only bona fides of training and successful case histories of the therapist, but also the scope of the therapist’s cover. If, for example, this was inadequate and a claim arose which was not covered, the claim could well be directed against the referring GP/doctor.

How the defence unions would cope with that is still unclear. Attitude shifts and conventions of opinion can take time to transform, and meanwhile, what does the doctor do? As long as he or she is confident of the therapist, then providing cover is in order. Otherwise, by refusing to refer a patient, he or she may be depriving the patient of the prospect of a speedier or better quality recovery.

GPs clearly need more information about complementary therapy trainings, plus education is needed as to the relevance (or not) for the patient’s condition. Self-referral, by asking the GP for approval without too many questions asked, could prove counter-productive and may leave the GP open to negligence for not exercising due care.

• Do defence unions have any view regarding standards required for referral, or types of therapy suggested?

Not really.

Implications for Complementary Therapists

• What happens if a doctor’s guidelines run counter to treatment you have been trained to do and a claim arises?

It is important for this area to be cleared up. Although defence may be provided for the referring doctor, he or she cannot be held completely responsible in every situation that could arise, particularly if he or she has acted properly within the tenets of training experience, and has exercised due care. If the therapist ignores the doctor and a claim arises, a policy may cover him or her, but as the doctor has to retain control of the patient if fees are to be paid on National Health, he or she could still be joined in the action. The position here is not clear-cut, as it depends on what the complementary therapist was trained to do, and what his or her Code of Conduct stipulates. Some block insurance schemes are granted on the basis of the training/code given and for agreed types of therapy only.

• The importance of thorough record keeping.

Because very often the only witness to a treatment with a therapist is the written word—notes taken during the sessions, particularly the initial one—this aspect of practice is vital, and some insurance policies do require this as a prerequisite of cover, either implied, as in public liability treatment risk policies (having checked the training before allowing therapy to be included) or where it is specifically warranted on the policy.

We have had a number of apparently spurious claims go away upon production of copious and detailed notes, and lack of solid evidence from the patient.

It is hard to remember exactly what information was given in the treatment room by the patient, or what specific treatments were carried out, and in what sequence. Under cross-examination a case can appear stronger in defence if clear cut answers are given to direct questions. If nothing else, it denotes responsibility and commitment to the patient, plus professionalism. The UKCC booklet on this is excellent.

• What covers are needed for overall protection?

Apart from professional indemnity cover, practitioners need public liability insurance, even if a health centre they work from may have this already. This would cover working from home, if say, the patient tripped over the cat and ended up with his or her head in the minestrone soup on the stove. Home visits would be covered for the occasional knocking over of the patient’s antique Ming vase.

Therapy room contents may also need protection. Products liability cover would take care of the sale of medicines and supplements etc. Household insurers need to be informed if you are practising from home.

Personal protection, including loss of income cover, or ethical investments, are other insurance areas which practitioners sometimes consider.

—notes by David Balen, printed in full because of their importance to practitioners.

David Balen is a professional insurance consultant with 24 years experience which includes developing special insurance schemes offering wide-ranging cover for complementary and paramedical practitioners. He is also a practitioner and teacher of healing and meditation. [Balens Specialist Insurance Brokers]

Dr Daniel Benor’s workshop was truly a workshop: within five minutes we were all on our backs on the floor experiencing a form of “psychoneuroimmunology”.

Our brain is a transformer, he says, transforming our experience of the world and putting it into our body. Tests of physical strength show that when we are thinking of something sad, we are much weaker than when we are in a neutral mood or happy. People who meditate daily or do some other form of relaxation have a higher white blood cell count than people who don’t. Cancer patients live twice as long if they meditate daily, and some even reverse the disease. The diagram of the “stress cycle” shows how people can get stuck in illness:

The group did a relaxation exercise, tensing each muscle and then relaxing it, working up the body from the feet.

Our unconscious mind can connect with every cell in our body and we can also connect consciously. We can relax our inner organs through meditation. Studies have shown that heart diseases can be reversed through meditation.

Visualisation is also used heavily in psychoneuroimmunology; imagining white blood cells to be white knights attacking the disease, or golden healing light, or even colours and musical tones. Whatever is most appealing to the client.

Relationships and repressed emotions were also looked at in relationship to disease. Illness can be used as a way of avoiding life issues: “I don’t want to talk right now, my head hurts again.”

Dr Benor feels the field of psychoimmunology needs to go one step further into “energies”—the mysterious energies that Einstein talked about, that hold together the loose particles that make up all things.

—from notes by Marietta Olsen

This workshop was an exploration of ideas and concepts from the patient’s perspective. Ms Browne started off by highlighting the size of the task and the need for humility in the face of it. However, we needed to address that perspective, as at the end of the day, the patient could be anybody, including you and me. Ms Browne suggested that one theme for the workshop and for the conference was the need to rebalance the scales which are heavily weighted in favour of orthodox medicine. In the process, a change of attitudes would be required and each side would need to maintain its integrity. And it was worth remembering that over the last decade, the number of complementary practitioners in Britain had increased to over 30,000.

There followed a discussion of terminology: How should the patient be described, and what messages about quality of relationship did the different terms give? Some of the alternatives explored included: “client”, “customer”, “service user” etc. While “client” came across as inappropriate and too business-like, the “traditional” labels of “patient” and “doctor” encouraged attitudes of dependency and superiority respectively. At the same time, it was recognised that “client” had more or less explicit rights over the professional.

The group came up with “partner”, “friend” (cf Dr Patch Adams), and “co-creator”. No one best alternative was decided on, but there was a lot of thought about the issue. The terms “complementary” and “orthodox” also came up. Regarding “orthodox”, all agreed that this term was unsatisfactory in describing the presently established world of medicine. Some thought that “complementary” could be construed as not mainstream or not a real alternative. This was countered by a metaphor of “complementary” as a tributary feeding into the larger entity called “health care”, which is formed from many other tributaries as well.

We then started to explore diversity and how this affects the kind of care that patients need. The inner ring of the diagram represents primary dimensions, and is the stuff of which people go to war over! The outer ring covers secondary dimensions, or ones which are relatively easier for individuals to change. We recognised that in some cases, religion could come under primary dimensions.

Obviously, when two people or different groups meet, the greater the overlap of segments, the easier the understanding between them. Ms Browne added that it would be all too easy to stereotype a person based on any one of these dimensions. Care and sensitivity were needed. For example, would a person from a particular ethnic group prefer to be described as “black”, “Afro- Caribbean” or even “West Indian”? This might need checking out. The practitioner would also need to approach this person with a clean slate—leaving behind any preconceived ideas about gender, race or whatever the dimension of diversity, as such prejudices could affect the quality of care given.

Finally, we spent some time on patients’ case studies. We talked about the reception we got as patients. Women especially had had bad experiences, among the most common being the feeling of being “written off’ because they are female or menopausal or over 45 or all three—the ultimate misfortune! A common experience was doctors not listening or not having enough time to explain. Doctors present in the group confirmed this feeling of not having enough time for their patients.

So, what were the lessons drawn about what people want from health care?

• Someone to listen first, and treat them as an individual, not as a stereotype or a collection of symptoms
• Someone to respect their vulnerability in even just coming to the doctor
• Someone to offer choices and the information to make the appropriate choice (accepting the fact that some patients do not want that responsibility)

A further lesson is that patients should be encouraged to talk and to question at all stages. They can begin to get what they want by being clear and speaking out, and, as things currently stand, by changing practitioners.

—from notes by John Scott and Elly Hood

Joan Browne is a freelance trainer and consultant specialising in personal development and the management of diversity and equality of opportunity. She works with groups and individuals in organisations to facilitate change. Much of this work is about healing old hurts, building confidence and channelling creative energy for personal change. Joan has a long-standing interest in health issues and healing and is a probationer member of the National Federation of Spiritual Healers.

A heroine and “pioneer” of alternative birthing models, Ina May Gaskin stands alongside others such as Michel Odent, Frederick Leboyer and Wendy Savage in demanding better birthing practices as a human right for women and their children, for humanity and the planet. They have all investigated the mechanical science of obstetrics with its recent history of just a few hundred years, only to rediscover the wisdom of millennia: the belief inherent that a woman’s body has the capacity to give birth unhindered and unshackled by dogma, pathology and fear.

An arts graduate and a spiritually seeking hippy in the late 60s, Mrs Gaskin herself was subjected to the highly medicalised birth prevalent at the time. Describing how her child was born as she lay strapped onto a delivery table by wrists and legs, with enforced anaesthesia, gave us a graphic understanding of her resulting conviction that other ways to give birth had to exist. Her role as a midwife came later.

She was pregnant and with several other women in a convoy of old school buses and vans as they travelled on a speaking tour around the United States, when she attended, untrained, her first “caravan” birth of several to follow. A sympathetic medical doctor heard the tales of the caravan births and offered Mrs Gaskin a one-hour course in midwifery, plus some equipment.

From this beginning, she and the other women on the caravan blossomed, and when they eventually reached their final destination in Tennessee, The Farm midwives were born. Unwilling to be subjected further to the high intervention process of hospital births, the women of The Farm sought better birthing experiences.

The Farm midwives learnt where they could. A sympathetic local doctor taught them what he knew from his many years of practice in poor rural communities. By 1977 enough was known for Mrs Gaskin to write Spiritual Midwifery, which is now in its third edition having sold over half a million copies. In this book The Farm midwives tell us of the special energy of the birth process, so sacred, that it makes the labouring woman glow; of cows and snakes and other animals appearing at the moment of birth to share in that birthing energy; of the total vulnerability of the woman giving birth, her sensitivity so great that even one uptight thought or fear held by a person in the room can derail the smooth passage of her labour; of the “sphincter law” where the unconscious has to be allowed to perform its part or the perineum, as with any bodily part ordered to perform, will get stage fright and clam up.

Mrs Gaskin told us of the simple idea that smooching during labour will lead to relaxation and also produce the endorphin hormone levels required for a beautiful birth: “The loving energy that got the baby in there can help to get it out.” She told us how nipple stimulation produces the release of oxytocin to assist or even start labour, and that we must accept that babies sometimes die. By accepting the natural law of birth and death we can take responsibility more completely for our actions from the moment of birth onwards.

We experience fear when we buy into pathological descriptions of our bodies sold to us by insurance companies, and the level of this fear is increasing throughout our daily lives. In this way we continue to brutalise ourselves, and it is this very brutalisation of health workers and their patients in the process of childbirth, that the pioneers of new/old and better ways seek to end.

—from notes by Susan J Wighton

Ina May Gaskin is an outspoken advocate for midwife-attended natural birth and the empowerment of mothers. She co-founded The Farm, an intentional community in Tennessee and developed a team of skilled independent midwives working in cooperation with local doctors. Their success with natural delivery methods for both normal and “difficult” births is legendary. She is the author of Spiritual Midwifery and Babies, Breastfeeding and Bonding. [Ina May Gaskin on Wikipedia]

With the current move towards having complementary medicine widely available in the National Health Service,, there is now a debate as to the future role of complementary medicine.

Ten people of varied experience and qualifications attended this workshop, including those skilled in acupuncture, aromatherapy, dietary therapy, caring and counselling and treating mental illness. Medical practice and orthodox therapies such as physiotherapy, occupational therapy and remedial gymnastics were also represented and there was also a retired nursing sister.

Orthodox therapies need to be, and are, currently accepted for registration with the Ministry of Health, prior to practising (as they have been for a number of years). They are part of the Council Supplementary to Medicine.

The workshop followed Dr Julian Kenyon’s plenary session on the role of scientific research in bringing orthodox and complementary medicine together, and was an opportunity to follow up some of the issues raised such as “gate keepers” and the “carrot” of the NHS, versus the “alarm bells” (of using complementary therapies within the NHS).

Dr MacPherson said the question was, as he saw it, not if, but when and how to join the NHS.

He had, however, been practising independently for some years and said he was now discouraged by his friends in the dental profession who were dissatisfied with the effects of the NHS on their practice and were opting out for independence. He prophesied what might happen in the next 20 years, listing four possible different reactions:

• Annihilation of complementary therapies.
• Systematic exclusion of complementary medicine by orthodox practitioners.
• Assimilation of complementary medicine by orthodox, after possible periods of extended training.
• Creative collaboration between orthodox and complementary medicine. (The idea to aim for, according to Dr MacPherson.)

Discussion followed about differences of approach and attitude by practitioners and patients and means of collaboration.
Concerning differences of approach and attitude, there is a tendency of orthodox medicine towards encouraging the “quick fix” cure without sufficient effort by the patient. Complementary therapists tended to encourage attitudes of independence and self-healing, seeking “inner change” within the patient to promote healing.

It was felt that the benefits of registering with the NHS could be negated by bureaucratic restrictions, therefore some complementary therapists are aiming for statutory self-regulation. This has already been achieved by osteopaths, and the acupuncturists were aiming to follow the same course.

A question was raised as to what extent basic training could be established between orthodox and complementary practitioners.

It was suggested that the Natural Medicines Society was worthy of support to enable well-tried natural medicines to be available on the market, since some allopathic medicines sold by pharmaceutical companies had been known to have harmful and dangerous long-term effects.

Aromatherapists wanted to point out that chemicals present in some aromatic oils could be counter-productive for some individuals and should only be used by fully trained therapists.

Auditing of all types of treatment and healing was considered to be an advantage, and could help to relate costs to outcomes.

It was also suggested that therapists could devise referral forms for doctors, to help doctors relate their prescriptions to treatments available.

—from notes by Pamela Scott

After obtaining a PhD in mathematics, Dr Hugh MacPherson went on to train in acupuncture and Chinese herbs. He subsequently established the Northern College of Acupuncture based in York which provides a three-year training for aspiring acupuncturists and a two-year postgraduate training in Chinese herbs. He has an interest in research into the benefits of acupuncture through the foundation for Traditional Chinese Medicine. [Hugh MacPherson in Wikipedia]

Drumming up Health—Drumchapel Community Health Project, has been in existence since June 1990. It runs a community health volunteer scheme from the community health library which since November 1993 has been based in Drumchapel Health Centre. It aims to empower local residents to take part in community health activity and encourages collaborative working between local agencies and projects. It is funded by the urban aid programme with the coordinator and health visitor seconded from the Greater Glasgow Health Board health promotion department and the Community and Mental Health Services Trust.

The Kendoon Community Health profile, carried out in Drumchapel in 1991, identified the extent to which mental health problems exist in Drumchapcl and recommended that counselling and self-help groups should be made available. The need for counselling and stress management provision was also recognised from health visitors’ drop-in sessions in the Project’s community health resource library. At the same time, the Project noted a growing awareness of and interest in complementary therapies among the community health volunteers, as well as other people using the library.

These factors led first to a T’ai Ch’i class being set up and then a small “sub -project” called “One-to-One” which has been running since January 1994 and offers counselling (3 sessions a week), relaxation (one session a week), shiatsu (one session a week) and a ten week “stress and relaxation” group using flower essences and visualisation.

This sub-project is seeking funding for a 2-4 year period to enable the development of evaluation systems and exploration of a way to integrate into local mainstream health services.

Issues for discussion include:

• Therapists: terms and conditions, premises, working in a multi-disciplinary team.
• Service providers: purchasing of services, organisation of project.
• Service users: quality of care, diagnosis, accessibility, relevance.

For more information on this project you can contact: Pauline Craig, Project Health Visitor/Deputy Coordinator, Drumchapel Community Health Project, Drumchapel Health Centre, 80-90 Kinfauns Drive, Drumchapel, Glasgow G15 7TX.

—from notes by Pauline Craig

Pauline Craig is the Project Health Visitor for the Drumchapel Community Health Project, Glasgow [for more information see Evaluating the Health Cities Project in Drumchapel, Glasgow chapter in Healthy Cities by Sarah McGhee and James McEwen]

Dr Benor began by describing situations in which healing works well, such as in cases of anxiety and letting go of old patterns of holding hurts inside. He mentioned that healing goes to the core problems that create “dis-ease” in people.

He asked the question, “Is it important to know only the root of the problem, or are people who are working purely with the laying on of hands missing something?”

The group introduced themselves and their various backgrounds as GPs, healers, psychotherapists, psychiatrists, psychic readers etc and commented on the above question. We then looked at a Jungian model:

Dr Benor explained that doctors and nurses, through their education, often use more of the thinking and sensations way of experiencing the world. The feeling side and the intuition side can become, if not acknowledged, a shadow, something we just push away. This can lead to an extreme situation, such as the burning of witches. Witches represented uncomfortable parts of ourselves we did not want to look at.

When we come to spirituality and spiritual healing, we need to experience it rather than talk about it, since words are often insufficient to express it. If we work with healing we are often more aware of our intuitive and feeling side and yet it is vitally important that we also stay connected with our intellectual side.

Dr Benor described a case where eight people were observing somebody with a known problem. All eight had the impression that they had got to the core of the problem and yet when they shared their views there were eight different kinds of perspectives. Seven of the eight interpretations had been important information to the client.

The group talked more deeply about the roots of any problem and suggested that there may even be several core issues, or different layers of a problem. Dr Benor added that there is no scientific research yet around this issue.

From this point the burning question came: “What do we do when we have discovered the core of a client’s problem?” One answer was that healing helps us to be in love with ourselves and to give love and unconditional positive acceptance, with the knowledge that both ourselves and the client are okay and we are both on a path of learning.

The role of education in therapy is also very important; giving information and a clear diagnosis as in a case of alcoholism for example.

Dr Benor pointed out the importance of training for self-awareness and self-care in the medical profession where there is a very high incidence of alcohol and drug abuse and a very high rate of suicide. He also mentioned examples of integrating nutrition, meditation, T’ai Ch’i and acupuncture into the medical education of the UK.

Next we addressed the spiritual components in psychosis. Dr Benor stated that people who are psychotic, much too rarely understand the spiritual side of their process and often have severe emotional disturbances which cause them to get lost in their personal situations.

People who have spiritual experiences, for example experiences with the Kundalini energy (negative symptoms can be: feeling overwhelmed by it, feeling panic or nervousness, being ungrounded, having bizarre physical sensations) can need to be protected from the immediate psychiatric profession because sometimes those who are trying to help, ignore the spiritual aspect of a patient’s condition.

Dr Benor described a case where spiritual healing enabled a woman to accept medication after first having completely rejected it. He also noted that when healing is applied, the use of medication is lessened, the time the healing process takes may be shortened and there are fewer side effects.

-from notes by Ruth Pfitzenmaier

As a doctor working in a multidisciplinary team (physiotherapist, homoeopath, shiatsu practitioner, nutritionist, psychotherapist, counsellor and social worker) I find myself in the privileged position of coordinating care for patients. As a medical student I studied basic acupuncture and homoeopathy and I came to respect the complexity and beauty of these systems of world view which seemed so alien to me in my “western orthodox medical” mind. I recognised that I could study them and apply them in my practice in a way that could be compared with driving a Rolls Royce in first gear only all the time. It was then that I developed the desire to work together with experts in complementary fields to provide an integrated system of care for the patient.

The doctor’s role in a multidisciplinary team begins with the assessment of the patient (physical examination, history taking, social/emotional aspects of the presenting problems, assessing reports etc). The clinical judgement obtained through the doctor’s training and practice of medicine is an essential element which the doctor brings to the team. It may be that further investigations or assessments are required before a clear picture can be seen.

Interdisciplinary cooperation for reaching a diagnosis is common within orthodox medicine. To benefit from the assessment of complementary approaches is still a new and exciting field and most often very rewarding. Sometimes, it is even quite funny. Once, a syndrome that didn’t make much sense to me was explained to me by an acupuncturist: “That is because the spleen is weakened and there is too much cold.” I am humbled by the fact that a treatment based on this diagnosis proved to be successful! I am ever learning.

After assessing the patient, there is then the sharing of information with the patient about their current state of health and of the different options open to them. The options may include orthodox treatment, complementary therapies or self-care measures such as diet, exercise or stress management. It may well be that at this point I will refer to the case conference and ask the patient to wait for me to have input from the other practitioners with whom I work.

For the patients to make their own decisions they need sufficient information and support. This can take the form of encouragement or some discussion of their options with the doctor. It may be that a patient feels unable to choose and in those cases I will accept the task of telling them what to do. while still keeping as my aim that eventually they will be in a position of taking full responsibility for themselves.

I will then either treat the patient myself or refer them to another practitioner. If the patient is treated by one of the other practitioners, I will hear about their progress in the case conferences. This allows my continued engagement with the case and input into care. The case conference allows clinical supervision even if it does not necessarily provide technical supervision. Technical supervision for complementary therapists can only be provided by an expert in the same field with more skill and experience than the practitioner.

—from notes by Dr Cornelia Fellner

Judging by the number of attendees this was a very popular workshop and Dr Kenyon made a wholehearted attempt to lead us into the “difficult-to- grasp” world of so-called basic science. We were introduced to some of the steps he and others had made on the often discouraging path of attempting to measure the subtle energies, or make them visible by objective means.

Even though I am an MD myself and have a slight interest in this frontier of science, it was quite hard to follow and to understand all that was presented to us. And it was only little comfort to realise afterwards that I was not at all alone with this problem.

Dr Kenyon began by mentioning some very expensive investigations with photons and then went on to speak about £150,000 magnetic-field equipment that gave only very few results, though seemed to be of some use in measuring the effect of acupuncture.

We then spent some time on the essence of “coherence”, which can be likened to a flock of birds shifting their direction of flight all at the exact same time. It seems that coherence works on a quantum level, which is even more fundamental than electromagnetic fields. The principle of the quantum level is that every part of the body knows what is going on everywhere else (like a hologram), and this is responsible for the body’s biochemistry organising itself. (The biochemists cannot explain why it organises, but they can see that it does). When organisation occurs in a coherent way, the body is, becomes, or stays healthy.

Coherence is maximal in the cell division process. When the activity is incoherent, illness develops. Dr Kenyon stated: “The body is a hologram, a space-efficient way of getting information stored.”

We turned our attention next to “factor stability” and some interesting investigations with fruitflies which emit light previously radiated onto them in a way that is very different from what would be expected. They do it in a hyperbolic fashion, ie they absorb the light, use it and then radiate it. They behave like living computers being fed the right software that then makes them work.

What the fruit flies do is a kind of “resonance”, which is very important in biological systems. Cancer cells emit light in a linear form, ie they have lost the ability to communicate with other cells. This effect can be measured and the equipment developed to measure it has a sensitivity level of 98% in detecting the cancer cells.

Plasma physicists talk about “scalar fields” which are quantum fields which are really information. These fields are more subtle than electromagnetism and are not detectable by any electromagnetic means.

Quantum fields produce observable effects by changing the phase relationship of electrons. The quantum physicist David Bohm made investigations into thought power using a solenoid and showed that the energy produced had an effect on a picture being created. Dr Kenyon added, “Scalar fields do not carry force, they arc dependent on highly non-linear systems to detect them.”

Experiments have shown that humans can detect these energies, and that we are sensitive to a change in one quantum, the smallest change in the cosmos. Even a very small change can make us fatally ill.

Then Dr Kenyon took us into the concept of “free energy”, because the quantum fields seem to be “beyond” time and space. He thinks that in 50 years we will be using this free energy, even though many commercial interests are presently against using it. At this point there were comments from the participants about the possibilities of misuse of free energy.

Dr Kenyon then talked about how scalar fields are made in the laboratory via a method found by Nicolas Tesla, using special coils to produce two opposing magnetic fields. Where they meet—in the centre—is the experimental scalar field. This led us to discuss the “ether”, which is “now seen as a sea of intensely fluctuating energy.”

Glenn Reinell has experimented on lymphocytes which seem to react to scalar fields. It is probable that we or our cells are reading these fields all the time. If electromagnetism was the whole story of our biochemistry, then it is likely that we would not be able to function at all in a modern world filled with so many new kinds of electromagnetism.

This research has led to the possibility of measuring, for example, the effect of homoeopathic remedies in a circuit without electrical contact. The measured change produced by a remedy lasts for some hours after the remedy has been removed and then fades slowly. The effects last for a much shorter time in sick people and for a longer time in children. These experiments using this new equipment have produced many surprises while monitoring the mixing of remedies, and seem much less influenced by the investigator than other types of tests. It is possible also to measure the effects of acupuncture which have already been shown to be very fast and precise.

Dr Kenyon is very confident about future possibilities of measuring and evaluating all of the complementary therapies and remedies with these new techniques.

—from notes by Henrik Langgard MD

Most people imagine that “the law” has all the answers regarding every problem including those arising from complementary medicine. Unfortunately this is not the case. At this point in time there is no case law, no legislation and no regulating body for all therapies.

Case law creates precedents and so far no one has raised a civil court action specifically in relation to complementary therapies. Until such time as there is a relevant civil court case we can only guess at any outcomes.

The impetus to create government legislation usually arises from pressure exerted by pressure groups. Complemetary therapies would benefit greatly from legislation to establish a regulating body for all therapies which would set standards for training and practice. Currently, training and practice are controlled on an ad hoc basis, whereas there could be one supervisory body for all therapies which could gather representatives from each therapy and exert pressure on the government to introduce legislation to control training and practice. This would increase the credibility of complementary therapies with the general public.

Legal accountability can be discussed under five headings:

• Employment. An employee engaged as a member of a profession is liable in damages if he or she fails to exhibit the
degree of skill reasonably expected from an ordinary member of his or her profession. This is the standard expected by
the employer of a professional. Where an employer is held vicariously liable for the fault or negligence, he or she is
entitled to reclaim from the employee for the damages and expenses he or she has to pay.

• Partners. The firm is liable for any wrong act or omission of any partner acting in the ordinary course of business or with the authority of his or her co-partners. Every partner is jointly and severally liable for all debts of the firm. It is good practice to constitute the partnership in writing.

• Professional bodies. The practice of nurses, midwives and health visitors is regulated by the United Kingdom Central Council which was created by the Nurses, Midwives and Health Visitors Act of 1979. This body has a statutory duty to regulate the training and practice of nurses and fulfils this obligation by creating, publishing and distributing to nurses the standards that they must maintain in practice.

Patient records are a must and can be required as evidence in court. The Access to Health Record Act of 1990 gave patients access to their medical records, while the Data Protection Act 1984 gave patients access to computer held records. If there is good reason, the patient can be refused access, but a lawyer can demand it if there is a court case.

Chiropodists, dieticians, occupational therapists, orthoptists, physiotherapists and radiographers are regulated following the terms of the Professions Supplementary to Medicine Act of 1960. The first complementary therapy to achieve legislative control was osteopathy. The Osteopaths Act of 1993 introduced the registration of practitioners and the regulation of training.

• Client. Most people, when thinking about law, think about the criminal courts. Fortunately, criminal cases against nurses, doctors and therapists are rare. The civil courts are more likely to deal with a client’s complaint about treatment received.

In the case of negligence there are two main categories in case law (i) treatment—the wrong treatment given and (ii) non-disclosure of the consequences of treatment. To be successful the patient must prove three points: that a duty of care existed, that there was a breach of the duty to care, and that she or he suffered a loss as a result of the breach.

• You. Practitioners have a duty to themselves to ensure that their standards of practice are adequate, that they have adequate insurance and that they undertake proper training and follow this up with regular refreshers.

The future can bring legislation but the process is slow and requires a great deal of pressure on an understanding Member of Parliament. Self-regulation is much quicker and exhibits a professional attitude which may be looked upon favourably by the courts. Complementary therapies are being recognised by the traditional health care providers. The BMA have produced an extensive report which contains many encouraging points.

In conclusion, we all assume that it will not happen to us, that the client is also our friend, but remember, when things go wrong even the best of friends can fall out.

—from notes by Linda Lamb

Linda Lamb, former district nurse and midwife, is a legal trainee developing expertise in all aspects of the law, with a particular interest in personal injury and medical negligence. Her experience of nursing within the NHS has led her to speak out for the need for nurses to be fully responsible and independent within the system.

There are two realities, two worlds existing simultaneously, and Ms Myss refers to them as Orbit 1 and Orbit 2. In Orbit 1. people are operating from their first three chakras (energy centres) only. External things cause internal reactions, time and space are external, matter is more important than life. In this orbit power is external, people have only five senses and the fuel for energy is carbon based.

In Orbit 2, people are operating from their fourth, fifth, and sixth chakras. Internal things cause external reaction, time and space are internal, energy comes before matter. In this orbit life comes before profit, power is internal and people are multisensory.

Practitioners dealing with Orbit 1 clients cannot prescribe Orbit 2 cures. They won’t work.

People moving from Orbit 1 to Orbit 2 may experience illness during the transition due to friction caused by their new awareness meeting old behaviour patterns that have not yet changed. According to Ms Myss all physical illnesses come from chakras one, two or three, and the worst old behaviour a person can hold on to is the internal attitude: “If I only knew why!” She says that self-pity is an addiction and a toxic (perverted) form of intimacy.

We all have an energy at our disposal, called “prana”, that helps us create our world. When we use up too much of our energy on old wounds and vengeance, we don’t have much prana left to heal ourselves and create a wonderful world.

Energy medicine is activated mostly by being in “present time” and forgiveness is the only way to release the things that keep us in the past. One thing that blocks forgiveness is that when we truly forgive someone, they may then disappear from our life because we’ve learned the lesson they bring to us and we have no need for them anymore. The fear of this happening may stop us from forgiving and entering present time.

—from notes by Marietta Olsen

Many physical diseases in mid-adult life have their origins in poor emotional and mental health. Problems with emotional and mental health stem from emotional instability and poor self-esteem in early childhood and adolescence. The workshop therefore focused on the emotional health of the growing child and saw the child in terms of relationships.

The current bio-medical model of looking at child health care does not give sufficient weight to the emotional aspects of the nurture of children. The conceptual framework we worked with in this workshop sees the child as moving through concentric circles or environments, each of which has the right balance of safety and freedom in its different phases of development.

The first environment is the uterus where the foetus can be secure and safe. Its sensations of sound, vision, movement and touch develop gradually. It is here that the child’s sensations and neurology develop in relationship to what is experienced in the mother’s uterus and where he or she develops a sense of safeness and self.

The second environment is the baby’s experience of birth and early experiences with its mother. Birth is traumatic for the baby as it is the death of its intrauterine world, and with the current health care emphasis on controlling the birth process, there is often interference with the intrinsic biological process. Although society sees the baby as separate from its mother as soon as the umbilical cord is cut, in emotional terms the baby is not separate and separation from the touch and sound of its mother at birth results in the baby feeling as if it is losing its identity and sense of being. If baby and mother do not reunite through immediate contact using touch and sound, an infant will seek some material substitute for the emotional closeness it is missing.

In our society a mother is expected to care physically for her baby, taking on a wide range of physical tasks, but not enough importance is placed on the precious emotional relationship that a mother and baby need to develop at this time—it is simply not given the space in which to occur. (In some societies a mother will leave her husband’s house to live with her own mother until the baby is six months old.) To provide this circle of safety it is first necessary to see how vital the mother and baby relationship is at this stage.

The next circle of safety is the toddler years when the infant takes more control of its life by taking control of its body through walking, bladder and bowel control, control in asserting its will on eating or sleeping. The safe, secure child in close and intimate relationship with mother and then father and other members of close family, learns through imitating those it loves. At this stage the baby learns holistically through the whole process of rhythms of body, sound and movement. At this stage, learning by systems of rewards and sanctions actually confuse the child who is programmed to learn through imitation, because its identity is linked with those whom it loves and is programmed to imitate.

Much of the stimulation our children receive today is artificial, or non-human, ie sounds, colours, recorded music or television. This input is “bitty”, lacking in human perspective. It is confusing to the young child who is programmed to imitate the whole human and is instead being fed with fragments.

The primary school child continues to learn through imitation and also enters into the phase of imagination. The nurturing environment at this stage is one which fosters imagination and not analytical intellectual learning. Fantasy, mythology, fairy tales and scriptures form an important part of the child’s mental life. At this stage the focus is still not on an external objective reality, and to emphasise those aspects too much will impoverish the emotional and imaginative lives of our children.

In adolescence the child begins to develop an identity as separate from its parents. The adolescent needs to make a statement of this separateness by being “different”. This is the time when intellect develops and there is questioning of all previous values, and authority is suspect. The circle through which the adolescent moves needs the right balance of safety and freedom as she or he moves out emotionally from the family into society.

In summary, the child grows up through various concentric circles and during each phase needs a specific combination of support and freedom to explore that phase and move to the next. During the very early phases of childhood the means to provide these circles may lie within the mother and the immediate family but as the child grows older these values have to be shared by the wider and wider society, ie the school for the young child or the community in general for the adolescent. We are failing to nurture our children if they are not brought up in the context of a community—which implies shared values, aims and directions. The long term approach to the care of our children has to be the resuscitation of communities and community sense of values.

—from notes by Dr Arthur Paynter

Dr Arthur Paynter is Consultant Paediatrician in Community Health Care with West Cumbria Health Care.

About eight people attended this workshop, most of whom were either setting up, running or practising in complementary health care. The central issue was the challenge of building links between complementary therapy practitioners and orthodox GP surgeries and hospitals. Several illustrations were given, each with different obstacles and degrees of success:

• Having convinced doctors and managers of the benefits of aromatherapy in orthodox hospitals, resistance was encountered amongst nursing staff who would permit the therapist to prescribe oils but not to massage.
• An approach to GPs to establish a community counselling centre produced a few referrals but no funding or true integration.
• A complementary health project did eventually get funding because people who used its services gave good feedback to their GPs.

We then discussed the different facets of a successful approach to orthodox practices. One of these was marketing, and another, more problematical, was the issue of professional respect. We agreed that each complementary profession must be “grown up”—clear about itself, its aims and standards, and what the therapy it offers can and cannot achieve.

Dr Reilly argued that in addition to this self-respect, the profession must be able to back up its assertions with solid evidence—ie, for each medical condition the therapy claims to cure or ameliorate, there must be evidence gained by clinical trials, audit or even research.

Then there is the problem of mutuality of respect: this is difficult when, in the case of psychotherapy, the complementary practitioner believes that the orthodox (psychiatric) model of pathology is simply wrong.

The group then considered what such a complementary-orthodox partnership should look like to the patient. One “consumer model” of unguided free choice was discussed. Whilst the freedom is valuable, some felt it could lead to fragmentation of the service—thus reducing its ability to supply holistic care.

Dr Reilly concluded with an overview of the Glasgow Homoeopathic Hospital as an example of integration and highlighted the meticulous and sustained work over many years needed to bring it to fruition.

—from notes by Guy Riggs

This was a lively group of approximately 16 people from varied backgrounds. With Dr Adams’s lead we were able to help one or two of our participants who suffered from tiresome stresses, especially one person who was experiencing no joy in what seemed to her an unabated straggle with life. Her distress was a surprise to those who had spent time with her, because of her charm and apparent cheerfulness.

She revealed to us some troubles in her childhood which had probably been the cause of her negative attitudes, and eventually realised with the help of our encouragement and Dr Adams’s affirmations, that she must in truth be a lovable person whose presence was valuable to others. Being nearly at the end of her medical training, she had her future career in front of her, and was much cheered by all our good wishes and by having found Dr Adams as a new friend.

Another of us was pestered by guilt and regrets, which she was able to release when she understood that her feelings could only have been caused by some previous religious prejudices.

The healing value of cartoons was mentioned by a participant—who had an outstanding collection—because they induced laughter and humour.

Some people were amazed at Dr Adams’s unending energy in helping and healing people. He said he never needed rest because he was always invigorated by his life style and his patients and friends gave back to him as much as he gave to them. His greatest joy is to serve and help other people.

—from notes by Pamela Scott

After having been to two other workshops which had quite a number of participants, it was rather a relief to me to be together with Dr Cornelia Fellner and four MDs, each at very different places in life and in the “doctor-world”.

We started out with brief introductions of ourselves, focusing on the challenges that each of us was having and had had in our professional lives. We then dealt with the differences between the German, Danish and British medical systems, especially in the GP area.

We then discussed in detail the three different settings that Dr Fellner works in: (i) The Findhorn Bay Holistic Health Centre (serving the Findhorn Foundation Community and guests: people with a well-developed sense of self-responsibility and familiarity with complementary therapies), (ii) HealthWorks, The Forres Centre for Holistic Health Care (a brand new centre, spearheaded by Dr Fellner in the nearby town and serving a diverse population including people from the local area and from the RAF base at Kinloss), (iii) The Total Health Centre, Aberdeen (serving a larger population and practising twice monthly with a heterogenous group of practitioners).

This was just about the highlight of the conference for me, dealing with the questions: what are the roles to be played in the different settings; what processes were going on in the doctor and in the “team”; what does it take for a doctor to function in the complementary arena; is it satisfying for a doctor just to function as the “gatekeeper”. The latter is a term which we really didn’t find very appropriate for the role in a complementary practice or in teamwork, but we couldn’t find anything better. (Someone suggested “gate-adviser”.)

Through the workshop discussion we became inspired about working in integrated health care. The one colleague who didn’t know much about complementary medicine made the commitment to find out more about this aspect of health care.

—from notes by Henrik Langgard MD

This workshop attracted a pleasantly high number of participants, most 0f whom were complementary practitioners. During the introductory round, people spoke of varying degrees of success and fulfilment in practising, and of markedly different degrees of satisfaction in the quality of training and postgraduate support they received. In particular, some would have appreciated more clinical supervision, and the benefits of critical self-review were mentioned.

We started out by listing the qualities people expected of a health practitioner. Dr MacPherson pointed to the split between, on the one hand, technique and knowledge competency— basic qualities that many schools teach well, and on the other, the more subtle supporting and communicating skills that are more time consuming and difficult to teach. At this point we noted concern that, in an attempt at “holism”, some practitioners stray into territory more suited to psychotherapists.

A brief discussion on setting nationally agreed standards moved on to Dr MacPherson’s illuminating exposition of a developmental model for training.

The model divides the time spent training into three phases: the early “high energy, high enthusiasm” stage; the middle “low” stage, which starts when the students realise their lack of competence; and the final stage characterised by a more realistically based confidence and idea of competence.

Dr MacPherson emphasised the point that some trainings actually end at the first stage, producing wonderfully enthusiastic people who do not know they are incompetent. A similar point had been raised by one of the participants at the beginning: that people would do just the first part of a course, get a certificate and then disappear!

The second stage is where the important personal changes start and it is inevitably when most drop-outs occur. It is the stage when the distinction between promising and unpromising students becomes clear—the art is getting the “right” people to drop out—and when most of the heavier group dynamics occur.

The important thing is to move through this stage to competence and eventually mastery.

—from notes by Guy Riggs

Dr Reilly suggested that as practitioners we need to ask the questions: “What am I doing? Why am I doing it?” He suggested that we take time to talk to sceptics, rather than to friends, about the effectiveness of our work.

The main question Dr Reilly wanted to be answered is, “Does it work?” In particular, “Does it work better than a placebo, and how cost effective is it?” He recommended that we spend time on what questions need to be asked in an audit and why.

The group came up with some suggestions for possible motives for audit (i) to generate income and/or fame (ii) to prove to yourself or to demonstrate the therapy is good (iii) to pursue understanding (iv) to have fun (v) defensiveness (vi) to reassure patients.

Dr Reilly suggested that there is great value in clear case evaluation. He suggested when questions are asked, we use words the patient can easily understand, and offer symmetrical choices eg: worse or better? More than one or two questions at a time cannot really be answered from the point of view of research procedures, so care needs to be taken in identifying questions that need to be addressed.

Because surveys show that young GPs are influenced by: clinical/experimental audit; clinical trials; colleagues; self-experience; theory and laboratory evidence, in that order, it is vital to do clear case evaluations of complementary therapies.

In considering research, it is important to be concerned not only with cost, but with practicality also.

A possible method for research is to audit 100 sequential cases (non selected) and record basic information:

• How many had previous CAM for any problem
• Mean age
• Female-male ratio
• Median length of treatment
• Distribution between consultants, % referred from each type
• Diagnosis
• Therapies used by these patients

Also, evaluation of:
• Presenting problem
• Sleep
• Overall physical strength or wellbeing
• Level of interest in surrounding events
• Overall mood

The scale of evaluation must go from (-) to (+), symmetrically.

An improvement scale could look like:
0 = no change
1 = minimal improvement
2 = improvement in value of daily living
3 = substantial improvement
4 = complete recovery/back to normal
-2 = deterioration sufficient to effect daily living
-4 = major deterioration leading to hospitalisation

Base line for this, is how much the presenting symptom is affecting daily life on a scale of -4 to +4. Results may be expressed in the form of a histogram. Follow-up questionnaires can be presented at one and two year intervals following the initial visit (and may need to be chased up if forms are not returned).

It is useful to ask specifics such as how much less conventional medicine is being taken since the beginning of treatment. It is therefore useful to keep details at the outset, such as a chart showing what medicines were taken at various stages, or how many doctors were seen in the last year before they came for holistic treatment.

—from notes by Robyn Alexzander