Integrated healthcare

A QUIET revolution is taking place in a number of GP clinics across the State. In these primary care centres, medical herbalists and homeopaths are working alongside conventionally trained doctors for the first time.

In some cases, the treatment rooms are still separate but in others, such as at the Strand Road General Practice in Clonakilty, Co Cork, the medical herbalist and the GP use the same clinic and share the same diagnostic equipment.

"I work in the medical part of Dr O'Reilly's clinic and not the complementary therapy centre, which has a reflexologist, a massage therapist, a cognitive-behaviour therapist and a cranio-sacral therapist," explains Rosari Kingston, medical herbalist and member of the Irish Institute of Medical Herbalists.

Kingston is keen to explain how she carries out the same medical examinations (for example, those for respiratory, cardiovascular or nervous system complaints) as the GP, but the difference lies in how the case history is taken and, of course, the use of traditional Irish herbal medicine rather than pharmaceutical drugs.

"I'm very pleased to have a medical therapist work in the practice because I see that there is a huge longing for the holistic approach to illness," says Dr Fiona O'Reilly, who also treats some of her own patients with acupuncture.

Kingston has been working in the Clonakilty GP practice for more than five years. "Initially I asked her to see female patients with menstrual or menopausal problems but over time, she has begun to treat patients with colitis, ulcers, polycystic ovaries and diabetes," says O'Reilly.

Kingston also runs her own independent herbal medicine clinic and the West Cork Herb Farm.

O'Reilly admits that other GPs in the area had some reservations about her decision to take a medical herbalist into her practice. "I was criticised in the beginning even for giving patients arnica.

"Now, some of the other local doctors are doing so too. I think conventional doctors can get carried away with all the freebies they get from medical representatives but if you try some of the herbal mixtures for coughs and colds, you'll find they are very good. It's been a learning curve for me too," she says.

Sometimes, Kingston and O'Reilly work together on a patient with high blood pressure or high cholesterol.

"Patients with high blood pressure might be put on blood pressure medication at first and when their condition stabilises, they might try the herbal approach," explains Kingston. "Similarly with high cholesterol, herbal medicine is good for bringing it down and then we monitor the levels and if it's volatile, they will put patients back on conventional medicine."

Interestingly, the issues around sharing patient records between complementary and conventional medical practitioners were investigated recently as part of the European move towards standardised electronic health records. The authors of a UK study (International Journal of Medical Informatics) found that in the future, it will be feasible for patient records from homeopathy to be included in such a system.

Meanwhile, on Haddington Road in Dublin, a GP practice has recently taken on a homeopath to work alongside them.

"I'd say 40 to 50 per cent of our patients have tried complementary therapy such as acupuncture, osteopathy and homeopathy, and by having a homeopath in the clinic, it gives patients a sense of comfort that you accept their treatment choices," says Dr Patanne Harte. "There are certain problems that we don't have perfect solutions for. Menopausal problems are one example and if you have a patient who is not suitable for, doesn't want or is coming off Hormone Replacement Therapy (HRT), homeopathy fits the bill perfectly," she says. "Also, it's appropriate for patients with chronic complaints or those who need emotional support."

Her colleague, Dr Sonja Bobart, adds that she might refer teenagers with sleep problems and other patients with sleep problems linked to bereavement to the homeopath.

Homeopath Jennifer Gordon, who is a member of the Irish Society of Homeopaths, says that the integrated care model gives her better access to conventional medical doctors.

"For me, working at this practice allows me to take my work to another level. For instance, I had a 13-year-old boy with migraine recently and I sent him to the GP to rule out more serious conditions such as a brain tumour.

"Then, once I got the all-clear, I gave him homeopathic medicine and he has done brilliantly."

Gordon refers to how integrated practices are so much further developed on the European continent and in Britain. "There, homeopaths and GPs work much more side by side. It's early days still in Ireland."

Sheelagh Behan, spokeswoman for the Irish Society of Homeopaths, says: "We welcome an integrated healthcare system because patients can choose the approach which suits them best. Also, homeopathic remedies, which are less costly than conventional drugs, can help patients build up their immune system and therefore prevent the recurrence of some illnesses."

Harte says patients who have been failed by the conventional medical system might also be able to rekindle their relationship with conventional medicine when they see both systems working together.

Kingston is adamant that such levels of integrated care are only safe for patients when complementary therapists are well qualified.