PPVE

• What constitutes complementary and alternative medicine? (3)

  -treatments that fall outside of mainstream healthcare

  -when a non-mainstream practice is used together with conventional medicine, it's considered "complementary"

  -when a non-kainstream practice is used instead of conventional medicine, it's considered "alternative"
• Give examples of CAM

  -homeopathy ("treatment" based on the use of highly diluted substances, which practitioners claim can cause the body to heal itself -> said to perform no better than placebos -> not available on the NHS)

  -acupuncture (fine needles are inserted at certain sites in the body for the therapeutic or preventative purposes -> sometimes available on the NHS)

  -osteopathy (way of detecting, treating and preventing health problems by moving, stretching and massaging a person's muscles and joints)

  -chiropractic (treatment where a chiropractor uses their hands to relieve problems with the bones, muscles and joins)

  -herbal medicines (contain active ingredients from plant parts -> not necessarily safe to take can be harmful if not used correctly)
• Who tend to use CAM?

  -users of CAM tend to be more educated, have higher incomes, poorer health status, a holistic philosophical orientation to health and are between the ages of 30-49
• Which diseases are associated with high CAM use?

  -Alzheimer's disease

  -multiple sclerosis

  -rheumatic diseases

  -cancer

  -acquired immunodeficiency syndrome

  -back problems

  -anxiety

  -headaches

  -chronic pain
• How might an ageing population affect CAM use?

  -increase in chronic illnesses, therefore an increase in usage
• Why do people use CAM? (4)

  -some people think conventional medicine doesn't adequately treat their chronic illness

  -dislike of reductionist mechanical model of medicine and prefer a holistic model of medicine

  -desire to avoid treatments W/ adverse effects and reduce iatrogenic conditions (illnesses caused by medical examination or treatment)

  -greater knowledge of how nutritional, emotional and lifestyle factors affect health
• Why might some physicians oppose CAM? (3)

  -alternative therapists not having enough knowledge to diagnose an illness properly

  -lack of evidence on the efficacy of CAM

  -CAM is potential,h harmful due to adverse effects or because people don't seek appropriate medical care for their problems
• Why should physicians be informed about CAM use? (2)


  -patients are using it and will continue to do so if it helps them

  -one way to direct future investigation of the efficacy is to see which CAM therapies are considered most useful by physicians based in their clinical experience
• Which CAM therapies have the highest referral rates?

  -Chiropractic and acupuncture
• Why might doctors refer patients to CAM therapies? (4)

  -patients lack of response to conventional treatment

  -patients request or preference

  -belief in efficacy

  -fewer adverse effects
• Why are some less popular reasons for the referral of CAM by physicians? (3)

  -belief that the scientific world view that is supported by conventional medicine is limited

  -conception that there is a synergy between cam and patients cultural beliefs

  -perception that patients diseases are non organic or psychological in nature
• What is medical dominance?

  -refers to the medical profession's control over the content, terms and conditions of its own work (autonomy), control over other health occupations and the health division of labour (authority), control over clients and control over the broader context of health care (sovereignty)
• How has medical dominance changed in recent years?

  -in 2005 there was a legislation change to say suitably trained nurses and pharmacists could undertake a diagnostic role and could prescribe without a cmp (care management plan) or medical supervision

  -training is mandatory- period of learning in practice where a designated medical practitioner provides support in clinical setting

  -there was some resistance to pharmacist non-medical prescribing and concerns about patient safety and nurses competencies
• What are the downsides of medical dominance? (3)

  -exclusion: taking away the legitimacy of other professionals

  -limitation: restricting other health territories

  -subordination: making sure all other health professionals work under and answer to doctors
• Which societal changes have operated to undermine medical power?(5)

  -proliferation of expert systems, have rationalised or routinised many medical tasks

  -more knowledgable patients seek to challenge and authority

  -greater levels of medical specialisation= more reliant upon technical staff

  -development in self-help and allied health professionals input means patients have greater choice

  -growing awareness and reading costs of medical care
• Outline how the status of medicine has changed over time

  -being seen as quacks and rogues -> profession W/ considerable power, authority and status

  2 strands: GP who was in same social world as patient and the hospital consultant who the gp referred patients to= more distant figure W/ access to more k owldrg

  -after the second ww, they were exemplary members + took over from priests who treated bodily ills + about advice on how to live well and judgements on the right and wrong behaviour

  -further enhanced in 50s and 60s where there were more surgical treatments

  -in recent decades doctors have been challenged from inside and outside the medical world on their position as experts -> greater knowledge by patients makes them have more doubts about the nature of their power
• How has medical authority been challenged? (4)

  -general managers control both doctors and resources

  -reproductive services: social movements have diluted medical authority

  -exercise caution- lawyers and journalists bring negligence claims

  -lay perceptions and health politics are controlled by journalists and the media
• How has medical autonomy been challenged?(3)

  -general managers appoint consultants and merit awards (white paper, 1989) - these managers may question practice

  -expert patients know a lot about their conditions, non-compliance

  -clinical autonomy is challenged by clinical governance
• How was medical expertise been challenged? (4)

  -nurses can now provide screening, counselling, education and health promotion

  -nurses and pharmacists may independently prescribe and diagnose

  -expert patients have their own base of knowledge which may be at odds with the doctor's

  -CAM challenges doctor's biomedical treatment of patients