Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2003; 8: 484–5
Complementary medicine, with its emphasis on individual diagnosis, seems at odds with evidence-based medicine which accentuates systematic group studies. However, the other pole of evidence-based medicine is the casuistic experience. But how to systematically analyse and document cases without losing the ‘richness’ of the original encounter? This points to techniques from cognitive psychology and sociolinguistics. They are applied in the homoeopathic curriculum in the Liverpool faculty of medicine.
(1) Comparison of diagnostic categories by text analysis of fragments on gastric pain. Fragments are from medical text books on internal medicine, homoeopathy and Chinese medicine. (2) Micro-analysis of video/audio registrations, using conversational analytic techniques.
(1) Text: disease categories are prototypes, consisting of three kind of data: (a) common symptoms (in most patients with the same pathophysiological process); (b) typical individual symptoms (sensations; modifiers of the main complaint; comorbidity; etiology); (c) typical features (also beyond disease episode) – mental, general and local. This forms a patient – specific registration, to be used for both qualitative and quantitative studies. (2) Consultation: data, significant for diagnosis, are selected during ‘FDS’ –Sequences of ‘Formulations’ (mostly the doctor) and ‘Decisions’ (mostly the patient).
Structured case analysis (SCA) accounts for heterogeneity in patient populations and can be applied for: (1) process-comparison of diagnosis (biomedicine, homoeopathy, Chinese medicine, and others); (2) patient-oriented audit in NHS for diverse types of medicine; (3) database development in multicentre studies in complementary medicine; (4) relating outcome with patient features (cf. pharmaco-genomics).
