Complementary And Alternative Medicine Practitioners Research Articles

Complementary Medicine in Palliative Care and Cancer Symptom Management

Complementary and alternative medicine (CAM) use among cancer patients varies according to geographical area, gender, and disease diagnosis. The prevalence of CAM use among cancer patients in the United States has been estimated to be between 7% and 54%. Most cancer patients use CAM with the hope of boosting the immune system, relieving pain, and controlling side effects related to disease or treatment. Only a minority of patients include CAM in the treatment plan with curative intent. This review article focuses on practices belonging to the CAM domains of mind-body medicine, CAM botanicals, manipulative practices, and energy medicine, because they are widely used as complementary approaches to palliative cancer care and cancer symptom management. In the area of cancer symptom management, auricular acupuncture, therapeutic touch, and hypnosis may help to manage cancer pain. Music therapy, massage, and hypnosis may have an effect on anxiety, and both acupuncture and massage may have a therapeutic role in cancer fatigue. Acupuncture and selected botanicals may reduce chemotherapy-induced nausea and emesis, and hypnosis and guided imagery may be beneficial in anticipatory nausea and vomiting. Transcendental meditation and the mindfulness-based stress reduction can play a role in the management of depressed mood and anxiety. Black cohosh and phytoestrogen-rich foods may reduce vasomotor symptoms in postmenopausal women. Most CAM approaches to the treatment of cancer are safe when used by a CAM practitioner experienced in the treatment of cancer patients. The potential for many commonly used botanical to interact with prescription drugs continues to be a concern. Botanicals should be used with caution by cancer patients and only under the guidance of an oncologist knowledgeable in their use.

Use of complementary and alternative medicine in epilepsy

Complementary and alternative medicine (CAM) has become much in vogue, and CAM practitioners have increased in tandem with this. The trend of using CAM for treating epilepsy does not differ from that in other medical conditions, with nearly one half of patients using CAM. In this article we review the major complementary and alternative medicines used for treatment of epilepsy. They include mind-body medicines such as reiki and yoga; biologic-based medicine such as herbal remedies, dietary supplements, and homeopathy; and manipulative-based medicine such as chiropractic. In the available literature, there is a sense of the merit of these therapies in epilepsy, but there is a paucity of research in these areas. Individualized therapies such as homeopathy and reiki cannot be compared with medicines in a conventional pharmaceutical model. Hence, many studies are inconclusive. In a science of double-blind, randomized controlled trials, appropriate designs and outcome measurements need to be tailored to CAM. This article explains the principles of the major CAM therapies in epilepsy, and discusses peer-reviewed literature where available. More effort needs to be put into future trials, with the assistance of qualified CAM professionals to ensure conformation to their therapeutic principles.

Integrative medicine: implementation and evaluation of a professional development program using experiential learning and conceptual change teaching approaches

Objective To meet the increasing patient interest in complementary and alternative medicine (CAM), conventional physicians need to understand CAM, be willing to talk with their patients about CAM, and be open to recommending selected patients to appropriate CAM modalities. We aimed to raise physicians’ awareness of, and initiate attitudinal changes towards CAM in the context of integrative medical practice. We developed and implemented a professional development program involving experiential learning and conceptual change teaching approaches. Methods A randomized controlled study with a pre-post design in a large academic medical center. The 8-hour intervention used experiential and conceptual change educational approaches. Forty-eight cardiologists were randomized to participant and control groups. A questionnaire measured physicians’ conceptions of, and attitudes to CAM, the likelihood of changing practice patterns, and the factors most important in influencing such changes. The questionnaire included an embedded control question on a topic that was not the focus of this program. We administered the questionnaire before (pretest) and after (posttest) the intervention. We compared differences in pre- and post-intervention scores between the participant ( N = 20) and control ( N = 16) groups. We used both groups to identify factors that influenced their practice patterns. The study was NIH-funded and IRB-exempt. Results Both groups initially had little knowledge about, and negative attitudes to CAM. The participant group had significant positive changes in their conceptions about, and attitudes to CAM after the program, and significant improvements when compared with the control group. Participant physicians significantly increased in their willingness to integrate CAM in their practices. Physicians (combined groups) rated research evidence as the most important factor influencing their willingness to integrate CAM. They requested more research evidence for CAM efficacy, and more information on non-conventional pharmacology. Participants reflected enthusiasm for the experiential program. Conclusions The participants were able to experience the positive effects of selected CAM modalities. It is possible to increase physician knowledge and change attitudes towards integrative medicine with an eight-hour intervention using experiential and conceptual change teaching approaches. Practice implications Professional development on integrative medicine can be offered to medical practitioners using experiential learning and conceptual change teaching approaches, with the help of local CAM practitioners.

Race/Ethnicity and Women’s Use of Complementary and Alternative Medicine in the United States: Results of a National Survey

We studied the use of complementary and alternative medicine (CAM) among women in 4 racial/ethnic groups: non-Hispanic Whites, African Americans, Mexican Americans, and Chinese Americans. We obtained a nationally representative sample of women aged 18 years and older living in the United States in 2001. Oversampling obtained 800 interviews in each group, resulting in a sample of 3068 women. Between one third and one half of the members of all groups reported using at least 1 CAM modality in the year preceding the survey. In bivariate analyses, overall CAM use among Whites surpassed that of other groups; however, when CAM use was adjusted for socioeconomic factors, use by Whites and Mexican Americans were equivalent. Despite the socioeconomic disadvantage of African American women, socioeconomic factors did not account for differences in CAM use between Whites and African Americans. CAM use among racial/ethnic groups is complex and nuanced. Patterns of CAM use domains differ among groups, and multivariate models of CAM use indicate that ethnicity plays an independent role in the use of CAM modalities, the use of CAM practitioners, and the health problems for which CAM is used.

New Canadian natural health product regulations: a qualitative study of how CAM practitioners perceive they will be impacted

BackgroundNew Canadian policy to regulate natural health products (NHPs), such as herbs and vitamins were implemented on January 1st, 2004. We explored complementary and alternative medicine (CAM) practitioners' perceptions of how the new regulations may affect their practices and relationships with patients/consumers.MethodsThis was an applied ethnographic study. Data were collected in fall 2004 via qualitative interviews with 37 Canadian leaders of four CAM groups that use natural products as a core part of their practises: naturopathic medicine, traditional Chinese medicine (TCM), homeopathic medicine and Western herbalism. All interviews were transcribed verbatim and coded independently by a minimum of two investigators using content analysis.ResultsThree key findings emerged from the data: 1) all CAM leaders were concerned with issues of their own access to NHPs; 2) all the CAM leaders, except for the homeopathic leaders, specifically indicated a desire to have a restricted schedule of NHPs; and 3) only naturopathic leaders were concerned the NHP regulations could potentially endanger patients if they self-medicate incorrectly.ConclusionNaturopaths, TCM practitioners, homeopaths, and Western herbalists were all concerned about how the new NHP regulations will affect their access to the products they need to practice effectively. Additional research will need to focus on what impacts actually occur as the regulations are implemented more fully.

Status of Credentialing Alternative Providers Within a Subset of U.S. Academic Health Centers

Complementary and alternative medicine (CAM) clinical services are increasingly provided within conventional health care settings. To determine how a subset of U.S. academic health centers is credentialing CAM providers. An electronic survey was created focusing on the credentialing method utilized for six specific types of CAM clinical practitioners within academic medical settings. This survey was electronically distributed to 33 academic health centers in the United States during the summer 2004. Ninety-five percent (95%) of academic centers surveyed provide some CAM clinical care. Acupuncture and massage are most common, with naturopathy and homeopathy least common. State licensure requirements for CAM providers appear to not be well-understood. Most commonly, CAM professionals do not receive full medical staff credentials. Results cannot be extrapolated to remaining academic health centers within the United States. Mind-body practitioners were not included in the survey. Credentialing and privileges are most commonly granted via indirect methods. Variability in state licensure compounds the challenge of credentialing CAM practitioners. Suggestions for beginning discussions on guiding principles for integrating CAM practitioners within conventional settings are proposed.

Working complementary therapies into mainstream health care

Complementary and alternative medicine (CAM) is speculative and practitioners and policy makers question its validity in the care of people within the NHS. However, increasing numbers of people are using private CAM therapists to address their health needs. This has consequences in terms of cost to the patient, of using CAM instead of traditional health care, and for policy makers and educators raises questions of competency, regulation and research to validate its efficacy. This article provides a personal account of a nurse educator's discovery of homeopathy as a complementary therapy, its impact upon health status, training undertaken and action taken as a result. It outlines the potential use of CAM as a holistic approach that embraces the interprofessional framework and suggests CAM practitioner inclusion within mainstream healthcare provision. The article emphasizes the need for further quantitative and qualitative research of CAM treatment.

Book Review

In countries with a long history of traditional medical practice (e.g., China and India), it is customary to find patients adopting traditional therapies and “Western” medicines side by side. However, complementary and alternative medicine (CAM) is becoming increasingly popular, even in many Western countries where “conventional” treatments are readily available. Demographic studies conducted in the United States estimated that the use of CAM increased by almost 50% between 1990 and 1997, with the number of total visits to CAM providers exceeding that to all U.S. primary care physicians. Patients with epilepsy are no exception. Surveys conducted in the United States and United Kingdom suggest that up to one-third of patients with epilepsy take herbs or dietary supplements or both, and that the majority of these patients do not discuss such use with their physicians. However, as the editors of this book pointed out, the vast majority of physicians do not understand and are uncomfortable with CAM. This book is, therefore, a very timely resource publication on the topic of CAM and epilepsy. The chapters, written by CAM practitioners who presented their work during a special conference at the NYU Epilepsy Center on CAM and epilepsy, cover a very diverse range of therapies from neurobehavior, biofeedback, and meditation, to massage, aromatherapy, and from herbal medicines, nutritional approaches, oxygen therapy, to chiropractic manipulation and music and art therapies. One chapter deals with research methods for CAM. The chapters are generally well referenced, and each chapter is followed by a brief commentary by the editors to provide a perspective on the content, albeit often from the standpoint of Western medical culture. Overall, the book has served the purpose of introducing the readers coming from a Western medical background to the various CAM therapies currently used to treat epilepsy. In-depth discussion is not feasible because of the large number of treatment modalities covered (more than 20). In addition, because the chapters are written by different authors, their formats and standards are variable. I particularly like the chapter, Herbal Therapy in Epilepsy, which critically and authoritatively appraises the evidence of the efficacy and safety of a range of herbal medications and their potential interactions with antiepileptic drugs. Other chapters with more anecdotal reporting of personal experiences are well supplemented by comments from the editors to give a more balanced view on the subjects. Because most of the authors are unknown to conventional physicians unfamiliar with the field of CAM, it would be helpful if their background and affiliation could be provided to the readers. Very few books of a similar nature are available on a topic of increasing relevance to everyday clinical practice. I strongly recommend this book to all professionals caring for patients with epilepsy.

Gaining insight into the what, why and where of complementary and alternative medicine use by cancer patients and survivors

The aim of this study was to gain a greater understanding of complementary and alternative medicine (CAM) use among cancer patients and survivors. Specific objectives included types used and timing, motivations for use and benefits received, sources of information on CAM and communication with doctors. Semi-structured in-depth interviews were conducted with 19 patients and survivors (mean age = 57 years). Findings on frequency and type of CAM use were consistent with previous studies. Additionally, we found that the main expected benefit from using CAM was to boost the immune system, that participants could not readily explain the nature of the benefits they received, that CAM practitioners and books were the main sources of CAM information, and that the majority reported some discussion of CAM with a doctor. A greater range of questions needs to be asked of cancer patients in future quantitative studies. Reasons for commencing and stopping use of CAM and the quality of the CAM information source will be imperative to uncover, especially as the Internet is increasing in importance as a source for health information.

An analysis of sickness absence in chronically ill patients receiving Complementary and Alternative Medicine: A longterm prospective intermittent study

BackgroundThe popularity of complementary and alternative medicine (CAM) has led to a growing amount of research in this area. All the same little is known about the effects of these special treatments in every-day practice of primary care, delivered by general practitioners within the health insurance system. From 1994 to 2000 more than 20 German Company health insurances initiated the first model project on CAM according to the German social law. Aim of this contribution is to investigate the effectiveness of multi-modal CAM on chronic diseases within primary health care.MethodsA long-term prospective intermittent study was conducted including 44 CAM practitioners and 1221 self-selected chronically ill patients (64% women) of whom 441 were employed. Main outcome measure is sick-leave, controlled for secular trends and regression-to-the mean and self-perceived health status.ResultsSick-leave per year of 441 patients at work increased from 22 (SD ± 45.2) to 31 (± 61.0) days within three years prior to intervention, and decreased to 24 (± 55.6) in the second year of treatment, sustaining at this level in the following two years. Detailed statistical analysis show that this development exceeds secular trends and the regression-toward-the-mean effect. Sick-leave reduction was corroborated by data on self-reported improvement of patients' health status.ConclusionResults of this longterm observational study show a reduction of sick leave in chronically ill patients after a complex multimodal CAM intervention. However, as this is an uncontrolled observational study efficacy of any specific CAM treatment can not be proven. The results might indicate an general effectiveness of CAM in primary care, worthwhile further investigations. Future studies should identify the most suitable patients for CAM practices, the most appropriate and safe treatments, provide information on the magnitude of the effects to facilitate subsequent definitive randomised controlled studies that will help to position complementary and alternative medicine in health care.

Variations in provider conceptions of integrative medicine

Consumers often turn to complementary and alternative medicine (CAM) and use it concurrently with conventional medicine to treat illnesses and promote wellness. However, prior studies demonstrate that these two paradigms are often not combined effectively. Consumers often do not tell physicians about CAM treatments or CAM practitioners about conventional treatments that they are using. This can lead to inefficient care and/or adverse interactions. There is also a lack of consensus about the structure and practice of integrative medicine among the various types of practitioners. This qualitative study aimed to identify key domains and develop a conceptual model of integrative medicine at the provider level, using a grounded theory approach. Purposive sampling was used to select 50 practitioners, including acupuncturists, chiropractors, internists/family practitioners, and physician acupuncturists in private practice and at academic medical centers in Los Angeles. We conducted semi-structured, in-depth interviews with practitioners and then identified core statements that describe practitioners′ attitudes and behaviors toward integrative medicine. Core statements were free pile sorted to ascertain key domains of integrative medicine. Four key domains of integrative medicine were identified at the provider level: attitudes, knowledge, referral, and practice. Provider age, training, and practice setting also emerged as important factors in determining clinicians’ “orientation” toward integrative medicine. “Dual-trained” practitioners, such as physician acupuncturists, exemplified clinicians with a greater orientation toward integrative medicine. They advocated an open-minded perspective about other healing traditions, promoting co-management with and making referrals to practitioners of other paradigms, and treating patients with both CAM and conventional healing modalities.

Use of complementary and alternative medicine practitioners by people with physical disabilities: Estimates from a National US Survey

Purpose. To estimate the prevalence of complementary and alternative medicine (CAM) practitioner use, assess the reasons for use, and determine the symptoms for which CAM practitioners were consulted in a national US sample of insured adults with physical disabilities.Methods. Data for this study come from a longitudinal survey conducted in 2000 and 2001 on a national sample of 830 adults with health insurance who had one of four disabling conditions: multiple sclerosis, cerebral palsy, spinal cord injury, and arthritis. Estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted are derived from cross-sectional analysis of the 2001 survey data. Prior use of CAM was assessed using the 2000 survey.Results. CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. CAM use was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%) and among prior users (62%) compared to non-users (8%). There were no significant differences in CAM use by condition, although individuals with spinal cord injury reported the lowest use (14%). Common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). Common reasons for using CAM practitioners included lifestyle choice (67%) and because they are perceived to be more effective than conventional medicine (44%).Conclusions. Evidence from the current survey suggests that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning.

An Approach to Teaching Primary Care Physicians How to Integrate Complementary Medicine into Their Daily Practices: A Pilot Study

This paper describes a pilot educational approach to integration of complementary and alternative medicine (CAM) into the daily routine of primary care practice. Twelve (12) family practice residents and specialists were assigned to develop an integrative treatment program geared to address the needs of their own patients. In the process, participants were asked to formulate treatment plans by searching resources to find appropriate CAM modalities and consult with CAM practitioners. The effectiveness of the educational process was assessed by questionnaires. The researchers found that providing a short course in advanced integrative medicine improves physician ability to better formulate an individualized treatment plan. This approach of teaching has long-standing results, as noted with a 2-year follow-up evaluation.

Physicians′ Attitudes Toward Complementary and Alternative Medicine and Their Knowledge of Specific Therapies: A Survey at an Academic Medical Center

The purpose of this study was to evaluate the attitudes of physicians at an academic medical center toward complementary and alternative medicine (CAM) therapies and the physicians' knowledge base regarding common CAM therapies. A link to a Web-based survey was e-mailed to 660 internists at Mayo Clinic in Rochester, MN, USA. Physicians were asked about their attitudes toward CAM in general and their knowledge regarding specific CAM therapies. The level of evidence a physician would require before incorporating such therapies into clinical care was also assessed. Of the 233 physicians responding to the survey, 76% had never referred a patient to a CAM practitioner. However, 44% stated that they would refer a patient if a CAM practitioner were available at their institution. Fifty-seven percent of physicians thought that incorporating CAM therapies would have a positive effect on patient satisfaction, and 48% believed that offering CAM would attract more patients. Most physicians agreed that some CAM therapies hold promise for the treatment of symptoms or diseases, but most of them were not comfortable in counseling their patients about most CAM treatments. Prospective, randomized controlled trials were considered the level of evidence required for most physicians to consider incorporating a CAM therapy into their practice. The results of this survey provide insight into the attitudes of physicians toward CAM at an academic medical center. This study highlights the need for educational interventions and the importance of providing physicians ready access to evidence-based information regarding CAM.

Complementary and alternative medicine: Beyond users and nonusers

Studies of complementary and alternative medicine (CAM) commonly distinguish between "users" and "nonusers". To examine the group of "users" of CAM practitioners' services, and to characterize its heterogeneity in relation to the conventional medicine system. The heterogeneity of CAM users was examined with respect to three variables: user-type-CAM only or both CAM and conventional therapies, provider-type-CAM provider is a medical doctor or not, and referral-type-by a physician or self-referral. The data are drawn from two health surveys conducted among 4500 persons representing the Israeli Jewish urban population aged 45-75 in 1993 and in 2000. Multivariate analyses confirm the heterogeneity of CAM users, and indicate that the variation within "users" is often larger than the variation between "users" and "nonusers". For a better understanding of consumers' behavior with respect to CAM use, one must go beyond the classical classification of "users" versus "nonusers". The present analysis offers three additional dimensions-user-type, provider-type, and referral-type.

Reasons for Choosing and Complying with Complementary Health Care: An In-House Study on a South Australian Clinic

The aim of this study was to explore the reasons why clients initially consult a complementary and alternative medicine (CAM) practitioner, the reasons that influence clients to seek treatment, and the factors that influence clients to be compliant with their treatment. A combination of quantitative and qualitative methods were used. Quantitative data were obtained via a self-completion survey (n = 158). Qualitative information was derived from eight semistructured interviews. The study took place in a clinic in Norwood, South Australia. Participants were primarily residents of the eastern suburbs of Adelaide. The study involved a convenience sample of clients. Survey and interview results demonstrated that clients access CAM practitioners not solely for improvement of physical symptoms, with 54% of clients indicating a desire for counseling for general health issues and 50% wanting dietary and nutritional treatment. Of the subjects 36% sought increased self-insight and benefit from a wider perspective of healing. In addition 55% of respondents indicated that quality of relationship between CAM and client has a major impact on compliance and continuity of treatment, which in turn affects the overall success of the treatment. Clients in this clinic accessed complementary health care for a variety of reasons including gaining another perspective on their health. It suggests that CAM does not replace conventional medicine but may be used as an adjunct to conventional medicine.

The Spectrum of Therapeutic Influences and Integrative Health Care: Classifying Health Care Practices by Mode of Therapeutic Action

The growing popularity of complementary and alternative medicine (CAM) and integrative medicine (IM) highlight the need for a clinically relevant system for classifying health care practices. All systems, modalities, and techniques of health care (conventional, complementary, alternative, and traditional) can be organized in categories of "primary mode of therapeutic action." This results in six categories: biochemical; biomechanical; mind-body; energy; psychological (symbolic); and nonlocal. In each category, there are subdivisions. Organizing health care by primary mode of therapeutic action has numerous benefits: (1) conventional and CAM practitioners, and the public, can readily see some of the general similarities and differences among practices; (2) health care educators gain a common foundation and shared language for explaining CAM and IM; (3) professionals and the public, wishing to combine dissimilar practices, gain a common framework for evaluating the meaning of integration; and (4) the crossover problem can be understood as a natural occurrence in health care, not a confusing intellectual dilemma. The National Center for Complementary and Alternative Medicine (NCCAM) system of categories for CAM is briefly critiqued.

Multischool, International Survey of Medical Students??? Attitudes toward ???Holism???

Core and optional courses of study in complementary and alternative medicine (CAM) are being incorporated into medical curricula. The authors carried out this study to validate a tool to examine students' attitudes toward holism and CAM and explore the relationships between their attitudes and other demographic and education-related characteristics in a large, multischool, international sample of medical students. In 2003 the authors used a modified version of the Integrated Medicine Attitude Questionnaire (IMAQ) to survey students at a total of six medical schools in the United Kingdom, New Zealand, Canada, the United States, and Hong Kong, China. A three-factor model was tested using confirmatory factor analysis, and the internal consistency of the factors were identified using Cronbach's alpha coefficients. A multiple-indicator multiple-cause (MIMIC) analysis was carried out to determine the relationship between IMAQ factors and student characteristics. The authors validated a three-factor model for the IMAQ: (1) attitudes toward holism, (2) attitudes toward the effectiveness of CAM, and (3) attitudes toward introspection and the doctor-patient relationship. Cronbach's alpha coefficients ranged from .41 to .71. The MIMIC model indicated that various background variables were associated with IMAQ factors (gender, race/ethnicity, and school), depending on whether students had previously visited a CAM practitioner and whether students were willing to undertake a special study module in CAM. Further development work on the IMAQ is required and qualitative research to verify and examine the reasons behind the relationships found in this study between students' attitudes to holism and their demographic and education-related characteristics.

‘The illness is part of the person’: discourses of blame, individual responsibility and individuation at a centre for spiritual healing in the North of England

While the growth in usage and practice of varying forms of complementary and alternative medicine (CAM) continues apace, social science has increasingly turned to CAM's often individualistic approach to health and illness. CAM has been perceived as both partly a cause of and a response to the well-documented ideology in modern healthcare of 'individual responsibility for health'. This occasionally manifests in a 'victim-blaming' ideology amongst both orthodox and CAM practitioners alike. These issues emerged as key themes in an ethnographic study of a Centre for spiritual healing in the North of England. By drawing upon a range of qualitative data gained through the researcher's participation at this healing centre, I argue that the healers' focus on individual responsibility for health is not so much a part of the current socio-political health ideology of 'victim-blaming', rather, it is illustrative of an important contemporary social phenomenon: the movement towards the subjectification and personalisation of public life.

Empowering the Cancer Patient or Controlling the Tumor? A Qualitative Study of How Cancer Patients Experience Consultations With Complementary and Alternative Medicine Practitioners and Physicians, Respectively

The authors describe how patients with cancer, who have had consultations with both a conventional physician and a complementary and alternative medicine (CAM) practitioner, experience these consultations. The theoretical background of this study is inspired by a description of 2 models of principles of treatment. In the first model, the instrumental intervention (eg, the medicine) is defined as the causal factor for outcome. In the second model, the patient is defined as the causal factor; the outcomes of the treatment are dependent on the resources of the patient (eg, the body's ability to heal itself) and the impact of the patient's situation. Semistructured, in-depth interviews were conducted with 17 Norwegian cancer patients who had visited both a CAM practitioner and a physician. The patients were recruited from both an oncology department at a university hospital and a newspaper advertisement in the area of Trondheim in central Norway. Methods of data analysis used were open coding, relational coding, and categorizing of themes. The cancer patients have experienced 2 different modes of consultations: one characterized by practitioners focusing on controlling the tumor and another characterized by practitioners focusing on the patient. The patients' accounts of these 2 modes of consultation differ in a number of ways: which issues are discussed during the consultation, who is in control of the consultation agenda, what are the patients' perceptions of the practitioners' health and disease understanding (ontology), what are the practitioners' communication skills, and how empowered the patient feels during the consultation. Patients in this study ask for a consultation style that conveys a focus on both the disease and the whole patient. The results of this study point to a possible connection between the practitioners' understanding of health and disease and the content and form of the consultations. Future research should test this connection.