Exploring competencies of homoeopathic physician useful for patient compliance in chronic alcoholics

Dr. Vivek Gopalbhai Vasoya M.D. (Hom) Psychiatry
Dr. Manoj Patel M.D. (Hom), HOD In Dept of Psychiatry
Dr. M.L. Dhawale Memorial Homoeopathic Institute, Palghar

Introduction:
Chronic alcoholism is a psychiatric disorder which needs the holistic practitioner to understand the person behind the addiction. The core competencies needed of the physicians for undertaking this have been identified as follows:1. Patient care which includes patient and setting-specific assessment, evaluation, and management. Physician must demonstrate care that is effective, safe, high quality and equitable 2. Medical Knowledge which includes alcoholism as a psychiatric disorder and dynamics of alcohol addiction 3. Professionalism which is the ability to form a therapeutic relationship with the patient through the use of interpersonal and communication skills 4. Systems-based Practice which enables the practitioner to comprehensively consider all factors relevant for an optimal outcome and 5.

Practice-based Learning in which the practitioner displays the ability to creatively apply the lessons from practice and show willingness to change. Alcohol use disorder carries a very poor patient compliance and one would like to take care of the most important variable viz. lack of competencies of the physician. These interfere with the establishment of the depth of patient-physician relationship which in turn affects the treatment outcome. The first step would be to identify such competencies in the Homoeopathic set up. The purpose of this study is to explore competencies of Homoeopathic physician to establish a useful Doctor- patient relationship in chronic Alcoholics for enhancing patient compliance.

Methods:
In a prospective, qualitative study, case taking of 8 physicians who participated by taking a total of 30 cases of chronic alcoholism was observed. Every case was studied in depth to understand the problems faced by the patient in all spheres. The aim of the observation was to understand the dynamics of the patient-physician relationship through an analysis of the interview with the help

of transactional record analysis. This enabled the enlisting of the competencies and identifying the pattern of competencies used by the physician during the interview as well as the techniques. A study of the patient compliance through follow ups would help in correlating physician competencies with patient compliance. Duration of follow up was 6 months.

Results:
Professional relationship was associated with compliance in 63.15% of cases, while physician taking a role of family member was associated with compliance in 40% of cases. Physician taking the role of a friend absolutely failed in yielding compliance.

Cases in which physician had “positive treatment belief” considering alcoholism as curable disorder) was associated with compliance in 50% of cases. Considering “Addiction as treatable”, where physician treated alcoholism like any other illness and without much of a positive belief in treatment outcome was associated with compliance in 46.15% of cases. ‘Negative attitudes towards patient’s alcoholism” gave poor compliance.

Knowledge of disease particularly about bio-psycho-social causes of alcoholism is associated with compliance in 96%. Similarly, knowledge of homeopathic medicine- deep acting chronic medicine – and knowledge of interview techniques especially assertive questioning and exploration is associated with compliance in 100%.

Case taking skill of exploration and empathizing is associated with compliance in 92.85% and keen clinical and behavioral observations were associated with compliance in 85.71%. Acceptance of patient as person is associated with good compliance in 57.14% of case. Informing complications and available treatment modalities is associated with compliance in 50% of cases

Family counseling focusing interpersonal relations between husband- wife and group therapy like Alcohol Anonymous meetings is associated with compliance in 35.71%. Assurance about treatment outcome and prognosis is associated with compliance in 28.58%.

Conclusions:

  • Homeopathic physician needs to be unprejudiced and avoid judgement of character of an alcoholic. He should perceive patient as the one who has lost his ability of normal functioning and who needs someone to accept him with his emotional, physical and social suffering.

Good compliance can be achieved when

    • A physician accepts the patient completely by active listening and being empathetic towards events which allegedly have turned him into an alcoholic
    • Physician cultivates a positive attitude towards patient and adopts an optimistic view for curability of alcoholism.
    • Physician has fair knowledge of alcoholism as a disease and its impact on psyche
    • Physician imparts psycho education about alcohol and its ill-effects on the person and his surroundings.
    • Physician is well trained for holistic management that includes ancillary measures, diet and general management as well which helps him to establish effective communication and rapport with patient and his family.

KEYWORDS: Competencies, Homoeopathic Physician, Dr.-Pt. Relationship, Alcohol Use Disorder, Patient Compliance.

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