My kind of GP…

When we go to the GP, we all want our doctor to take our worries seriously and offer the very best advice and treatment available – and that may not necessarily be a pharmaceutical drug.  

Rare they may be, but there are a number of GPs out there who also offer acupuncture, homeopathy, hypnotherapy and even – my personal favourite – Ayurveda; and I recently had the privelege of interviewing some of these enlightened individuals for a feature in the Daily Mail.  Read the online version here. 

Here is my longer original version:

GPs are on the front line of Medicine and are the most likely of all doctors to want to fit in with patients’ agendas and beliefs, says

Dr Michael Dixon, an NHS GP at College Surgery, Cullompton, Devon, and chair of College of Medicine and the NHS Alliance.

‘But, more and more, we are also recognising that biomedicine doesn’t have all the answers. It is great for diagnosing patients, but not always able to treat the problems it identifies.

‘At our practice, we refer patients locally for osteopathy, hypnosis, massage, acupuncture and reflexology. And we frequently recommend herbal remedies.

‘The main criticism levelled against alternative medicine is that it lacks evidence to support it, but some herbs have a lot of evidence to back them up.

‘For example St John’s Wort is well proven to treat mild to medium depression and peppermint has long been used (and prescribed by GPs as Colpermin) for bowel spasms. Both have been lauded in the British Medical Journal.

‘Those remedies that do not have scientific evidence behind them often have long term traditional use instead. When our practice offered patients the choice of a herbal or an orthodox medicine for common complaints like insomnia, arthritis, coughs, and migraine, seven out of ten chose the herbal. Fifty per cent of them said it helped and forty per cent said they would buy it next time before booking a GP appointment, thus relieving the burden on the NHS.’

. Acupuncture

Practised by Dr Tanvir Jamil, an NHS GP and senior partner at the Burnham Health Centre, Burnham, Buckinghamshire.

‘As a GP registrar – my first job in General Practice 24 years ago - I had a number of patients asking about acupuncture after friends or relatives had told them it could help with various conditions. I decided I needed to look into it in order to answer their questions, and, when I did, I found it intriguing enough to want to know more.

‘I ended up training as an acupuncturist, and I’ve now been successfully treating my NHS patients with it for 22 years. ‘Acupuncture first developed in China after soldiers who’d suffered minor wounds in for example their foot or hand found that ailments elsewhere in the body had mysteriously cleared up.

‘The Chinese then experimented with artificial wounds until over 100s of years they’d worked out that, for example, a needle in the back of the hand could relieve sinusitis or one on the inner ankle bone could treat period pain. They developed a complex system of over 2000 key acupoints running along 14 meridians or energy channels in the body, treating hundreds of complaints.

‘Acupuncture is now recognised and accepted by many western doctors, with a growing number of studies in medical journals such as the BMJ, and recent NICE guidelines recommending it for osteoarthritis of the knees. Any sort of musculoskeletal problem often benefits from acupuncture – such as back and knee pain, tennis elbow and frozen shoulder. Chronic migraine also responds very well to it.

‘The general consensus is that it works by stimulating nerve fibres which go on to inhibit pain carrying nerves. It can also trigger a chain of events that lead to a rush of natural anti-inflammatory and pain relieving chemicals (eg endorphins).

‘However I have also successfully used acupuncture for conditions that do not involve pain – eg insomnia, anxiety, PMS and pregnancy symptoms, and even IBS.

‘There’s no clear reason why placing needles in certain points in the body can often be so effective for these conditions, so I have to accept that there may be something in the Chinese theory of meridians, even though science cannot yet explain it.

‘Any patient with odd unexplained symptoms should be thoroughly investigated by their GP before being referred for acupuncture.

‘And there are many medical conditions that I would never use it for – including diabetes, psoriasis, eczema, any sort of infection, vertigo and indigestion.

‘I would never use it for hypertension – that needs treatment with drugs. However if I thought a patient’s hypertension was exacerbated by anxiety, I would consider treating the anxiety with acupuncture. It has enabled some of my patients to come off tranquillisers or sleeping pills that they have been taking for years.’

. Ayurveda

Practised by Dr Donn Brennan, a private GP and Ayurvedic practitioner with clinics in London, Skelmersdale and Dublin.

‘As a newly qualified doctor, 30 years ago, I met patients who claimed they’d never felt better since taking up Transcendental Meditation (TM). Medicine couldn’t explain how it worked, but it was a core part of the ancient Indian practice of Ayurveda (from ayu for life and veda for knowledge), which has been around for 2000 years. 

‘In April this year the American Heart Association put out a statement that TM is proven to lower high blood pressure. I believe it is the basis of all good health, helping us tap into our innate ability to heal ourselves.

‘Since 1990 I have treated all my patients using Ayurvedic principles, believing that a person’s dosha – be it “pitta” (typically short tempered, impatient, competitive, work obsessed), “vata” (nervy, excitable, fast talking), or “kapha” (slow, steady, calm) –  influences the way that they cope with life and that this in turn affects their health.

‘For example stress will cause a pitta type to become irritable and angry, a vata type to become anxious and jumpy, and a kapha type to become demotivated.  Each of these responses leads to behaviour that will have a knock on effect on that individual’s health.

‘TM will play a part in the treatment of all three people, but I would also prescribe a specific change of diet together with herbal remedies, or even massage with specific oils, according to the dosha.

 ‘Many of the herbs used in Ayurveda – for example turmeric (which can reduce inflammation in the joints and lower blood cholesterol) - now have scientific evidence to support centuries of traditional use.

‘Others are less well known to Western doctors and herbalists – such Kanchanar Guggulu, a herb that is anti-inflammatory and removes toxins. I use it for patients with hypothyroidism. It enables  the thyroid gland to function normally again, while also giving the patient more energy.

‘However the herb may take three months to make a difference, so, with my GP hat on, I will also prescribe a short course of thyroxine.

‘My idea of Ayurveda is that it should work alongside modern medicine, not against it. It is not offered on the NHS, however, used well, it prevents many of the problems that are burdening our society and health service - such as obesity, diabetes and heart disease.’

. Homeopathy

Practised by Dr Tim Robinson, an NHS GP at the Barton House Medical Practice, Beaminster, Dorset, who is one of 400 GP members of the Faculty of Homeopathy.

‘I had been a GP for four years when my wife, Jenny, pregnant with our first child, started suffering leg cramps for which I could not prescribe any medication. I heard about a homeopathic remedy Cuprum Met that could help  - and it worked.

‘In those early years there had been many occasions when I could not prescribe drugs to my patients because of various contraindications – for example a man with a stomach ulcer who couldn’t take an NSAID painkiller, or a woman with a history of breast cancer who couldn’t use HRT.

‘There were also conditions for which there was very little I could offer medically - growing pains in children, chilblains, glandular fever, chronic fatigue syndrome.  I felt I was letting patients down when I told them: “I’m sorry, there’s nothing I can do.”

‘A year after treating Jenny’s leg cramps homeopathically, I enrolled on a four year part time course at the Bristol Homeopathic Hospital, and since 2000 I have been a fully qualified homeopath as well as a registered GP.

‘Typically I will treat one or two patients a day with homeopathy, having made the medical diagnosis and considered the options – conventional or homeopathic treatment.

 ‘Critics say that homeopathy “doesn’t work because there’s nothing in the pills – the basic remedies are too well diluted.”

‘However in 63 human trials, homeopathy has been proven to work better than a placebo.

‘In veterinary studies, too, homeopathy has trumped the placebo for conditions such as mastitis in cows and kennel cough in dogs.

‘And in laboratory experiments it is clear that homeopathic water is not just plain water as the critics claim.

‘It is a highly diluted substance, retaining just the memory or energy of the active ingredient – it is nano-medicine – but we see it working.

‘If it was a mere placebo any remedy would work for any condition. But that is not the case. Remedies are very carefully chosen based on the precise nature of the patient and symptom.

‘Another common criticism is that homeopathy is a waste of money. It costs the NHS £4 million a year to run homeopathic hospitals and pay for remedies. This is against an annual drugs bill of £7 billion, with £230 million going on SSRIs (eg Prozac) for depression, which could be successfully treated far more cheaply with homeopathy.

‘Belladonna, helpful for menopausal symptoms, costs the NHS 61p a month, compared to upwards of £10.00 for a month’s supply of HRT.

‘If homeopathy was not available, the cost to the NHS would go up – because there would be more hospital referrals and bigger drugs bills, with many prescription drugs causing side effects requiring further drug treatment.

‘Sceptics say that science cannot explain homeopathy and therefore scientists should not support it. I consider that the dogmatic and blinkered view of people who cannot think outside the box. We have to remember that there have always been things that scientists cannot explain – but may one day be able to. The world expected Columbus to sail off the edge of the earth.

‘Homeopathy can be extremely effective in many conditions such as anxiety, depression, grief, hayfever, catarrh, IBS, menopausal symptoms, PMS, osteoarthritis and eczema. In babies and children there are effective remedies for colic, teething, sleep problems, night terrors and car sickness.

‘But there are conditions I would never attempt to treat homeopathically. For example: it is no substitute for baby immunisations as it will not produce the antibodies needed to protect against diptheria, polio, pertussis and tetanus. And it cannot be used to protect against Malaria. I would never prescribe homeopathy if I suspected a patient had cancer, and it cannot be used to lower cholesterol or treat an under active thyroid.   As a doctor first and foremost these are some of the conditions I would only ever treat with conventional medicine. But practising homeopathy means I have an extra tool in my kit for the occasions when conventional medicine doesn’t have much to offer or my patients want an alternative.’

. Hypnotherapy

Practised by Dr Kate Barnes, an NHS GP at Prospect House Surgery, Great Missenden, Buckinghamshire, who sees private hypnotherapy patients at the Healthy Balance Clinic in Great Missenden, and in Harley Street.

‘I qualified as a GP in 1991 and trained at the London College of Clinical Hypnosis in 2009. Although a huge advocate of evidence based medicine, I had always been interested in mind-body medicine: how a patient’s emotional state affects their physical wellbeing.

‘Cognitive Behavioural Therapy (CBT), which challenges negative thoughts and is used widely for both anxiety and depression, is also increasingly recognised as being helpful for patients who struggle with chronic disease, for example chronic pain, breathing difficulties and diabetes, and is now available on the NHS.

‘But Hypnotherapy, which teaches positive mindfulness – staying relaxed and in the present – is, as far as I am aware, only available as an NHS resource at the Withington Hospital in Manchester, where it is used for Irritable Bowel Syndrome.

‘I hope that within the next few years it will become more widely available to anyone who needs it, but, for now, although I treat some NHS patients with CBT, I can only practise hypnotherapy privately.

‘While CBT can change one’s mindset, hypnotherapy enables deep relaxation, the perfect antidote to anxiety. Any condition that is exacerbated by stress or anxiety – be it chronic pain, shortness of breath, eczema, IBS, or high blood pressure – can be helped by hypnosis, if the patient is open to the idea.

‘In a hypnotic state (which is something we all slip into while daydreaming or just before we drift off to sleep) the mind is deeply relaxed and we cannot feel anxious, because it is impossible to experience these two conflicting emotional states at the same time. And, while a patient is in this state, I can make positive suggestions opening the mind to a more positive  - worry-free - way of thinking. Combining both CBT and hypnotherapy with my clinical experience as a GP is what really helps most of my patients. 

‘We get what we focus on, and have to learn to focus on what we want and not what we don’t want. Hypnosis helps with this by reinforcing messages such as “I can do this” rather than “I can’t do that”. 

‘As a GP I will always prescribe any medicines a patient needs. However, when anxiety and stress play a part in the condition, three or four sessions of hypnotherapy can sometimes help a patient reduce or come off that medication. As GPs we need to recognise that getting a patient better can go beyond just writing out a prescription.’

 . Herbal remedies

Used by Dr Sarah Brewer, a Guernsey based GP and medical nutritionist. (EDS: all GPs are private in Guernsey where there is no NHS provision).

‘In the early 1990s, working in an extremely deprived part of Plymouth, I realised that many of my patients’ health problems – diabetes, obesity, lack of energy - were not being helped by their diets of pasties and fish and chips.

‘I started prescribing vitamin supplements and saw their health perk up.

‘Realising malnutrition is at the root of many illnesses – even our susceptibility to coughs and colds – I completed a Masters degree in Nutritional Medicine at the University of Surrey, and started recommending a change of diet before medicine whenever I thought it would help.

‘My interest in herbal medicines was an adjunct to my passion for nutrition. Many of the drugs we use are derived from extracts of herbs – for example aspirin originates from an extract of willow bark and some chemotherapy drugs are derived from yew and periwinkle. Medicine often relies on an ingredient from a natural substance being isolated and turned into a drug.

‘But when we use the whole plant, instead of just a small part of it, we get other ingredients that support the active part, and these help the patient suffer fewer side effects.

‘Many doctors are sceptical about herbals, citing the occasions when something has gone wrong or a herbal product has been withdrawn for safety reasons. Cases where Chinese herbs have been found to contain steroids or Viagra have rung alarm bells across the medical community.

‘But since 2011 regulations have been in place to ensure the safety of herbal medicines.  The Good Manufacturing Practice (GMP) label guarantees the same quality as any over the counter medicine. The Traditional Herbal Remedy (THR) label shows the product contains the herbs it claims to contain, and, as with a Product Licence (PL) number, means the product has a recognised medical use. Both also come with a patient information leaflet just like any other medicine.

‘GPs cannot prescribe herbal remedies on the NHS, but there many that I recommend, because they have good evidence to support their use. For example, Agnus Castus for PMS, Black Cohosh for menopausal hot flushes, Feverfew for migraine, and Rhodiola for stress and lack of energy.

‘If one of my patients has a cold I can only prescribe painkillers and decongestants. But if they buy the remedy Pelargonium they will get rid of their symptoms within 24 hours. This herb comes from Africa where it was originally used for TB. It is now being reinvestigated for this – and could one day be the answer to the problem we have with multi-drug resistant forms of the disease.’

. Dr Sarah Brewer is author of The Essential Guide to Vitamins, Minerals and Herbal Supplements (£9.99 Right Way), and editor of Your Wellness Magazine (www.yourwellness.com).

. Naturopathy

Practised by Dr Deborah McManners, who works at the Hale Clinic London and was the first GP and aesthetic doctor in the UK to qualify as a naturopath.

‘When I started out as a GP, I wanted to not only give my patients the most thorough diagnosis and appropriate treatment they deserved but also to enable them to adopt a really positive lifestyle that would improve their energy levels, confidence and wellbeing.

‘There is so much more to good health than just the absence of disease and the real goal is a long, healthy and attractive life. ‘Qualifying as a registered naturopath in 1996 enabled me to achieve so much more for my patients and I am now a member of both the Royal Society of Medicine and the General Council and Register of Naturopaths.

‘Naturopathy is about balancing three sides of a health triangle: the biochemical (eg nutrition and environment), the physical (eg posture and fitness), and the emotional (eg everyday stress).

‘We do that through careful and thorough diagnosis and tailor made treatments – often involving advice about diet, exercise, sleep and relaxation.

 ‘As a doctor first, my priority is always to make sure that no underlying condition is missed – and this may involve further investigations or referral to a specialist.

‘But, as a naturopath, I am also looking for clues about why a problem has arisen and what can be done to prevent it happening again.

 ‘Sometimes, gently delving into what makes my patient tick, I will find that emotional issues contribute to a chronic physical condition.

‘For example a patient who has never followed their heart in their choice of career, but has instead stuck to a path that was expected of them may end up with chronic migraine or IBS. 

‘Really understanding a person and their issues helps me pick out the best treatments for them – be it a change of diet, guidance about sleep, an orthodox drug, licensed herbal medicine, or even a homeopathic remedy. Whatever is needed to restore their good health, and boost their energy.’