Available data suggest that general practitioners (GPs) in Germany use so-called alternative medicine (SCAM) modalities more frequently than GPs in many other countries. German researchers investigated the country differences perceived by GPs who have worked in Germany and in one of four other European countries with regard to the role of SCAM in primary care.
A qualitative study was conducted using semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of SCAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover SCAM.
Participants unanimously reported that they perceived SCAM to be more relevant in general practice in Germany compared to the other countries. The researchers identified four overarching themes in relation to the perceived reasons for these differences.
- Physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that SCAM modalities are not evidence-based as the main reason for the lower use of SCAM by GPs.
- Extensive training of communication skills was cited as a reason that reduced the need for SCAM in the Netherlands, Norway and the UK.
- Differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of SCAM by German GPs compared to the other countries.
- Country-specific reimbursement mechanisms were considered as a factor influencing the role of SCAM in general practice.
The authors concluded that their study results point to major differences between countries with regard to the role of SCAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here.
The authors comment that a remarkable finding is the very consistent narrative with regard to the Netherlands, Norway and the United Kingdom that a stronger scientific and EBM orientation is seen as the main reason for the lower utilisation of SCAM by GPs compared to Germany. I agree that this is an important and, as far as I can see, new aspect. It concurrs with my personal impression that many German doctors feel that EBM is some sort of ‘KOCHBUCH MEDIZIN’ [cookbook medicine] that limits their freedom of prescribing based on intuition and experience. This, I have always felt, is a profound misunderstanding of what EBM is about.
3 Responses to The role of SCAM in general practice in Germany, Italy, the Netherlands and the UK
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I think point 4 plays an important role. In Germany, many health insurance companies (especially private health insurance companies or private supplementary health insurance companies) still advertise that they will reimburse the costs of SCAM in order to attract new members.
Physicians can charge a higher rate for private bills than those for the statutory health insurance. For many physicians, this is an important additional source of income, as they openly admit time and again in interviews.
Finally, it should be remembered that SCAM in Germany is not demanded or used by poor or needy people, but by people who can afford it: Upper middle class or upper class.
My experience of living in Germany (12 years and counting) is the opposite. Scam is not at all a province of the rich. The use and acceptance of homeopathy and mistletoe are widespread. The majority of policeman and teachers are privately insured and most scams are paid for in full by the insurers. My family received horse riding, pendulum therapy, chiropractic, osteopathy, spot squeezing and fruit juices paid for at least in part by the insurers.
You said it: “privately insured”.
Many people who become civil servants still decide to take out private health insurance because of certain advantages, even though they do not have to. One reason for this decision is that financial costs are additionally covered by the Beihilfe (I have not found an English term for this).
https://de.wikipedia.org/wiki/Beihilfe_(Dienstrecht)