Receiving treatment from alternative health care providers
When attending a provider of alternative health care services for the first time, a consumer may not know very much (if anything) about the treatment and procedures that are offered. In addition, different providers within the same discipline may use different practices. This can mean that when something occurs that the first-time consumer is not expecting or finds distressing, they may not know whether that practice is a valid part of the treatment or is outside the parameters of an acceptable procedure.
Complaints
Consumers who are unhappy with the treatment they have received from a natural health practitioner, or who feel that their rights have been breached, have the right to make a complaint about the services they have received. They can make the complaint directly to the provider, to a health and disability advocate from the Nationwide Advocacy Service, or to the Health and Disability Commissioner.
Complaints tend to fall into two broad camps: a lack of information or understanding of the procedure, or poor performance of the procedure.
Complaints to the Commissioner about alternative therapies often concern a lack of information about what the proposed treatment involved and why the techniques were being used. Some consumers report feeling uncomfortable during treatment because of the way they have been treated by the therapist. For example, there may have been inadequate covering of their body during the procedure, or inappropriate comments and questions of a personal (sometimes sexual) nature, or a lack of privacy while undressing. Some consumers have reported distress caused by inappropriate touching: practitioners working too close to the genital area, or touching the breast or nipple during massage.
To keep themselves safe, consumers need to:
- be aware of their rights to information and to give informed consent;
- choose the health practitioner carefully to ensure that they are going to a qualified and reputable provider.
Informed consent
The concept of informed consent is central to most health procedures, including procedures provided by alternative or natural health care providers, such as spiritual healers, iridologists, reflexologists and therapeutic masseurs. Providers of these services are subject to the responsibilities set out in the Code of Health and Disability Services Consumers’ Rights, in the same way as are providers who follow traditional practices. The consumer’s properly informed consent is needed before services can be provided.
Before consumers embark upon a session of treatment, they need to be very clear that they understand what is going to happen and why, and must have an opportunity to consent to the proposed treatment. Under the Code, the giving of informed consent is a process which embodies three essential elements:
- effective communication (Right 5);
- provision of all necessary information (Right 6); and
- the consumer’s freely given consent (Right 7).
Information
Providers must voluntarily provide consumers with all the information that a reasonable person, in that consumer’s circumstances, would expect to receive or need to receive. This includes an assessment of the expected risks, side effects, benefits and costs of each option, and information about the safety and efficacy of the proposed therapy.
In situations where a practitioner wishes to offer a treatment they believe to be effective, even though its efficacy is not yet proven according to scientific or evidenced-based principles, the provision of information is crucial. Health professionals have a duty to disclose any lack of scientific evidence for a proposed procedure, and give specific reasons for recommending it. The provider must give honest, accurate and complete answers to questions. Consumers should be given a choice of options so they don’t feel pressured into receiving something they are not happy about.
Enough time must be allowed for the consumer to consider the information received before consenting to treatment. This may involve providing them with written information to take away to consider at home. Providers have a responsibility to provide a written summary of the information if the consumer requests it.
Communication
For communication to be effective, the consumer must feel comfortable about asking questions and feel that their queries are respected. The provider must be responsive to the needs, capacities and concerns of the individual consumer.
Consent
When a consumer is satisfied with the information received, and chooses to proceed with the treatment, they then give their consent. However, that consent may be withdrawn at any time, including during a procedure. Consumers should never be in a position where it is not possible for them to indicate to the provider that they wish to discontinue.
Standards of practice
Providers of natural medicine and therapies are not required by statute to be registered under the Health Practitioners Competence Assurance Act 2003, unlike mainstream providers of health services, such as doctors, dentists and physiotherapists. However, 42 different groups of practitioners involved in natural health care in New Zealand are represented by the New Zealand Charter of Health Practitioners Inc; members include practitioners of chiropractic, osteopathy, herbal medicine, meditation, acupuncture, homeopathy, Ayurvedic medicine, hypnotherapy, traditional Chinese medicine and Māori medicine.
The Charter was formed “to uphold the welfare and health concerns of the health consumer” by accrediting practitioners whose qualifications and practice meet an agreed professional standard. The Charter acts as a registration body that registers individual practitioners, approves Colleges (that teach providers) and accredits a variety of courses. Providers who are registered with the Charter are required to maintain their standards of practice, and need to gain a specified number of credits annually through participating in continuing education programmes to retain their registration. Chartered practitioner members in New Zealand are bound by a Common Code of Ethics and are subject to executive by-laws which deal with personal and professional conduct.
Selection of a natural health practitioner
Not all courses offered by an accredited College may be of adequate standard to gain approval, and not all providers offering natural therapies have passed appropriate training courses. Information about which providers are registered and which courses are accredited can be found in the New Zealand Charter of Health Practitioners Practitioner Directory. This publication is available in libraries and Citizens’ Advice Bureaux nationwide. Otherwise, information can be obtained directly by telephoning the Charter at (09) 414 5501, emailing email@healthcharter.org.nz, or by visiting the website www.healthcharter.org.nz.
Practitioners who are not registered, or who have not completed an accredited course, are still required to provide services in accordance with their responsibilities as set out in the Code of Health and Disability Services Consumers’ Rights.
Conclusion
Providers who meet their obligations under the Code, and consumers who make informed choices, will help create a safe environment in which alternative health procedures can be delivered.