Care Situation in Homeopathic Practice

To identify frequent treatment and consultation concerns with their diagnoses in outpatient practice with a specialty in homeopathy, a database analysis of the statistically recorded frequencies of a full-time practice from a period of 15 years served as a starting point.

From this, a survey[1] was developed to assess the current situation, which will serve as part of a future concept for the development of professional theory. The spectrum of care was recorded in questions 56-76 of the 2017/18 survey and divided into three survey blocks for analysis:

I) General Counseling and Treatment Concerns

II) Accompanying Treatment for Specialist Diagnoses

III) Acute Treatment and Emergency Management

I) General Counseling and Treatment Concerns

Included here are all primarily symptomatically defined disorders, as is common in general practice [1]. The ICPC-3 (International Classification of Primary Care) serves as the basis here and is supplemented by the ICD-10 and DSM-V when necessary[2].

Considered for the evaluations are all concerns that occur with clear significance in homeopathic practice and must therefore be safely recorded and differentiated by colleagues in the sense of good health care in the complementary medicine spectrum.

In the analysis, the frequent differential diagnoses are additionally included as they actually occur in full-time homeopathic practice. These are supplemented by occasional and rare differential diagnostic issues as mentioned in the general medical literature [1] [2] [3]. In this way, an overall view is possible that shows the spectrum of diagnostic skills required, which can be used as a standard for developing quality management (QM) in the practice.

II) Accompanying Treatment for Specialist Diagnoses

Patients with established specialist diagnoses, which are treated homeopathically concomitantly, were divided into the frequent specialist areas, such as: Neurology, Orthopedics, Internal, separately Autoimmune diseases, Cardiovascular and vascular diseases, ENT, Pediatrics and Oncology.

Since many diagnoses are overall rather rare in practice and thus also represent a rarity in homeopathic practice, all mentions were included, even if they are below the significance threshold[3] (>30%).

A final analysis {link to analysis} will address the expanded skill needs in relation to the frequencies in practice.

III) Acute Treatment and Emergency Management

Also in acute and emergency management in homeopathic practice, it is of particular interest to establish an overview of the more common acute treatment and consultation concerns as they actually occur in homeopathic practice at present.

This includes the separate distinction of primary diagnosis by the homeopathic physician or alternative practitioner himself, as well as the accompanying co-treatment in acute exacerbations of chronic diseases.

Furthermore, it should be determined how reflexively and responsibly the practitioners deal with their own competence and expertise in emergencies, since the persistent media reproach that "homeopaths in general" and especially alternative practitioners delay or hinder necessary medical measures and in this respect would represent a potential danger in patient care is repeatedly published in many places.

Treatment concerns and frequencies

In the survey, there was always the possibility of free additions to each individual question. This was to ensure that no significant information was overlooked that might have been missed by the preliminary analysis of the database evaluation.

Questions were also asked about frequency. The subdivision was divided into:

• More than 1x/month, more frequently (= regularly).
• Up to 10x/year, rarely (= single cases that occur repeatedly, e.g. 2x/month or 2x/quarter)
• Only a few single cases per year
• Not treated at all

Since many colleagues work part-time, the threshold values are set lower in order to capture the relative frequency without distorting the absolute numbers. Those who work less may have fewer cases in absolute terms, but this says nothing about the frequency distribution of diagnoses per se. It is likely that the common concerns are also regularly present in all practices. Consequently, this gives rise to the foci, since in the mix with full-time practices, the data on frequent treatment concerns are high (relative frequency > 75%). Accordingly, the relative frequency of single cases was set below 30%.[4]

From the analysis of the entire spectrum of care areas, we find:

• the actual demand for homeopathic treatment, as well as
• the focus of the diagnostic-therapeutic knowledge of the practitioners,
• the range of rare individual cases that fall outside the diagnostic routine and require special expertise in order to be managed well, and
• an overview of differential diagnostic considerations and avoidable life-threatening dangerous developments, highlighted separately in the analysis (red flags).

A separate analysis should show to what extent the caveat of inadequate care is actually justified by a primary use of homeopathic care and at which critical points this becomes apparent.

Avoidable life-threatening dangerous Developments and treatment failures in homeopathic practice

How frequent are serious treatment errors and omissions in a primarily homeopathic practice, especially a HP practice?

Special attention was paid in the survey to the analysis of the behavior on avoidable life-threatening dangerous developments in emergency management and on the interfaces of an inadequate or insufficient therapy (failure to treat). The question of whether and to what extent and by whom patients are further delegated due to diagnostic limitations was also investigated. This concerns especially the emergency management as well as the treatment of serious pathologies in relation to homeopathic treatment and thus the question: What actually occurs how often in practice?

Comment

The survey results present a representative sample of non-medical practitioners specializing in "homeopathy". Therefore, they cannot be transferred to the entire group of alternative practitioners and also not to the entire group of all homeopaths (physicians, HP and homeopathically working pharmacists and midwives). For this reason, the question of the potential danger of homeopathic HPs was additionally investigated by analyzing existing studies and expert opinions. These results are summarized separately.

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Due to a greater proximity to patients, colloquial terms with their vagueness have been deliberately left in many places, e.g. "breast cancer" instead of "breast CA". The ICPC-3 diagnosis codes,which were specified, and their explanations can be found here: https://browser.icpc-3.info/ , or in an overview at a glance, clearly displayed in color here: https://flyer.icpc-3.info. The specified ICD-10 are linked to the corresponding page of the BfArm: https://klassifikationen.bfarm.de/icd-10-gm/kode-suche/htmlgm2025/index.htm (ICD-10-GM Version 2025 German) or https://icd.who.int/browse10 (ICD-10 Version 2019 English). We are constantly updating corrections and welcome error messages or suggestions for improving the proposed diagnosis codes.

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[1] Tjado Galic HP Hannover: Content concept of the questionnaire, development of the questions, analysis and evaluation: Writing the written analysis / Helmut Schnellrieder HP Munich: Creating the online questionnaire and program support, monitoring the receipt of the questionnaire, creating the slides for the presentation of the results / Consultant: Prof. Dr. Hannah Bast University of Freiburg, Chair of Algorithms and Data Structures

[2] ICPC (International Classification of Primary Care), ICD (International Classification of Disease), DSM V Diagnostic and Statistical Manual of Mental Disorders

[3] Significance threshold or significance level is a statistical measure of when a value becomes significant or effective.

[4] The absolute frequency indicates how often an event (here a treatment) occurs. The relative frequency describes the share of the absolute frequency (events) in the total number of all, in this case, treatments.

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References

The sources mentioned served as a basis for the creation of the survey for structuring the question blocks. They can also be found as source references at individual points in the overall document on the supply situation in homeopathic practice.

[1] Mader, F. H. & Riedl, B. (2018). Allgemeinmedizin und Praxis (8th ed./first edition 1993). Springer Verlag.

[2] Hopcroft, K. & Forte, V. (2013). Differenzialdiagnostische Tabellen – Symptome in der Allgemeinmedizin (1st ed.). Huber Publishers.

[3] Klimm, H.-D. & Peters-Klimm, F. (Eds.). (2018). Allgemeinmedizin (6th ed.). Georg Thieme Verlag.

[4] Lehrke, P. (1998). Impfkonzepte in der Homöopathie Edition Forschung: Eine Erhebung zum Impfverhalten homöopathischer Ärzte. Hippokrates Publishers.

[5] Impfpflicht versus informierte Entscheidung. (2019, May 2). German Network EBM. Retrieved May 18, 2022, from https://www.ebm-netzwerk.de/de/veroeffentlichungen/stellungnahmen-pressemitteilungen May 02, 2019).

[6] Lyons-Wyler, J., Thomas, P. (2021 Jan 22;18(3):936). Relative Incidence of Office Visits and Cumulative Rates of Billed Diagnoses Along the Axis of Vaccination. Int J Environ Res Public Health. doi: 10.3390/ijerph18030936.

[7] Hautärzte sehen Krätze auf dem Vormarsch. (2016, November 28). Physicians Journal. Retrieved May 18, 2022, from https://www.aerzteblatt.de/nachrichten/71688/Hautaerzte-sehen-Kraetze-auf-dem-Vormarsch

[8] Schultz-Zehden, W. & Bischof, F. (1986). Auge und Psychosomatik (1st ed.). Deutscher Ärzteverlag.

[9] Jobst, D. (2013). Facharztprüfung Allgemeinmedizin: in Fällen Fragen und Antworten (4th ed.). Urban & Fischer Verlag/Elsevier GmbH.

[10] Menopausal Hormone Therapy and Cancer Risk. (2015, February 13). American Cancer Society. Retrieved June 1, 2022, from https://www.cancer.org/cancer/cancer-causes/medical-treatments/menopausal-hormone-replacement-therapy-and-cancer-risk.html

[11] Günthert, E. A. (2013). Psychosomatische Urologie: Leitfaden für die Praxis-Schriftenreihe der Thure von Uexküll-Akademie für Integrierte Medizin (2nd ed.). Schattauer.

[12] WONCA International Classification Committee, Mally, T., Committee, W. I. C., Tönies, H., Zehnder, K., Fischer, G. & Glehr, R. (2001). Internationale Klassifizierung der medizinischen Primärversorgung ICPC-2. Springer Publishing.

[13] Spinks A., Glasziou P.P., Del Mar C. B. (2021). Antibiotics for treatment of sore throat in children and adults. Cochrane Database Syst Rev. 2021 Dec 9;12(12):CD000023. https://doi.org/10.1002/14651858.CD000023.pub5

[14] Schweitzer, R., & Schröder, M. (2018). Die Heilpraktiker-Akademie. Gesetzeskunde, Notfallmedizin und Pharmakologie: Mit Zugang zur Medizinwelt. p.48.

[15] Galic, T. & Schnellrieder, H. (2018). Heilpraktiker mit Fachrichtung Homöopathie – ein Laienclub ohne Bildung? Homöopathie KONKRET. 11.Jahrgang, 12/2018, Heft 4. S.13-20.

[16] International Classification of Primary Care - 3rd Revision. Retrieved 11.1.2025 from https://www.icpc-3.info/

[17] BFARM - ICD-10-GM Version 2025. Retrieved 11.1.2025 from https://klassifikationen.bfarm.de/icd-10-gm/kode-suche/htmlgm2025/index.htm

Author: glt | Ed.: hk, pz | Last modified on 20.02.2025