How do homeopaths make decisions? An exploratory study of inter-rater reliability and intuition in the decision making process
Received12 June 2003
revised11 February 2004
accepted26 April 2004
19 December 2017 (online)
The validity of clinical decision making in homeopathy is largely unexplored and little is understood about the process or its reliability. This exploratory study investigated, in the context of a questionnaire based re-proving of Belladonna 30c, the extent to which decisions are based on clinical facts or intuition and how reliable decisions are. Three experienced, independent homeopathic clinicians/proving researchers rated the symptom diaries of the 206 subjects taking part. They reported their proving decision (ie positive proving response, no proving response or undecided) based on the total symptom profiles and rated (on a scale of 0–10) their use of clinical facts or intuition. Keynote symptoms and overall confidence scores were also reported. The level of agreement between raters was generally poor (weighted kappa 0.349–0.064). All raters used both facts and intuition. The rater's reliance on the facts was significantly associated with classifying those subjects who had no proving response [rater 1, P < 0.001; rater 2, P < 0.001]. Raters used significantly higher intuition scores when classifying a prover [rater 2, P = 0.001; rater 3, P = 0.012]. Issues regarding the education and practice of homeopathy are discussed.
- 1 Cornu C, Poitevin B, Lion L, et al. Controlled clinical trial and treatment for recurrent ENT and respiratory infections in children: preliminary survey of homeopathic physicians. Therapie 1995; 50: 41–46.
- 2 Aghadiuno M. A study of inter-observer reliability of paper case analysis. HOMP 2002; 91(1): 10–17.
- 3 Vickers AJ, van-Haselen RA, Pang L, Berkovitz S. Inter-rater reliability of symptom repertorisation: a pragmatic empirical study. Br Hom J 2000; 89(4): 188–190.
- 4 Fisher P. Is homeopathic prescribing reliable. In: Vickers A (ed). Examining Complementary Medicine. The Skeptical Holist. Cheltenham: Stanley Thornes Ltd, 2002, pp 74–87.
- 5 Benner P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, California: Addison-Wessley, 1984.
- 6 Greenhalgh T. Intuition, evidence—uneasy bedfellows. Br J Gen Pract 2002; 52: 395–400.
- 7 Boreham NC. Models of diagnosis and their implications for adult professional education. Stud Educ Adults 1988; 20: 95–108.
- 8 Hunter K. Don’t think zebras: uncertainty, interpretation and the place of paradox in clinical education. Theor Med 1996; 17: 225–241.
- 9 Brien S, Lewith G, Bryant T. Does ultramolecular homeopathy have any clinical effects? A randomised double blind placebo controlled pathogenetic trial of Belladonna 30c as a model. Br J Clin Pharmacol 2003; 56(5): 562–568.
- 10 Schroyens F. Synthesis Repertory. London: Homeopathic Book Publishers, 1999.
- 11 Altman D. Practical Statistics for Medical Research. London: Chapman & Hall, 1991, pp 403–407.
- 12 Cara Professional. 1.4r2. CARA for Windows Miccant Ltd. Nottingham, UK.
- 13 Vermeulen F. Concordant Materia Medica. Haarlem: Merlijn Publishers, 1994.
- 14 Kent JT. Reperatory of Homeopathic Materia Medica. Calcutta: Hahnemann Publishing, 1973.
- 15 Kent Homeopathic Associates Inc. MacRepertory for Windows. USA: California.
- 16 Quinn M. Intuition, Creativity, dialogue, tacit knowledge and…evidence? Br J Gen Pract 2002; 54: 588.