Nehir ASLAN YÜKSEL, Bilgehan AÇIKGÖZ, Cengiz YÜKSEL, Ferruh Niyazi AYOĞLU, Tuğçe ER

HEKİMLERİN GELENEKSEL VE TAMAMLAYICI TIP UYGULAMALARINA BAKIŞ AÇISI - PHYSICIANS' POINT of VIEW of TRADITIONAL and COMPLEMENTARY MEDICAL PRACTICES

Son yıllarda dünyada ve ülkemizde “Geleneksel ve Tamamlayıcı Tıp” (GETAT) uygulamalarında ve ürünlerinin kullanımında artış izlenmektedir. Hekimler GETAT uygulama ve ürünlerinin gerekliliği, yararı konusunda ikiye bölünmüş durumdadır. Bir görüş bu uygulamaların medikal tedavide yeri olduğunu savunmaktayken, diğer görüş kullanımının ve kullanımına bağlı sonuçların hekimin sorumluluğunda olmadığını savunmaktadır. Bu çalışmada Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi’nde görevli öğretim üyesi ve araştırma görevlisi hekimlerin GETAT uygulamaları konusundaki bilgi ve görüşlerini değerlendirmek amaçlanmıştır. Araştırma kesitsel tiptedir. Şubat 2017- Mayıs 2018 tarihlerinde görevli 327 hekimin tümüne ulaşılması hedeflenmiştir, 262’sine (%80,1) ulaşılmıştır. Verilerin toplanmasında anket kullanılmıştır. Hekimlerin %66,4’ünün kendi görüşlerine göre GETAT yöntemleri konusunda bilgi düzeyleri düşüktür, %43,1’i eğitim almak istemektedir, %2,3’ü GETAT kurs/sertifika programına katılmıştır. Hekimlerin %45,0’ı hastalarının GETAT kullanma durumunu bilmektedir, bilenlerin %41,5’i hastalarının GETAT yöntemi kullandığını, en fazla akupunktur (%63,2) ve kupa (%40,8) kullandıklarını belirtmiştir. Hekimlerin %48,5’i GETAT’ın faydalı olduğunu düşünmektedir. Hekimlerin hastalarına bir GETAT yöntemi önerme oranı %16,0, uygulama oranı %4,9’dur. Hekimlerin %15,2’sinin kendisi, %24,4’ünün ailesindeki bireyler bir GETAT yöntemi kullanmıştır. Öneren hekimlerin en fazla önerdikleri (%57,1), kullanan hekimlerin en fazla kullandıkları (%45,0) yöntem akupunkturdur. Hekimlerin GETAT yöntemlerini önerme durumu; kendi görüşlerine göre GETAT bilgi düzeylerine, kurs/sertifika programına katılma durumlarına, faydasına dair görüşlerine, hekimin ve ailesinin GETAT kullanma durumuna göre farklı bulunmuştur. Hekimlerin GETAT eğitimi almak isteme durumu; yaşa, akademik ünvana, bölüme, faydasına dair görüşlerine göre farklılık göstermiştir. Hekimlerin yarısından fazlası, GETAT ile ilgili yeterli bilgisi bulunmadığını belirtmiştir ve hastalarının yöntemleri kullanma durumuyla ilgili bilgi sahibi değildir. Meslekte geçirdikleri süre daha kısa olan genç hekimler ve dahili bilimlerde çalışan hekimler daha fazla GETAT eğitimi almak istemektedirler. Hekimler, tedavileri ile etkileşimleri bakımından hastalarının GETAT yöntemi kullanma durumunu sorgulamalı, toplumda sık kullanılan yöntemler konusunda yapılan bilimsel araştırmaları takip etmelidirler. Bununla birlikte hekimler, GETAT yöntemlerini ancak bilimsel yöntem izlenerek yapılan araştırmalar sonucunda ulaşılacak bilgiler ışığında tedavi seçeneği olarak düşünebilirler.

Anahtar Kelimeler:

Geleneksel Tıp, Tamamlayıcı Tıp, Hekim

PHYSICIANS' POINT of VIEW of TRADITIONAL and COMPLEMENTARY MEDICAL PRACTICES

In recent years, there has been an increase in “Traditional and Complementary Medicine” (T&CM) applications and use of its products in the world and in our country. Physicians are divided in terms of the necessity and benefit of T&CM application and products. One opinion argues that these applications have a place in medical treatment, while the other opinion argues that its use and its consequences are not the responsibility of the physician. In this study, it was aimed to evaluate the knowledge and opinions of faculty members and research assistants at Zonguldak Bülent Ecevit University Faculty of Medicine about T&CM applications. This research is cross-sectional. In the research, 262 (80.1%) of the 327 physicians working at Zonguldak Bülent Ecevit University Faculty of Medicine between February 2017 and May 2018 were reached. Questionnaire form was used to collect data. The 66.4 % of physicians have low level of knowledge according to their opinion, about T&CM, 43.1% are interested in training about T&CM, 2.3% have participated in T&CM course / certificate program. 45,0% of physicians have information about whether their patients use the T&CM and these physicians declared that acupuncture (63.2%) and cupping (40.8%) are the most used methods. 48.5% think that T&CM methods are useful. The rate of recommending any T&CM methods to the patients by the physicians is 16.0% and the physicians’ practice rate is 4.9%. 15.2% of the physicians themselves, family of 24% of doctors have used any T&CM methods.. Acupuncture is the most recommended method (57.1%) by physicians who recommended any and it's the most practiced method (45.0%) by who practices any methods. Physicians' recommendation of T&CM to patients differs according to their knowledge level that their declaration, to participate in the T&CM course / certificate program, their opinions on the usefulness of T&CM and the use of the T&CM by the physicians and their family. Physicians' request to receive T&CM training differ according to age, academic title, department, their opinions on the usefulness of T&CM, physicians' declaration about use of the T&CM by their patients. More than half of the physicians stated that they did not have enough information about T&CM methods and had no information about the use of their patients. Young doctors who spend less time in their profession and internal medicine doctors want more training in T&CM. Physicians should question the patient's use of these methods in terms of their interactions with their treatment, and follow the scientific researches on the methods commonly used in the community. However, physicians may consider T&CM methods as a treatment option in light of the information that will be obtained as a result of research conducted following scientific method.

Keywords:

: Traditional medicine, complementary medicine, physician,

PDF

___

WHO Traditional Medicine Strategy 2014-2023. WHO Library Cataloguing-in-Publication Data.
Öztürk H, Şaylıgil Ö. Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği’nin Etik Açıdan Değerlendirilmesi. Turkiye Klinikleri J Med Ethics 24(1):1-10, 2016.
Karahancı ON. ve Öztoprak ÜM, Ersoy M, Ünsal ÇZ, Hayırlıdağ M, Örnek Büken N. Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği ile Yönetmelik Taslağı’nın karşılaştırılması. Türkiye Biyoetik Dergisi, Vol. 2, No. 2, 117-26, 2015.
Ernst E. The role of complementary and alternative medicine. BMJ. Nov 4; 321(7269): 1133–1135, 2000.
Sandler AD, Brazdziunas CD, Cooley WC, Pijem LG, Hirsch D, Kastner TA et al. Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Pediatrics 2001; 107: 598-601.
Acupuncture: review and analysis of reports on controlled clinical trials, World Health Organization, 2003.
WHO Guidelines on Developing Consumer Information on Proper Use of Traditional, Complementary and Alternative Medicine, 2004.
Resmi Gazete. Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği. 27.10.2014; Sayı: 29158.
https://nccih.nih.gov/health/acupuncture/introduction Erişim tarihi:Nisan 2018.
Trumbeckaite S, Dauksiene J, Bernatoniene J, Janulis V. Knowledge, Attitudes, and Usage of Apitherapy for Disease Prevention and Treatment among Undergraduate Pharmacy Students in Lithuania. Evid Based Complement Alternat Med. 2015: 172502, 2015.
Elkins GR, Barabasz AF, Council JR, Spiegel D. Advancing research and practice: the revised APA Division 30 definition of hypnosis. Int J Clin Exp Hypn. 2015;63(1):1-9.
Singh AP. Medicinal leech therapy (Hirudotherapy) : A brief overview, Sri Dhanwantry Ayurvedic College, Department of Dravyaguna, Chandigarh, India. Complement Ther Clin Pract. 2010 Nov;16(4):213-5.
Vickers A, Zollman C. ABC of complementary medicine – homoeopathy. BMJ 1999; 319: 1115–8.
Ernst E. Chiropractic: a critical evaluation. Journal of Pain and Symptom Management, 35(5): 544-562, 2008.
Benchmarks for Training in Osteopathy, Benchmarks for training in traditional / complementary and alternative medicine. World Health Organization 2010.
Mammucari M, Gatti A, Maggiori S, Bartoletti CA, Sabato AF. Mesotherapy, definition, rationale and clinical role: a consensus report from the Italian Society of Mesotherapy. European review for medical and pharmacological sciences. 15(6):682-94,2011.
Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Primary Care: Clinics in Office Practice. 37(1):65-80, 2010.
Bocci V. Ozone as Janus: This controversial gas can be either toxic or medically useful. Mediators Inflamm. 13(1): 3-11,2004.
https://nccih.nih.gov/health/reflexology Erişim tarihi: Nisan 2018.
Bradt J, Dileo C, Magill L, Teague A. Music interventions for improving psychological and physical outcomes in cancer patients., Cochrane Database Syst Rev. 2016 Aug 15;(8):CD006911.
Bal B. Hemşire ve Hekimlerin Tamamlayıcı ve Alternatif Tedavilere İlişkin Görüşleri,İç Hastalıkları Hemşireliği Programı, Yüksek Lisans Tezi, Ankara, 2009.
Barnes J. Quality, efficacy and safety of complementary medicines: fashions, facts and the future. Part II: Efficacy and safety. J Clin Pharmacol 2003; 55: 331-340.
Suzuki N. Complementary and alternative medicine: a Japan perspective. Evid. Based Complement, Altern, Med 2004; 1: 113-118.
https://www.medscape.com/viewarticle/805545_1. Erişim Tarihi:Mart 2018.
Özçakır A, Sadıkoğlu G, Bayram N, Mazıcıoğlu, MM, Bilgel N, Beyhan I. Turkish general practitioners and complementary/alternative medicine. The Journal of Alternative and Complementary Medicine, 13(9): 1007-1010, 2007.
Bjersa K, Victorin ES and Olsén MF. Knowledge about complementary, alternative and integrative medicine (CAM) among registered health care providers in Swedish surgical care: a national survey among university hospitals. BMC Complementary and Alternative Medicine 12:42, 2012.
Koçdaş M. Hekim, hemşire ve hastaların tamamlayıcı ve alternatif tedavi konusunda bilgi, tutum ve davranışları, Marmara Üniversitesi Sağlık Bilimleri Enstütüsü Yüksek Lisans Tezi, Halk Sağlığı Ana Bilim Dalı, İstanbul-2013.
Ko GD, Berbrayer D. Complementary and alternative medicine: canadian physiatrists’ attitudes and behavior. Archives of Physical Medicine and Rehabilitation, 81: 662-667, 2000.
Mak JC, Mak LY, Shen Q, Faux S. Perceptions and attitudes of rehabilition medicine physicians on complementary and alternative medicine in Australia. Internal Medicine Journal, 39(3):164-169, 2009.
Giannelli M, Cuttini M, Fre MD, Buiatti E. General practitioners' knowledge and practice of complementary/alternative medicine and its relationship with life-styles: a population-based survey in Italy. BMC Family Practice, 8: 30. 2007.
IAMSA S, Ismail MFS, Yousuf WAAA, Salama RE. Knowledge, attitudes and practice of general practitioners towards complementary and alternative medicine in Doha, Qatar. Eastern Mediterranean Health Journal, 16 (5): 522-527), 2010.
Milden SP, Stokols D. Physician’s attitudes and practices regarding complementary and alternative medicine. Behavioral Medicine, 30: 73-82,2004.
Winslow LC, Shapiro H. Physicians want education about complementary and alternative medicine to enhance communication with their patients. Arch Intern Med, 162:1176–1181,2002.
Lewith GT, Hyland M, Gray SF. Attitudes to and use of complementary medicine among physicians in the United Kingdom. Complementary Therapies in Medicine, 9(3): 167–172, 2001.
Sawni A, Thomas R. Pediatricians' attitudes, experience and referral patterns regarding complementary/alternative medicine: a national survey. BMC Complementary and Alternative Medicine, 7: 18, 2007.
Burke A, Ginzburg K, Collie K, Trachtenberg D, Muhammad M. Exploring the role of complementary and alternative medicine in public health practice and training. Journal of Alternative and Complementary Medicine, 11: 931-936, 2005.