ASSESSMENT ON ACCEPTANCE OF
TRADITIONAL & COMPLEMENTARY
MEDICINE (T&CM) SERVICES
BY MEDICAL DOCTORS IN
KLANG VALLEY & PUTRAJAYA
Preface
Acknowledgement
Introduction
Background
• What is traditional medicine?
• What is complementary medicine?
• What is traditional and complementary
medicine?
T&CM Policy in Malaysia
Integration of Traditional &
Complementary Medicine in
Healthcare System
Selected T&CM services provided in
identified hospitals include:
• Acupuncture;
• Traditional Malay massage;
• Herbal therapy as an adjunct therapy to
•
oncology treatment; and
Malay Postnatal care established in July
2009 (Hospital Putrajaya)
General Objective
• To assess the acceptance of T&CM
services amongst medical doctors in
government hospitals at Klang Valley &
Putrajaya.
Specific Objectives
•
•
•
•
To determine the knowledge of medical doctors
regarding T&CM services and associated socio
demographic characteristics.
To determine the acceptance of medical doctors
regarding T&CM services and associated socio
demographic characteristics.
To determine the practise of T&CM services among
medical doctors for Klang Valley and Putrajaya
hospitals.
To explore the relationship between socio
demographic characteristics of medical doctors and
their willingness to discuss/refer the patients to T&CM
services.
Methodology:
• A cross sectional study using a self-
administered questionnaire conducted
among medical doctors in all government
hospitals within the Klang Valley and
Putrajaya.
Non T&CM
1. Hospital Kajang
2. Hospital Ampang
3. Hospital Sungai Buloh
4. Hospital Serdang
5. Hospital Tunku Ampuan
Rahimah, Klang
6. Hospital Kuala Lumpur
7. Hospital Selayang
T&CM
8. Hospital Putrajaya
Results
• Respondent Characteristics
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
9a.
Subject
Frequency
Percent (%)
Male
261
33.5
Female
517
66.5
Malay
444
57.3
Chinese
161
20.7
Indian
151
19.5
Others
19
2.5
<46
705
90.5
46+
74
9.5
Medical degree
516
66.5
Master/PhD
260
33.5
With T&CM service
91
11.7
Without T&CM
service
688
88.3
HO
180
23.2
MO
327
42.1
Specialist/Consultant
269
34.7
<10
503
64.6
10+
276
35.4
Formal TCM
education
Yes
57
7.3
No
720
92.7
Specific
qualification
Yes
2
0.3
No
777
99.7
Area of
modality
acupuncture &
herbal medicine
1
50.0
herbal medicine
1
50.0
Gender/sex
Ethnicity
Age
HQ
Hospital type
Position
Services
Item
6.
HO
180
23.2
MO
327
42.1
Specialist/Consultant
269
34.7
<10
503
64.6
10+
276
35.4
Formal TCM
education
Yes
57
7.3
No
720
92.7
Specific
qualification
Yes
2
0.3
No
777
99.7
Area of
modality
acupuncture & herbal
medicine
1
50.0
herbal medicine
1
50.0
Duration of
course
1 year
1
50.0
3 years
1
50.0
9c.
Certification
level
Masters
2
100.0
9d.
Institution/
organization
Nanjing TCM
1
50.0
Napier University
1
50.0
Sources on
T&CM
Friends & family
448
63.7
Self-reading
456
63.1
Others - Internet
13
30.2
Hospital CME
100
15.5
Seminar/ conference
72
11.2
Yes
294
46.5
No
338
53.5
7.
8.
9.
9a.
9b.
10.
11.
Position
Services
Share
knowledge
• Respondent Knowledge on T&CM Services
Questions
TCM (n/%)
N
Non TCM
(n/%)
N
1. Traditional &
Complementary
Medicine Division
is established to
ensure safe
practices of
T&CM.
65(78.3)
83
482(74.7)
645
2. T&CM services
offered in the
pilot hospitals are
for wellness
purposes.
59(71.1)
83
429(66.9)
641
3. Traditional and
Complementary
Healthcare
Practices Act has
been passed by
the Parliament.
31(37.3)
83
174(27.3)
638
4. The National
T&CM policy
(2001) states that
the T&CM therapy
shall be
incorporated into
Malaysia health
care system.
35(38.5)
83
202(32.1)
629
Questions
TCM (n/%)
N
Non TCM
(n/%)
N
5. Indicate
hospitals that had
been selected for
the T&CM pilot
project:Hospital Kepala
Batas, Pulau
Pinang.
Hospital
Putrajaya.
Hospital Sultan
Ismail, Johor.
5(7.2)
69
40(6.7)
596
6. Indicate the
T&CM modalities
offered by the pilot
hospitals:Acupuncture.
Malay traditional
massage.
Herbal treatment.
39(50.0)
78
132(21.4)
617
• Respondents’ Attitude on T&CM Services
Attitude
Non TCM
Hospital
(n/%)
53(8.4)
Total
(N/%)
Positive
TCM
Hospital
(n/%)
8(10)
Negative
72(90)
580(91.6)
652(91.4)
80
633
713
61(8.6)
Statement
Total
T&CM
n(%)
Non-T&CM
n(%)
a. T&CM services should be integrated
as part of hospital services.
390 (50.1)
58 (65.9)
332 (48.7)
b. T&CM services will reduce
workload of conventional medicine.
the
225 (28.9)
35 (40.2)
190 (27.9)
c. T&CM services will increase the quality of
life of the patients.
424 (54.4)
67 (76.1)
357 (52.9)
d. T&CM services will prevent patients
from
seeking
unregulated
T&CM
practices.
580 (74.4)
69 (78.4)
511 (75.3)
e. T&CM services speed up patients’
recovery process.
242 (31.3)
34 (40.0)
208 (30.6)
f. Patients
treatment.
for
570 (73.2)
59 (68.6)
511 (75.4)
hospitals
419 (53.8)
59 (67.8)
360 (53.0)
h. T&CM services are carried out in a
safe and accountable environment in the
hospital.
481 (61.7)
70 (81.4)
411 (60.7)
Integration
Benefits
have
more
choices
Safety
g. T&CM practitioners
practise patient safety.
in
Statement
Total
T&CM
n(%)
Non-T&CM
n(%)
i. T&CM will become the preferred treatment
in comparison to conventional treatment by
patients in the future.
177 (22.7)
12 (14.0)
71 (10.5)
j. T&CM has a future in the Malaysian
healthcare system.
468 (60.0)
56 (65.1)
412 (60.5)
k. CME on T&CM services should be
given to healthcare professionals on
regular basis.
455 (58.4)
47 (54.0)
408 (60.0)
l. T&CM should be included
conventional medical education.
in
413 (53.0)
51 (58.6)
362 (53.3)
m.
A medical doctor should not refer
patients to T&CM services provided in
government hospitals.
403 (51.7)
42 (48.2)
361 (53.1)
n. A medical doctor should consider using
T&CM for him/herself.
288 (36.9)
38 (43.6)
250 (36.7)
o. T&CM therapies hold promise
treatment of certain diseases.
357 (45.8)
45 (51.7)
312 (45.9)
Competition in service
Acceptance
for
Statement
Total
T&CM
n(%)
Non-T&CM
n(%)
p. Accepting T&CM services will reduce
the respect of my peers.
437 (56.1)
48 (55.1)
389 (57.1)
q. T&CM therapies need further scientific
testing
before
being
used
with
conventional medicine.
596 (76.6)
61 (70.9)
535 (78.8)
r. The results from T&CM therapies are
mainly due to a placebo effect.
16 (21.2)
17 (19.5)
148 (21.7)
s. T&CM therapies provide temporarily relief
without long-term gains.
192 (24.7)
16 (18.3)
176 (25.9)
t.
T&CM
services
“sham/quack” practices.
327 (42.0)
30 (34.9)
297 (44.2)
Skepticism
are
definitely
• Respondent Practice on T&CM Services
Proportions of Practice among Respondents in Klang Valley Hospitals
Statement
Yes/No
Frequency
(%)
1. Would you let your patients know about the T&CM therapies in
hospitals with T&CM services?
Yes
(n=688)
603(87.6)
2. Would you refer your patients to T&CM unit in hospitals with
T&CM services?
Yes
536(77.9)
3. Would you support the initiation of T&CM unit in your hospital?
Yes
525(76.3)
3.1. If no, why?
(n=163)
3.1a. Unethical
3.1b. Belief of ineffectiveness of T&CM
3.1c. Lack of evidence of effectiveness
3.1d. Competition
3.1e. Lack of legal recognition
3.1f. Costs
3.1g. Cost effectiveness
3.1h. Lack of training
3.1i. Distrust Philosophical differences
3.1j. Profit motive
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
59(36.2)
92(56.4)
133(81.6)
31(19.0)
121(74.2)
49(30.1)
68(42.3)
118(72.4)
75(46.0)
46(28.2)
4. Have you ever used T&CM for yourself?
Yes
(n=688)
303(44.0)
5. Have any of your family members used any T&CM therapies?
Yes
457(66.4)
6. Have you documented any T&CM use by your patients in their
records?
Yes
323(46.9)
7. Have you documented any adverse effects of T&CM
experienced by your patients?
No
362(52.6)
Proportions of Practice among Respondents in Hospital Putrajaya
Statement
Yes/No
Frequency
(%)
1. Have you offered your patients on T&CM options?
Yes
(n=91)
37(40.7)
2. Have you sought the opinions of others regarding T&CM
options?
Yes
34(37.4)
3. Have you referred patients to T&CM services?
Yes
35(38.5)
3.1. If yes, which services do you refer to?
(n=35)
3.1a. Herbal treatment
3.1b. Massage
3.1c. Acupuncture
Yes
Yes
Yes
5(14.3)
27(77.1)
22(62.9)
4. Have you ever used T&CM for yourself?
Yes
(n=91)
28(30.8)
5. Have any of your family members used any T&CM therapies?
Yes
39(42.9)
6. Have you documented any T&CM use by your patients in their
records?
Yes
26(28.6)
7. Have you documented any adverse effects of T&CM
experienced by your patients?
No
75(82.4)
• Relationship between Socio Demographic
Characteristics of Medical Doctors and
Their Willingness to Discuss/ Refer the
Patients to T&CM Services
T&CM (n/%)
Non T&CM
(n/%)
>46 yrs
(2/5.7)
(42/78)
Female
(27/77.1)
(375/70.1)
Rheumatologists
O&G
(3/25)
(24/82.8)
Generalists
(24/68.6)
(369/70.4)
Ever used
(8/22.9)
(263/49.1)
positive acceptance
(6/20)
(53/10.7)
have knowledge in T&CM
services
(23/92)
(410/93.2)
Specialty
Discussion
• Based on literature
reviews:
Demographic
characteristics of
doctors:
Age
Gender
Specialty
Self use
• From the findings:
>46 yrs
Female
Generalists
Ever used
• Based on literature
reviews:
Physicians’ knowledge
of T&CM:
QoL
• From the findings:
Wellness purposes
Fulfill needs
• Based on literature
reviews:
Physicians’ attitude
towards T&CM:
Integration
Competition
Acceptance
• From the findings:
As part of hospital
services
Future
Not to use
Regular basis &
included in
conventional medical
education
• Based on literature
reviews:
Physicians’ attitude
towards T&CM:
skepticism
• From the findings:
Need further testing
Reduce respect
• Based on literature
reviews:
Physicians’ practice of
T&CM:
referral
• From the findings:
Referred patients
Massage &
acupuncture
Conclusion
Limitation
Suggestion
References
•
•
•
•
•
•
•
•
•
Ahmad Syukri Chew. 2008. Traditional/Complementary Medicine. Possible Ethical Dilemma. MMA News. April:18-22.
Annual Report, T&CM Division, MOH, 2007.
Corbin, W. L. & Shapiro, H. 2002. Physicians want education about Complementary and Alternative Medicine to enhance
communication with their patients. Archives International Medicine 162:1176-1181.
Deraf Penilaian Pertengahan Penggal Rancangan Malaysia Ke-9 Kementerian Kesihatan Malaysia Program: Penyelidikan Dan
Sokongan Teknikal, Disember 2007.
Eisenberg, D.M., Kessler, RC., Foster, C. 1993. Unconventional medicine in the United States: prevalence, costs and patterns
of use. New England Journal of Medicine 328:246-252.
Eisenberg D.M., Davis, R.B., Ettner, S.L., Appel, S., Wilkey, S., & Van Rompay, M. 1998.
Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 280:15691575.
Eirnarson,A., Lawrimore T., Brand, P., Gallo, M., Rotatone,C & Koren, G. 2000. Attitudes and Practices of Physicians and
Naturopaths Toward Herbal Products, Including Use During Pregnancy and Lactation. Can J Clin Pharmacol. 7: 45-49.
Furnham, A. & Kirkcaldy, B. 1996. The health beliefs and behaviors of orthodox and complementary medicine clients. British
Journal of Clinical Psychology 35: 49-61.
•
•
•
•
•
•
•
•
•
•
Furnham, A. & Forey, J. 1994.The attitudes, behaviors and beliefs of patients of conventional vs complementary
(alternative) medicine. Journal of Clinical Psychology. 50: 458-469
Kurtz, M.E., Nolan, R.B. & Rittinger, W.J. 2003 Primary care physicians’ attitudes and practices regarding Complementary
and Alternative Medicine. Journal of the American Ostheopathic Association 103(12): 597-602.
Levine,M.A.& Levine, M.L.W. & Mayberry, R.M. 2003. Complementary and Alternative
Medical Practices: Training, Experience, and Attitudes of a Primary Care Medical School Faculty. The Journal of the American
Board of Family Medicine. 16(4):318-326.
Lie, D.A & Boker, J. 2006. Comparative survey of Complementary and Alternative Medicine (CAM) attitudes, use, and
information-seeking behaviour among medical students, residents & faculty. BMC Medical Education 6:58.
Majeed, K., Mahmud, H., Khawaja, H.R., mansoor, S., Masood, S & Khimani, F. 2007. Complementary and Alternative
Medicine: Percetions of Medical Students From Pakistan. Med Educ Online 12:11.
Micozzi, M.S. 1996. The Need To Teach Alternative Medicine. The Chronicle of. Higher Education Aug (A48).
Murray, J & Shepherd,S. 1993. Alternative or Additional Medicine? An Exploratory Study in General Practice. Soc Sci Med,
37:983-988.
National Policy of Traditional & Complementary Medicine, T&CM Division, MOH, 2nd ed. 2007).
Oberbaum, M., Notzer, N., Abramowitz, R & Branski, D. 2003. Attitude of Medical Students to the Introduction of
Complementary Medicine into the Medical Curriculum in Israel. IMAJ 5: 139 – 141.
•
•
•
•
•
•
•
•
•
Poynton,L., Dowell, A., Dew, K. & Egan, T. 2006. General practitioners’ attitudes toward (and use of) complementary and
alternative medicine: a New Zealand nationwide survey. http://www.nzma.org.nz/journal/119-1247/2358.html [6 Februari
2008].
Sikand, A. & Laken, M. 1998. Pediatricians’ experience with and attitudes toward Complementary/Alternative Medicine.
Archives of Pediatrics & Adolescent Medicine 152:1059-1064.
Tiralongo, E. & Wallis, M. 2008. Attitudes and perceptions of Australian pharmacy students towards Complementary and
Alternative Medicine - A pilot study. http://www.biomedcentral.com/1472-6882/8/2.html [6 February 2008].
Traditional & Complementary Medicine Division. Standard Operating Procedures for T&CM Unit in Hospital, Revised Edition,
July 2009.
Verhoef,M.J & Sutherland, L.R.1995. General Practitioners’ Assessment of and Interest in Alternative Medicine in Canada.
Soc Sci Med 41:511-515.
Wahner-Roedler, D.L., Vincent, A., Elkin, P.L., Loehrer,L.L, Stephen S. Cha & Bauer, B.A. 2006. Physicians’ attitudes
toward Complementary and Alternative Medicine and their knowledge of specific therapies: A survey at an academic medical
center. eCAM 3(4): 495–501.
Wetzek, M.S., Eisenberg, D.M. & Kaptchuk, T.J. 1998. Courses involving complementary and
alternative medicine at
U.S. medical schools. JAMA 280: 784-787.
Zwicky, J.F., Hafner, A.W. & Barrett, S. 1993. Reader’s Guide to Alternative Health Methods: Scientific Perspective. Chicago,
Ill: American Medical Association 3-13.
Wilkinson, Leland; APA Task Force on Statistical Inference (1999). "Statistical methods in psychology journals: Guidelines
and explanations". American Psychologist 54: 594–604. doi:10.1037/0003-066X.54.8.594