How do homeopaths make decisions? An exploratory study of inter-rater reliability and intuition in the decision making process.
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.
Department of Primary Medical Care, Complementary Medicine Research Unit, Aldermoor Health Centre, University of Southampton, Aldermoor Close, Southampton, Hampshire, S016 5ST, UK. s.brien@soton.ac.uk
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D000328:Adult; D001532:Atropa belladonna; D001533:Belladonna Alkaloids / Q000627:therapeutic use*; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D006705:Homeopathy / Q000379:methods / Q000592:standards*; D006801:Humans; D019545:Intuition; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010358:Patient Participation / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards; D011795:Surveys and Questionnaires; D013997:Time Factors
D001533:Belladonna Alkaloids