23: Clinical Practice: Getting Started

CHAPTER 23 Clinical Practice: Getting Started



Susan G. Wynn, Barbara J. Fougère


Teachers frequently hear students complain that they are well educated but not confident to practice herbal medicine. It is a big subject, and in this chapter, the goal is to provide concrete starting points and resources.



WHY USE HERBAL MEDICINE?


This subject has already been covered earlier in this book; however, it is worth reviewing and perhaps looking at it from another angle. In terms of encouraging clients to try herbal medicine, it is worth knowing that in many cases, owners are interested in herbal medicine but will not divulge this to the practitioner—multiple studies have shown this to be the case in human medicine. Careful questioning during history taking may reveal that the owner is already using herbal medicine, giving the practitioner an opportunity to fine-tune that treatment when possible.


Clients are often willing to try herbal medicine for the following reasons:


• The perception is that it is natural

• Clients are likely to be using some form of natural medicine themselves

• Herbs can be used to treat subclinical conditions

• Herbs can be used in the absence of a medical diagnosis

• Herbs may be more effective than other agents for many chronic conditions intractable to conventional medication

• Herbs have actions that medications do not offer, such as adaptogenic activity, nutritional support, and immune stimulation

• Herbs can be used to treat particular organs like the liver, or systems such as the digestive system

• Herbal medicine is part of a holistic approach to animal health care.

The veterinarian can provide to clients a simple brochure that outlines what herbal medicine is about. A basic one can be found on the Veterinary Botanical Medicine Association Web site at www.vbma.org. When clients know that a particular veterinarian has an interest in herbal medicine, word spreads fast.



OBSTACLES TO PRACTICE


One of the greatest obstacles to the practice of veterinary herbal medicine is not lack of support from clients, but lack of support from other veterinarians. Colleagues might argue that the practice of herbal medicine is not evidence based, and that it is not known how it works, or whether it actually does. This is not true. The body of scientific validation is ever increasing, but clinical practice has validated the use of many herbs, in stark contrast to the lack of evidence for many novel drugs. When mechanisms of action are unknown, scientists cannot offer such an evidence base for conventional drugs. When a particular herb lacks scientific support, the traditional knowledge base provides some support.


Time and money are two other obstacles to the practice of veterinary herbal medicine. Herbal medicine does not generate the same revenue as is produced in regular practice, where a throughput of clients and a high average transaction fee caused by other services generate fees for the practice. Herbal medicine takes more time. Extended consultation may be needed for the practitioner to take a comprehensive history and perform a thorough examination of the patient. Clients must be taught to understand that an extended consultation is more expensive, and the veterinary herbalist must charge appropriate fees. The upside of this is the satisfaction that comes when health is restored in seemingly difficult cases, as well as the referrals that come from a job well done. Each practice must work out the best way that it can to deal with the financial restraints of this style of consulting.


Space for a dispensary can also be difficult to find. To begin with, the veterinary herbalist may meet with a local herbalist who can provide needed formulas or herbs.



SEEKING SUPPORT


Support consists of confidence building and reassurance when one is beginning work in veterinary herbal medicine. Where should the practitioner turn for quick, practical information on treating a case? What about ongoing mentorship to help him or her to develop the practice of veterinary herbal medicine? The following steps are suggested:


• Join a holistic veterinary group or veterinary herbal group. The Veterinary Botanical Medical Association (VBMA) is an organization of veterinary herbalists from around the world that provides an email listserv of professionals who can help on cases. An answer to a question is usually provided within 24 hours. This Association also provides a journal and regular continuing education meetings. For more information, the reader is referred to the VBMA Webpage at http://www.vbma.org.

• In each city, a network or organization of human herbalists can be located that is only too willing to assist with assessment of cases and with prescribing. A local herbalist can usually be identified who is very helpful in providing formulas and acting as the practice dispensary, at least in the beginning.

• Plenty of seminars and classes are available for the herbalist to join and participate in.

• Many herbal manufacturers and distributors are staffed by knowledgeable and helpful practitioners. These staff members can also help the herbalist to locate information or to find other practitioners who can assist.


DAY-TO-DAY LEARNING


Clearly, a basic herbal medicine library is essential; it may include both printed textbooks and bookmarked Internet sites (in the authors’ opinion, the well-managed practice cannot function successfully without Internet access). It is useful to think of books as belonging to two general categories—those that provide detailed information on the herbs themselves (Materia medica–type books) and those that describe treatment strategies. Following are lists of useful texts and Internet sites:



Materia Medica Texts



Felter HW, Lloyd JU. King’s American Dispensatory (1898). Available at: www.henriettesherbal.com/

Skenderi G. Herbal Vade Mecum. Rutherford, NJ: Herbacy Press; 2003.

Bone K, Mills S. Principles and Practice of Phytotherapy. St. Louis, Mo: Churchill Livingstone; 2000.

Bone K. A Clinical Guide to Blending Liquid Herbs. St. Louis, Mo: Churchill Livingstone; 2003.


Clinical Strategy Texts



Wynn S, Marsden S. Manual of Natural Veterinary Medicine: Science and Tradition. St. Louis, Mo: Mosby; 2003.

Weiss R. Herbal Medicine. 1st edition. Beaconsfield, England: Beaconsfield Publishers Ltd; 1988.

Hoffman D. Medical Herbalism. Rochester, VT: Healing Arts Press; 2003.

Although the practitioner can always expect to learn more with each major course in herbal medicine that is taken, it is useful to spend time with a colleague, watching diagnostic and prescription strategies used in his or her practice.



LENGTH OF CONSULTATIONS AND PRICING


The practice of herbal medicine is not simply about prescribing herbs; it requires a philosophy based on whole health, or holism. To begin with, the new herbalist should plan to allow 1 hour per patient to achieve this.


One of the very first considerations is what to charge for services and medicines. The first herbal consultation is usually a long one, ranging from 40 minutes to an hour; the practitioner may need to factor in time for dispensing unless he or she has hired trained staff. Follow-ups usually last from 20 to 30 minutes.


When the price of herbal medicines is considered in the fee, the practitioner must include the cost of the herbs, bottle, cap, and label, along with the time needed to dispense and order and maintain stock. A 100% mark-up is recommended to start. To start with, one should make up four or five formulas and calculate the time it takes to make them, as well as the costs of the herbs and materials. A consistent price for bottles of different sizes makes inventory easier, although for some herbs that are more expensive (e.g., Panax ginseng), or in cases in which formulas contain a larger number of herbs, a premium should be added to the price. In one author’s practice (SW), every formula costs the same, but price is calculated in a way that ensures that the cost of the more expensive herbs is incorporated.


If pre-prepared formulas are used, a 50% to 100% mark-up is realistic.


Appointments should be scheduled according to the likely duration of the initial herbal prescription. When prescribing, one should work out the dose and decide how long the formula will last. A 2-week check-up and a follow-up visit usually provide enough time to indicate whether the formula is working; if it is not working, this plan allows the practitioner the opportunity to change the formula.

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Related posts:

  1. 17: Conserving Medicinal Plant Biodiversity
  2. 20: Veterinary Herbal Medicine: A Systems-Based Approach
  3. 5: Overview of Traditional Chinese Medicine: The Cooking Pot Analogy
  4. 24: Materia Medica

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Jul 18, 2016 | Posted by in PHARMACOLOGY, TOXICOLOGY & THERAPEUTICS | Comments Off on 23: Clinical Practice: Getting Started

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