Changes in use of hormone replacement therapy after the report from the Women's Health Initiative: cross sectional survey of users.

rishi vedic medicine, treat me as an equal, and we exchange views frankly and freely. I can take their advice on issues I raise, and they can suggest options without the slightest hint of offence if I decline. My use of maharishi ayurveda herbal preparations, lifestyle changes (diet, frequent swimming, etc), and regular meditation mean that I minimise the possibility of side effects and maximise my resistance to future problems. My only real criticism of this paper by Lewis and colleagues is that such a small number of people were interviewed. Based on my own experience, I would like to amplify some points from their research. x True dialogue between patient and doctor is essential, and patients’ preference and values must be respected x Patients want to make decisions to maximise their quality of life, and negotiated prescribing will yield better outcomes than imposed treatment x Doctors will tend to have different values from patients, but the imbalance of power in the doctor-patient relationship causes them to have undue influence. To counter this, I would recommend that greater emphasis be placed on listening skills in doctor training and that more opportunities for “expert patient” training be provided on a routine basis x People dislike unnecessary drug taking and would prefer lifestyle changes to “imperfect treatment.” (Is there such a thing as perfect treatment?) Unnecessary drug taking, which could include preventive treatment, can lead to the feeling of loss of control over health and reduce wellbeing, with subsequent negative impact on physical and mental health x There is an urgent need to research those who decline treatment, and to provide alternative options including complementary therapies as required x Finally, the cost of treatment is a huge issue. Cost is the biggest problem facing me, as I am living on a low income from incapacity benefit and income support. NHS treatments would be free, but herbal options and lifestyle choices cost money. Perhaps the NHS should fund well researched and patient friendly solutions such as transcendental meditation and maharishi ayurveda for those with chronic conditions.