Models of health and models of interaction in the practitioner-client relationship in acupuncture

Realizing Holism in Traditional Chinese Medicine (TCM) Consultations through the Voice of TCM (VOTCM): An Interactional Analytical Approach

In recent years, doctor-patient communication in the context of traditional Chinese medicine (TCM) has attracted increasing attention. Highly influenced by ancient Chinese philosophy, TCM is unique in its exemplification of Chinese wisdom, particularly with respect to how the idea of zhěngtǐguān () (lit. whole body concept), realized as "the idea of the whole" or simply "holism," is valued and realized in TCM consultations. Adopting an interactional analytical approach, our study aims to illustrate how TCM doctors and patients co-construct a medical consultation that can exemplify the idea of holism. Based on a spoken corpus of Mandarin Chinese totaling 443 minutes in length, this paper identifies instances of what can be labeled as the voice of TCM (VOTCM) in a typical TCM consultation that reflect the idea of holism and describes and analyzes the communicative routines that are specific to these TCM consultations. It is observed that the steps and strategies involved in the consultation not only illustrate the collaborative co-construction of holism but also point to the holistic aspect of TCM philosophy, particularly topics related to the different body parts and the lifeworld. The diagnostic explanations provided by doctors and the co-topical talks between doctors and patients at various stages of the consultation also play an important role in the co-construction and realization of holism.

"I'm Worth Saving": Making Sense of Medication Taking in a Care Coordination Organization

Patients and healthcare providers (HCPs) may communicatively make sense of medication taking in divergent ways. Often, HCPs prioritize medication adherence, the extent to which patients consume medications as prescribed. In contrast, patients may focus on how medications fit in with their everyday lives. Care coordination organizations (CCOs) provide cohesive, interdisciplinary, health services to chronically ill patients and may help bridge the gap between patient and HCP sensemaking. Our qualitative study asked: How do patients and HCPs involved in a CCO communicatively make sense of medication taking? Through thematic analysis, we found three themes related to patients' sensemaking. Patients (N = 9) made sense of medication taking (1) as necessary and important through embodied experiences, social discourses, and interpersonal interactions; (2) as easy when supported; and (3) through building bonds. We also found three themes related to HCPs' sensemaking: HCP participants (N = 5) made sense of medication taking (1) through dialogue with patients; (2) by interacting in patients' home spaces; and (3) through building relationships with patients. Our final theme explores how communicative sensemaking became more complicated for participants in the context of psychotropic medications. Using Mishler's Voice of the Lifeworld (VoL) and Weick's sensemaking, we advance a constitutive perspective on medication taking. We suggest that researchers and HCPs should focus on constructing shared meanings about medication taking through dialogue, rather than on increasing adherence. Our study provides evidence that, by promoting engagement with the VoL, CCOs may facilitate such dialogs.

Classifying knowledge used in complementary medicine consultations: a qualitative systematic review

Background

Complementary Medicine (CM) is widely used internationally but there is limited understanding of the forms of knowledge CM practitioners use in their clinical practice and how they use this knowledge in interactions with patients. This review aims to synthesise the existing evidence on the forms of knowledge that are mobilised, and the role of this knowledge in the interactions between practitioners and patients during CM consultations. It considered a diverse range of CM practice areas to develop a classification of CM practitioners’ knowledge use in consultations.

Methods

Systematic searches of health and sociology databases were conducted using core concepts, including complementary and alternative medicine, practitioners, and knowledge. Articles were included where they reported on data from recorded CM practitioner and patient consultations and offered insights into the types and applications of knowledge used in these consultations. 16 unique studies were included in the review. Data were extracted, coded and analysed thematically.

Results

Results demonstrate that diverse sources of knowledge were mobilised by practitioners, predominantly derived from the patients themselves –their bodies and their narratives. This reflected principles of patient-centredness. The use of discipline specific forms of knowledge and references to biomedical sources illustrated ongoing efforts towards legitimacy for CM practice.

Conclusion

CM practitioners are navigating tensions between what some might see as competing, others as complementary, forms of knowledge. The classification system provides a useful tool for promoting critically reflective practice by CM practitioners, particularly in relation to self-assessment of knowledge translation and patient interactions.

The Provider's Body in the Therapeutic Relationship: How Complementary and Alternative Medicine Providers Describe Their Work as Healers

Although the body is central to health outcomes, the provider's body has been largely absent in the provider-patient relationship. Drawing upon semi-structured interviews with complementary and alternative medicine (CAM) providers (N = 17), this study examines how CAM providers use their body to characterize their work as healers. The findings suggest the provider's self-reflexive awareness of their own body's illness and faith experiences informs their understanding of the patients' experience of health and disease. The study foregrounds the intersubjective nature of the provider-patient relationship as an embodied interaction in the mutual construction of therapeutic goals. Provider reflection on their own bodies to make sense of their patients' experiences emphasizes provider-patient coproduction of meaning and suggests ways for including the provider's self-reflexive awareness of their own body in a patient-centered healthcare relationship in ways that benefit both the patient and the provider.

Breaking Boundaries: Complementary and Alternative Medicine Provider Framing of Preventive Care

This textual examination extends understandings of how complementary and alternative medicine (CAM) providers constitute preventive care in their discourse by identifying the frame of breaking boundaries referencing relational, structural, and philosophical orientations in their practice with their clients. Analysis of semistructured, in-depth interviews with CAM providers ( n = 17) reveals that the frame of breaking boundaries was comprised of three themes: finding one's own strength; I don't prescribe, so I'm exploring; and ground yourself, and have an escape route. The themes describe preventive care by identifying how CAM providers negotiate their relational positionality in connecting with clients, structural positionality within the field of health care, and philosophical positionality within the ontological understandings that guide how health is defined and conceptualized. The study contributes toward enhancing diverse understandings of constituting preventive care in practice and suggests pragmatic implications for addressing biomedical provider communication with their patients seeking CAM care alongside conventional treatments.

Challenging integration: clinicians' perspectives of communicating collaboration in a center for integrative medicine

A shift has occurred in the provision of health care to include a focus not just on biology and disease but also on the whole person, preventative care, and an array of healing modalities based on systems of beliefs and values not typically included within biomedical practice. This approach to health care, termed integrative medicine (IM), blends biomedicine with a broader understanding of patients and their illnesses, including elements of mind, body, and spirit that may be contributing to an ailment. While the use of integrative medicine has increased and centers for integrative medicine have proliferated within conventional health care organizations, distinct tensions arise from this amalgamation. The tensions between IM and biomedical clinicians often center on their differing training and philosophies, as well as on a larger system of health care that privileges biomedicine. As a result, this research is designed to explore the challenges IM clinicians face in collaborating with conventional practitioners to provide patient care. Analysis of interviews with 14 clinicians at one center for integrative medicine revealed four specific challenges they face in their attempt to co-practice IM with conventional medicine. The four challenges include (a) challenges to collaboration, (b) challenges to legitimacy, (c) challenges to consistency, and (d) challenges to unification. Future research should investigate the ways in which these challenges can be addressed so that collaboration throughout the system is facilitated. The professional training of clinicians, the structuring and institutionalization of integrative medicine, and enhanced systems for communicating patient information all play a significant role in this transformation.

Negotiating biomedical and traditional Chinese medicine treatments among elderly Chinese Singaporean women

In this article we examine how elderly Chinese Singaporean women navigated between biomedicine and traditional Chinese medicine in their practices of maintaining well-being. We interviewed 36 elderly women to understand their negotiation of medical choices in the interplay of structure, culture, and personal agency. Our findings show that participants made situational decisions under structural and cultural influences, such as family members' changing expectations and interpretations of medical practices, institutional preferences for biomedicine, and the patients' negotiating position between biomedicine and traditional Chinese medicine. Participants demonstrated their capacity to enact agency through their examination of the effects and side effects of each medical system and through their integrative use of different medical treatments, depending on the purpose. Through our findings, we unveil contextual meanings of health among elderly women and the unique coexistence of traditional and modern medical practices within the context of Singapore.

Trailblazing healthcare: institutionalizing and integrating complementary medicine

OBJECTIVES

This study examines three integrative health centers to understand their (1) historical development, organizational goals, and modalities, (2) the processes and challenges of integrating complementary and allopathic medicine, while encouraging staff collaboration, and (3) how each center becomes institutionalized within their community.

METHODS

We focus on three organizational case studies that reflect varying forms of integrative health care practices in three U.S. cities. Participant-observation and in-depth interviews with center directors were analyzed qualitatively.

RESULTS

Important patterns found within the three cases are (1) the critical role of visionary biomedical practitioners who bridge complementary and allopathic practices, (2) communicating integration internally through team interaction, and (3) communicating integration externally through spatial location, naming, and community outreach.

CONCLUSION

IM centers continue to blaze new trails toward mainstream access and acceptance by gathering evidence for IM, encouraging team collaboration within organizational contexts, constructing organizational identity, and negotiating insurance reimbursements.

PRACTICE IMPLICATIONS

IM is not the enactment of specific modalities, but rather a philosophy of healing. Though scheduling conflicts, skepticism, and insurance coverage may be obstacles toward IM, collaboration among specialists and with patients should be the ultimate goal.

Patients as healthcare consumers in the public and private sectors: a qualitative study of acupuncture in the UK

Background

The aim of this study was to compare patients' experiences of public and private sector healthcare, using acupuncture as an example. In the UK, acupuncture is popular with patients, is recommended in official guidelines for low back pain, and is available in both the private sector and the public sector (NHS). Consumerism was used as a theoretical framework to explore patients' experiences.

Methods

Semi-structured face-to-face interviews were conducted in 2007-8 with a purposive sample of 27 patients who had recently used acupuncture for painful conditions in the private sector and/or in the NHS. Inductive thematic analysis was used to develop themes that summarised the bulk of the data and provided insights into consumerism in NHS- and private practice-based acupuncture.

Results

Five main themes were identified: value for money and willingness to pay; free and fair access; individualised holistic care: feeling cared for; consequences of choice: empowerment and vulnerability; and "just added extras": physical environment. Patients who had received acupuncture in the private sector constructed detailed accounts of the benefits of private care. Patients who had not received acupuncture in the private sector expected minimal differences from NHS care, and those differences were seen as not integral to treatment. The private sector facilitated consumerist behaviour to a greater extent than did the NHS, but private consumers appeared to base their decisions on unreliable and incomplete information.

Conclusions

Patients used and experienced acupuncture differently in the NHS compared to the private sector. Eight different faces of consumerist behaviour were identified, but six were dominant: consumer as chooser, consumer as pragmatist, consumer as patient, consumer as earnest explorer, consumer as victim, and consumer as citizen. The decision to use acupuncture in either the private sector or the NHS was rarely well-informed: NHS and private patients both had misconceptions about acupuncture in the other sector. Future research should evaluate whether the differences we identified in patients' experiences across private and public healthcare are common, whether they translate into significant differences in clinical outcomes, and whether similar faces of consumerism characterise patients' experiences of other interventions in the private and public sectors.