Can holism be practiced in a biomedical setting? A qualitative study of the integration of complementary medicine to a surgical department

The salutogenic gaze: Theorising the practitioner role in complementary and alternative medicine consultations

Research on why people use complementary and alternative medicine (CAM) shows clients value the CAM consultation, where they feel listened to and empowered to control their own health. Such 'empowerment' through CAM use is often theorised as reflecting wider neoliberal imperatives of self-responsibility. CAM users' perspectives are well studied, but there has been little sociological analysis of interactions within the CAM consultation. Specifically, it is unclear how user empowerment/self-knowledge relates to the CAM practitioner's power and expert knowledge. We address this using audio-recorded consultations and interviews with CAM practitioners to explore knowledge use in client-practitioner interactions and its meaning for practitioners. Based on our analysis and drawing on Foucault (1973), The Birth of the Clinic: an archaeology of medical perception and Antonovsky (1979), Health, Stress and Coping, we theorise the operation of power/knowledge in the CAM practitioner-client dyad by introducing the concept of the 'salutogenic gaze'. This gaze operates in the CAM consultation with disciplining and productive effects that are oriented towards health promotion. Practitioners listen to and value clients' stories, but their gaze also incorporates surveillance and normalisation, aided by technologies that may or may not be shared with clients. Because the salutogenic gaze is ultimately transferred from practitioner to client, it empowers CAM users while simultaneously reinforcing the practitioner's power as a health expert.

Contributions of Hippocratic medicine and Plato to today's debate over health, social determinants and the authority of biomedicine

By exploring a competition for authority on health and human nature between Plato and Hippocratic medicine, this paper offers a fresh perspective on an overarching debate today involving health and the role of healthcare in its safeguarding. Economically and politically, healthcare continues to dominate the USA's handling of health, construed biophysically as the absence of disease. Yet, notoriously, in major health outcomes, the USA fares worse than other countries in the Organisation for Economic Co-operation and Development (OECD). Clearly, in giving pre-eminence to healthcare, the USA is doing far less than it could to protect and improve health. Meanwhile, mounting evidence supports the view that health impacts of social determinants besides healthcare (eg, education) surpass healthcare in heft. Circumscribed shifts in the USA's current frame will not suffice: what's needed is a change in its overall template for addressing health. Unless this is widely seen, the sway of biomedicine will likely be reduced slowly, if at all. That biomedicine's role in relation to health is raised increasingly as a question is a sign that its ongoing supremacy is not a forgone conclusion. But making the most of this opportunity requires appreciating that 'How should health's relationship to medicine be conceptualised?' is not the most fundamental query that we need to pose. Through consideration of Hippocratic medicine and Plato, I argue that the most availing answer to this particular question can come only after exploration of three larger questions involving health's status as a human good and its relationship to human flourishing. Exploration of the Greeks is, thus, valuable methodologically. What's more, it supports today's advocacy of 'health promotion', a perspective tying health closely to well-being that has yet to achieve the overall prominence that it warrants.

"You become a slightly better doctor": Doctors adopting integrated medical expertise through interactions with E-patients

The accessibility of information via the internet has radically altered the doctor-patient relationship. By means of in-depth interviews with Israeli physicians from four different specialties, this study explored how physicians cope with internet-informed patients, referred to as e-patients, and examined how they make sense of their new professional roles. Findings show that three types of boundaries in the doctor-patient relationship have been blurred by the emergence of the e-patient: the boundaries between doctors' and patients' knowledge, between doctors' authority and patients' autonomy, and between positivistic knowledge and humanistic knowledge. Each of these is a boundary between liberal and non-liberal values. Only the combination of all these components produces, according to the participants, a good doctor. I call this new phenomenon integrated medical expertise and explain how it diverges from previous notions of 'good doctoring'.

Evaluation of an Integrative Care Program in Pediatric Oncology

Purpose: This article discusses the results of an evaluation of the one-year implementation period of an integrative care program at a pediatric oncology ward, which consists of integrative care treatments offered three times a week to the patients. The guiding questions are how the model was implemented, which factors have to be considered for successful implementation, and which factors showed to be obstacles during implementation. Methods: A mixed-methods approach was applied for data saturation. Qualitative data consist of participant observations and informal conversations during the implementation phase. All observational records were filed in the data program MAXQDA. For the quantitative data, all integrative care treatments applied on the intensive care unit were documented and subsequently filed in an Excel sheet. Both sets of data were analyzed for the evaluation. Results: Four main thematic clusters influenced the implementation: (1) the organization and structure of the intensive care unit; (2) mood and atmosphere; (3) feedback on treatment; and (4) time and experience. All factors are interlinked and cannot be looked at independently. Results of the quantitative data show that the most frequent used treatments were those with calming and relaxing effects, followed by treatments for stomachache, nausea, and obstipation. Conclusions: The implementation of an integrative model of care is a process that demands thorough understanding of the complex setting of the ward, ongoing adaptation to the structures and organization of the ward, and the integration of factors like feedback, time, atmosphere, and the mood of parents, patients, and nurses.

First, keep it safe: Integration of a complementary medicine service within a hospital

OBJECTIVES

This paper sought to explore risk/safety considerations associated with the integration of a complementary medicine (CM) service within a public academic medical centre in Israel.

METHODS

We reviewed various sources pertaining to the CM service (interviews with CM staff, patients' electronic charts, service guidelines, correspondence with hospital administration) and conducted a thematic analysis to evaluate safety-related incidents during the 7 years of operation. In addition, we systematically assessed the charts for reports of treatment-associated adverse effects, which were documented in an obligatory field on treatment reports.

RESULTS

After reviewing transcripts of interviews with 12 CM practitioners and with the director and vice-director of the CM service as well as transcripts of 8560 consultations that included 7383 treatments, we categorised 3 major domains of CM safety management: (i) prevention of safety-related incidents by appropriate selection of CM practitioners and modalities, (ii) actual adverse incidents and (iii) prevention of their recurrence using both hospital and CM service safety protocols. CM staff reported 5 categories of adverse incidents, most of which were minor. Twenty-nine adverse incidents were documented in the 7383 treatment sessions (0.4%).

CONCLUSIONS

Safety management needs to be addressed both before introducing CM services in hospitals and throughout their integration. Important considerations for the safe integration of CM practices in the hospital include communication between CM and conventional practitioners, adherence to hospital safety rules, implementing a systematic approach for detecting and reporting safety-related incidents and continuous adaptation of the CM service safety protocols.

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.

MERGING conventional and complementary medicine in a clinic department - a theoretical model and practical recommendations

Background

Today, the increasing demand for complementary medicine encourages health care providers to adapt and create integrative medicine departments or services within clinics. However, because of their differing philosophies, historical development, and settings, merging the partners (conventional and complementary medicine) is often difficult.

It is necessary to understand the similarities and differences in both cultures to support a successful and sustainable integration. The aim of this project was to develop a theoretical model and practical steps that are based on theories from mergers in business to facilitate the implementation of an integrative medicine department.

Methods

Based on a literature search and expert discussions, the cultures were described and model domains were developed. These were applied to two case studies to develop the final model. Furthermore, a checklist with practical steps was devised.

Results

Conventional medicine and complementary medicine have developed different corporate cultures. The final model, which should help to foster integration by bridging between these cultures, is based on four overall aspects: culture, strategy, organizational tools and outcomes. Each culture is represented by three dimensions in the model: corporate philosophy (core and identity of the medicine and the clinic), patient (all characteristics of the professional team’s contact with the patient), and professional team (the characteristics of the interactions within the professional team).

Conclusion

Overall, corporate culture differs between conventional and complementary medicine; when planning the implementation of an integrative medicine department, the developed model and the checklist can support better integration.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-015-0696-2) contains supplementary material, which is available to authorized users.

'A necessary evil that does not "really" cure disease': The domestication of biomedicine by Dutch holistic general practitioners

Against the background of studies about the domestication of complementary and alternative medicine into biomedical settings, this article studies how biomedicine is integrated into holistic settings. Data from 19 in-depth interviews with Dutch holistic general practitioners who combine complementary and alternative medicine with conventional treatments demonstrate that they do not believe that conventional biomedicine 'really' cures patients. They feel that it merely suppresses the physical symptoms of a disease, leaving the more fundamental and non-physical causes intact. As a consequence, they use conventional biomedicine for strictly practical and instrumental reasons. This is the case in life-threatening or acute situations, understood as non-physical causes of disease having been left untreated with complementary and alternative medicine for too long. More mundane reasons for its use are the need to take patients' demands for biomedical treatment seriously or to obey authoritative rules, regulations and protocols. The integration of biomedicine into complementary and alternative medicine, then, follows the same logic of domestication of complementary and alternative medicine into biomedicine: it is made subordinate to the prevailing model of health and illness and treated as a practical add-on that does not 'really' cure people.

Complementary medicine as a path toward empowerment of Arab-Palestinian women in Israel

Arab-Palestinians in Israel compose a traditional minority population that previously relied on traditional folk medicine and religious healing. Today some among this minority population are adopting imported complementary medicine. We interviewed Arab-Palestinians of the first generation of complementary medicine practitioners. Their decision to study complementary medicine constitutes a path toward empowerment, providing healers with an aura of modernity, enabling integration into the predominantly Jewish Israeli medical establishment to gain professional recognition as experts, and to acquire a sense of belonging. Practicing complementary medicine provides financial independence, liberation, and self-fulfillment and an opportunity to help female patients break through constraining barriers.

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers

Background

Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care.

Methods

Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women’s health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage.

Results

Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach.

Conclusions

From the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services.

Dual embedded agency: Physicians implement integrative medicine in health-care organizations

The paradox of embedded agency addresses the question of how embedded agents are able to conceive of new ideas and practices and then implement them in institutionalized organizations if social structures exert so powerful an influence on behavior, and agents operate within a framework of institutional constraints. This article proposes that dual embedded agency may provide an explanation of the paradox. The article draws from an ethnographic study that examined the ways in which dual-trained physicians, namely medical doctors trained also in some modality of complementary and alternative medicine, integrate complementary and alternative medicine into the biomedical fortress of mainstream health-care organizations. Participant observations were conducted during the years 2006–2011. The observed physicians were found to be embedded in two diverse medical cultures and to have a hybrid professional identity that comprised two sets of health-care values. Seeking to introduce new ideas and practices associated with complementary and alternative medicine to medical institutions, they maneuvered among the constraints of institutional structures while using these very structures, in an isomorphic mode of action, as a platform for launching complementary and alternative medicine practices and values. They drew on the complementary and alternative medicine philosophical principle of interconnectedness and interdependency of seemingly polar opposites or contrary forces and acted to achieve change by means of nonadversarial strategies. By addressing the structure–agency dichotomy, this study contributes to the literature on change in institutionalized health-care organizations. It likewise contributes both theoretically and empirically to the study of integrative medicine and to the further development of this relatively new area of inquiry within the sociology of medicine.