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Demarcating the medical/non-medical border: Occupational boundary-work within GPs' accounts of their integrative practice
... General practice is one branch of medicine where CIM has made its presence felt (Adams 2004b;Phelps and Hassed, 2011). General practitioners (GPs) and family practitioners or family physicians are regional terms for the same profession or specialisation of medicine. ...
... Despite its widespread use and acceptance, CAM is often represented as a risk and as a health service that impedes the provision of conventional medical care (Adams, 2004;Ernst, 2001). National and regional studies of CAM deal with the extent of CAM use, the cost of its use, and the beliefs about conventional medicine that influence its use (Astin, 1998;Barnes, Powell-Griner, McFann, & Nahin, 2004;Eisenberg et al., 1998;Lloyd, Lupton, Wiesner, & Hasleton, 1993;MacLennan, Wilson, & Taylor, 2002;Oldendick et al., 2000;Sherwood, 2000;Thomas, Nicholl, & Coleman, 2001). ...
The diversity within CAM use in the community, and the beliefs, concerns, and characteristics of the users of individual CAM modalities was explored via a survey mailed to a randomly selected sample of 1,308 people in different metropolitan and rural localities in Victoria, Australia. The response rate was 40% (n = 459). The respondents' overall current CAM use was 52% and lifetime use was 85%. Chiropractic (50%), massage therapy, (50%), and vitamin or herbal supplements (39%) were the most frequently used modalities. A set of beliefs labeled holistic health care beliefs strongly predicted the use of Natural Remedy and Wellness modalities. Users of these modalities were more likely to be female, under the age of 60, and tertiary educated. Rurality characteristics did not predict rural CAM usage and were equally present in metropolitan and rural respondents. The respondents' decisions concerning CAM involved choosing a modality that fit their self-assessed health care needs.
... Most studies examine the ways that those working from a biomedical perspective 'bring in' CAM to their practice in the form of alliances with complementary therapists or inclusion of specific modalities within existing institutional settings [6]. Adams [7] has examined doctors' approaches to integrative medical practice in the UK but generally there has been less attention given to the range of ways in which doctors bring together different modalities within their own practice. This range includes providing CAM healing modalities to their patients – either specialising in specific CAM modalities only or using both CAM and biomedical forms of diagnosis and treatment. ...
Introduction: A holistic approach to medical care is a key component of integrative medical practice. As an alternative to biomedical emphasison illness and disease, integrative medical practice focuses on wellness. Principles of vitalism and humanism inform complementary and alternative medicine (CAM) approaches to health and healing, thus integrative medical practitioners have capacity to extend ideas of healing from the individual biology to broader public health trends and concerns.
Methodology and approach: We report on qualitative semi-structured interviews with 23 integrative medical doctors. Our research explored how they drew on CAM philosophical approaches to health and healing and how such approaches shaped their approach to practice.
Results: Integrative medical practitioners draw on CAM to understand causes of health problems, approaches to healing, and the role of the individual in healing. The key tenets of the philosophical approach identified by doctors were holism, vitalism, and empowerment. These notions inform their health practice. They focus on helping patients to become actively engaged in their health, in particular, in lifestyle change. These doctors see their practice as distinctly different from biomedicine, seeing biomedicine as too limited to in its approach.
Conclusions: While the principles underpinning CAM may open up opportunities for integrative medical practitioners to take a public health stance in their work, this approach is limited. Integrative practitioners see their approach as different to their biomedical peers, but their capacity to re-orient health from cure to prevention is often limited to notions of lifestyle advice and individual responsibility for health and healing.
A key dimension of the institutional response to sexual assault is the forensic medical examination of a victim's body conducted for purpose of documenting, collecting and testifying to corroborative evidence. Drawing upon in‐depth interviews with forensic examiners and forensic nurse practitioners in one region of England, this study addresses a gap in the existing research on medico‐legal processes, and critically examines the nature and dynamics of the relationship between doctors and nurses involved in this intervention. Using an analytic framework based on Thomas Gieryn's notion of ‘boundary‐work’, we explore how this historically gendered dyadic relationship is experienced and understood in a context influenced by both medicine and law. We demonstrate very clear boundaries demarcating (i) physicians as experts and nurses as non‐experts in the collection and representation of medical evidence, and, (ii) physicians as equated with technical competence and nurses with ‘caring’ duties. We conclude by positing implications that may stem from these professional relations with respect to sexual assault evidence, professionals and victims.
In response to concerns about the standards of training for non-medically qualified homeopathic practitioners, between 1999 and 2009 a number of UK universities taught Bachelor of Science (BSc) degrees in homeopathy. All the courses were subsequently closed following media coverage of a vigorous campaign from scientists against the degree courses. A boundary-work analysis of 65 articles published in the UK print media reveals the use of metaphors from a number of different fields as rhetorical strategies to malign homeopathy education. As well as the commonly used contrasts of profit versus academic integrity, rationality versus faith and logic versus magic, media reports associated homeopathy with new universities and Mickey Mouse degrees, both of which had been denigrated in the press previously. In the press coverage, much attention was also drawn to the fact that the method of repeatedly diluting homeopathic medicines defies both logic and common sense, and the plausibility argument became a decisive blow in the debate over the legitimacy of teaching homeopathy as a science degree. It seems that the boundary work sought to protect the authority of both science and medicine by expelling homeopathy from higher education. These findings contrast with previous studies that suggest that orthodox medicine has occasionally expanded to incorporate desirable aspects of complementary and alternative therapies. Scientists carry out boundary work not just to demarcate the boundaries of science and directly defend their own interests, but also to protect the authority of other allied professions.
In response to the emergence of the holistic health movement in the early 1970s and the rising popularity of complementary and alternative therapies, a growing number of biomedical physicians and institutions have embraced complementary and alternative medicine (CAM), often under the guise of integrative medicine. Whereas alternative medicine is often defined as functioning outside biomedicine and complementary medicine beside it; integrative medicine purports to combine the best of both biomedicine and CAM. Some social scientists have argued biomedicine has become more holistic as a result of this development, whereas others suggest it has embarked upon a subtle process of absorbing or co-opting CAM. This special issue consists of six articles that address changes in the health care sectors of four Anglophone societies, namely the United States, Great Britain, Australia, and New Zealand, associated with the adoption of integrative medicine or CAM. The authors examine some of the causes and consequences of this development. Is this a reframing of biomedicine itself, an erosion of medicine's political, economic, and social authority, a response to managerialism and the demands of consumers or market pressures, an expression of rising legitimacy for CAM, or a new professional strategy for biomedicine? And finally, where might the push for evidence-based medicine fit into this equation?
The ideal of combining biomedicine with traditional, complementary and/or alternative medicine (CAM) is now widespread in global healthcare systems. Called integrative medicine (IM) or integrative healthcare (IHC), biomedicine and CAM are being combined in myriad healthcare settings; select medical curricula are incorporating CAM while new ‘integrative’ physicians are graduating; and widescale health policy on CAM is being created by such organisations as the World Health Organization (WHO). While the IM trend is fast developing, little theory has been applied to examining the epistemology of this new health phenomenon and if, in fact, integration between divergent health paradigms is possible. Drawing on an anti-colonial analysis of new IM settings in Canada, we suggest that fundamental challenges exist to integrating biomedicine and CAM that have been largely ignored in the push for integration. They are: (a) the devaluing of non-biomedical health knowledges; (b) accepting only biomedical evidence; and (c) the creation of a biomedical monolithic worldview. As a part of paradigm appropriation and assimilation, we trace these challenges to the colonial devaluation of Indigenous knowledge. We argue that an anti-colonial analysis of IM provides the ‘missing link’ to understanding the fundamental processes through which biomedicine appropriates CAM, and the reasons it continues to do so.
Has mind–body spirituality become a significant resource within the National Health Service (NHS) in the UK? And, to the extent that it is a growing presence, how is this to be explained? This paper looks at the expansion of complementary and alternative medicine (CAM) in the NHS, and explores its connection to spirituality. In addition, the effects on healthcare professionals are examined, concentrating on the example of nursing. To introduce the argument, cultural factors, influencing nurses and patients, work together with policy directives to ensure that mind–body spirituality is an attractive way of articulating the value the NHS attaches to the patient-centred, the whole person and ‘spirituality’.1 To pave the way, I first provide a brief summary of a recently completed research project – a project that helps explain my interest in developments within the NHS, the approach adopted in this article, and – critically – what is meant by holistic ‘mind–body spirituality’. The research by the author and his colleague (Heelas and Woodhead, 2005) was reviewed in Volume 6, No. 3 of Spirituality and Health International. Copyright © 2006 John Wiley & Sons, Ltd.
This paper explores the traditional notion that two discrete forms of medicine exist. One being bio-medically led, the other being holistic in origin. A qualitative study of place visualization in nursing is used to illustrate how health care may not always fit neatly into one of these paradigms. It is suggested that, through the use of this practice, an organically occurring therapeutic intervention emerges that includes core elements of each category. Based on the findings of this small scale inductive study, it is suggested that greater attention be afforded to areas of practice shared by both health care approaches.
La médecine homéopathique fait partie de ce que certains auteurs nomment maintenant « les systèmes complexes » propres aux médecines non conventionnelles (MNC). Ces médecines ne s'inscrivent pas de la même manière que les médecines alternatives et complémentaires (MAC) dans la réalité médicale ou sociale. Certaines recherches sociologiques ont été faites à propos des MNC ou des MAC, toutes thérapies confondues, mais très peu exclusivement sur la médecine homéopathique. L'homéopathie est à la fois, la plus controversée des MNC et la plus utilisée dans le monde. Comme dans la plupart des sociétés occidentales, le recours à la consultation en médecine homéopathique est en croissance constante, mais n'a pas chez nous de légitimité juridique. Dans ce contexte social, comment les gens arrivent-ils à consulter un homéopathe et pour quelles raisons ? Pourquoi adoptent-ils par la suite, cette pratique de santé? Quel en est l'impact médical et social sur leur santé à long terme et dans leur vie? Pour répondre à ces questions il est nécessaire de considérer d'abord le paradigme holiste selon lequel la médecine homéopathique aborde la santé, la maladie et les soins de santé. Ensuite, il convient de tenir compte de la façon dont l'homéopathe s'adresse à la personne qui consulte en l'envisageant comme un sujet actif, savant et compétant. Cette recherche, prenant la perspective du constructivisme social féministe et se servant de l'analyse thématique descriptive, présente le résultat de l'étude d'entrevues menées auprès de mères québécoises qui ont consulté un ou une homéopathe pour elles-mêmes et leurs enfants. En redonnant la place à leur discours et à leur expertise, ces femmes nous révèlent la complexe démarche qui les a conduites à la consultation en médecine homéopathique, les transformations qui s'y sont opérées à travers un empowerment et leur perception sur l'efficacité sans équivoque de cette médecine face à leurs divers problèmes de santé.
Cette étude dévoile ainsi la singularité de la consultation homéopathique comme espace social unique, laquelle autorise un partage des savoirs, un apprentissage incomparable sur le couple santé-maladie et pourrait représenter une solution à long terme pour les besoins de santé d'une population. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Santé, Médecine homéopathique, Efficacité, Sociologie, Pratique de santé, Mères, Constructivisme social féministe, Consultation médicale.
Amidst the substantial change currently gripping primary health care are two developments central to contemporary debate regarding the very nature, territory and identity of general practice - the integration of complementary and alternative medicine (CAM) and the rise of evidence-based medicine (EBM). This paper reports findings from a study based upon 25 in-depth interviews with general practitioners (GPs) personally practising complementary therapies alongside more conventional medicine to treat their NHS patients. The paper outlines the GPs' perceptions of EBM, its relationship to their personal development of CAM, and their notions of good clinical practice more generally. Analysis of the GPs' accounts demonstrates how CAM can be seen as a useful resource with which some GPs defend their clinical autonomy from what they perceive to be the threat of EBM.