Patient-practitioner communication in acupuncture treatment

Social Interactions Between Alternative Therapists and Patients

The goal of the research in this work has as its focus interactions that take place among natural and social groups. This work will study a social group in its natural state and natural setting; ethnography seeks to describe culture in its terms. The statement of thesis in this work is that 'The holistic nature of the practice of acupuncture occurs within a paradigm that critically requires effective communication between the patient and the physician in order to effect successful results from this form of treatment and this is because this type of treatment is 'whole' patient treatment geared toward balance within the individual's physical, mental, emotional and spiritual self in what is a 'whole' body treatment method. First impressions of the social interaction upon observation lends a view that this social system is what makes acupuncture so popular and while this is true there is more than meets the eye as this social interaction between the patient and practitioner is the very 'enabler' of this method of treatment which is dependent upon effective communication and a level of trust that the patient vests in the practitioner as the practitioner attempts to address the problems that the patient is coping with on several levels which includes the physical, mental, emotional and spiritual levels of the individual presenting for acupuncture treatment.' The literature reviewed in this study indicates that communication is increased between patients and practitioners during the course of acupuncture and other alternative holistic forms and methods of treatment as compared to communication between patient and doctors in conventional methods of treatment. Frank and Stollberg (nd) state findings that include a variation in the relationship of physician and patient exists across the various forms of alternative treatment and that the differences in these relationships are due to "the social standing and the conceptual features of each form of complementary medicine..." It is likely as noted in this study that the increase of patient-physician interaction is very much market-based and derived from the knowledge that patients desire more communication and interaction from physicians than traditionally and historically experienced with traditional physicians. Lack of study in this area is attributed to the lack of measures by which to assess the layers of evidence existing within the paradigm of this type of alternative treatment form. The limitations of this study include the inability to find but only a few reliable sources to give evidence and reason to the popularity of acupuncture in Southern California- which is still something the researcher desired to focus on.

SOCIAL INTERACTIONS BETWEEN ALTERNATIVE THERAPISTS and PATIENTS

OBJECTIVE

The goal of the research in this work has as its focus interactions that take place among natural and social groups. This work will study a social group in its natural state and natural setting; ethnography seeks to describe culture in its terms.

STATEMENT of THESIS

The holistic nature of the practice of acupuncture occurs within a paradigm that critically requires effective communication between the patient and the physician in order to effect successful results from this form of treatment and this is because this type of treatment is 'whole' patient treatment geared toward balance within the individual's physical, mental, emotional and spiritual self in what is a 'whole' body treatment method. First impressions of the social interaction upon observation lends a view that this social system is what makes acupuncture so popular and while this is true there is more than meets the eye as this social interaction between the patient and practitioner is the very 'enabler' of this method of treatment which is dependent upon effective communication and a level of trust that the patient vests in the practitioner as the practitioner attempts to address the problems that the patient is coping with on several levels which includes the physical, mental, emotional and spiritual levels of the individual presenting for acupuncture treatment.

SETTING

This study will take place at AAA Acupuncture Clinic in West Hollywood, California. This clinic has been in business for more than 10 years in this particular location. The researcher will observe at the waiting room, front desk, doctor's office, and inside the treatment room.

RESEARCH QUESTIONS

Questions addressed in this research study include the questions of: (1) What are the social mechanism between patients and therapists at the AAA Acupuncture Clinic and how that may help to explain the phenomenon of acupuncture's (and perhaps other alternative medicine) popularity in Southern California? (2).Why do people come in to the clinic in the first place? How did they get here? (Doctor recommendation, ads, etc.) Why are they interested in acupuncture to treat their ailments? What attracted them to acupuncture? And (3) Do the patients normally visit "regular" doctors? or, do they usually get acupuncture treatments? - or, in what situations do they visit "regular" doctors as opposed to acupuncture doctors? What are the medical differences in treatments? Are there social differences in treatment? (i.e. How much face interaction time is spent? How much time they get to talk to the doctor about their problem?)

PARTICIPANTS

Participants will be comprised by all individuals who are employed at AAA Acupuncture Clinic including the acupuncture doctor, two massage therapists, and secretary. Also, participants include any patients who come in while I was there at the clinic to make observations for this study. The researcher will fill the role of participant-as-observer by participating in getting acupuncture treatments, moxibustion, cupping, and massage.

APPARATUS/INSTRUMENT voice recorder has been used in this study for the purpose of taping the interviews for personal use, and which were deleted after the concluding the study. During the observation, notes were recorded on paper and typed up on the computer to document personal feelings and observations. A question list was used to guide the interview.

PROCEDURES

The researcher went to the clinic whenever the researcher had available time to make observations. The researcher asked each patient there whether they were willing and had the time to answer some questions for the study being conducted about acupuncture. The researcher interviewed all the patients who were willing. Additionally, the researcher asked the participants whether they were willing to let the researcher record them on tape... some people felt uncomfortable with the recording but the researcher was able to get most interviews recorded.

THEORETICAL FRAMEWORK/RATIONALE

The researcher in this study desires to provide an explanation for the reason that acupuncture along with other alternative medicine and holistic practices is a growing trend. The paradigms of micro- and macro-theory and the third of symbolic interactionism are examined in this study and from much the same perspective of inquiry as utilized by qualitative researcher Mary P. Guerrera in hopes of 'filling in the blanks' through the experience of 'being' through observation of the acupucturer through attempting to observe the process in which Guerrera is one of healing that is derived in the interaction that takes place between the medical practitioner and the patient.

PURPOSE of the STUDY

The main purpose of this study is the analysis of the social interaction / structure between acupuncture doctors and their patients. Perhaps, that will help to explain the rising popularity of acupuncture and alternative medicine in Southern California. Alternative medicine and acupuncture, historically practiced in China, have become popular in America. The purpose of this study is to analyze the acupuncture treatment in a qualitative approach... To understand the underlying social interaction / structure between acupuncture doctors and their patients. Perhaps, that will explain, or make some contribution to the explanation of, the rising popularity of acupuncture in Southern California.

LITERATURE REVIEW

Findings from studies conducted in relation to the views of doctors on patients and alternative therapies reports that 68% of all doctors surveyed stated that approximately 15% of their patients utilize complementary medicine. Among these doctors, 58% always or often asked their patients about these therapies. Obviously, more patients are utilizing the alternative medical treatment and the work of Christine an Barry entitled: "The Role of Evidence in Alternative Medicine: Contrasting Biomedical and Anthropological Approaches" relates that the growth of alternative medicine and its insurgence into the realm of the biomedical system raises a number of questions about the nature of evidence." (Barry, 2005)

Because of the increase in the availability to alterative therapies in the Western world, resulting as well is a movement by the 'grassroots' element toward what is known as integrative treatment and this has occurred concurrently to the "rise in alternative and integrated medicine" combined with a "movement towards increasing reliance on science-based research to judge the effectiveness of treatments, otherwise known as evidence-based medicine (EBM)." (Barry, 2005) Paul J. Rosch and Helen M. Kearney presented a comprehensive overview in 1985 of the growing trend of holistic medicine in relation to the state of conventional medical technology. Their analysis focused on the field of American medicine, which seemed to be the most appropriate site for observing the development and use of medical technology in conjunction with the growing interest in natural, holistic approaches to health enhancement. Rosch and Kearney (1985) describe this interaction between technology and holistic health as a "modern dialect" that has generated important qualitative discussions concerning the nature of health care. Rosch and Kearney's examination of this issue also touches on what they call a "search for a new paradigm" where both the holistic movement and the movement for medical technology could come to a point of "workable equilibrium."

Rosch and Kearney (1985) begin their analysis with an overview of how people think about conventional medicine and alternative care, respectively. The authors assert that American physicians are witnessing rapid changes in the delivery of conventional medicine. Some of these rapid changes are ultimately resulting in the depersonalization of the patient by means of decreased time for patient care, computerization of medicine, etc. At the opposite end of the playing field we see the state of the holistic health movement, where the patient population is becoming increasingly well-informed about their own bodies and are enthusiastically latching on to the idea of health-care as opposed to sick-care. Throughout their comprehensive overview, Rosch and Kearney (1985) underline the fact that the doctor-patient relationship is going through wholesale changes and emerging as something closer to an equal partnership. Other studies have shown the difficulties of analyzing alternative healthcare in quantitative terms. Raphael J. Leo and Jesus Salvador a. Ligot Jr. produced a systematic review of randomized controlled trials (RCTs) that tried to test the effectiveness of acupuncture in the treatment of depression. Leo and Salvador Jr. examined nine RCTs, five of which were deemed to of low quality. The purpose of this review was to analyze and further understand the relationship between acupuncture's ability to treat physical pain and its ability to effect emotional states. Ligot Jr. And Leo's review concluded with mixed results, demonstrating the difficulty of analyzing alternative care in terms of standardized categories.

Guerrera (2008) writes in the work entitled: "Healing with Needles" as follows:

now more than ever, the rediscovery of the importance of relational healing factors and optimal healing environments is on the rise. Those subtle, often elusive aspects of healing, so challenging to measure and define, seem key to the preservation of medical practice and the well-being of those we serve. The current conventional system's lack of valuing these aspects of healing relationships has driven the public's movement toward and eager adoption of holistic, integrative medicine, where practitioners often spend more time with the patient and listening to their story. Are not the roots of conventional allopathic medicine founded upon the concepts of holism? Have we somehow lost sight of these important underpinnings of our profession? Time, presence, and generous listening have been fundamental aspects of healing relationships for generations of family physicians, for generations of healers. Why relinquish their importance now?" (Guerrera, 2008)

The work of John a. Astin (1998) reported in the work entitled: "Why Patients Use Alternative Medicine" states that research "Research both in the United States and abroad suggests that significant numbers of people are involved with various forms of alternative medicine. However, the reasons for such use are, at present, poorly understood." Astin reports a study that investigated the possible predictors of alternative health care use and states that "Three primary hypotheses were tested. People seek out these alternatives because (1) they are dissatisfied in some way with conventional treatment; (2) they see alternative treatments as offering more personal autonomy and control over health care decisions; and (3) the alternatives are seen as more compatible with the patients' values, worldview, or beliefs regarding the nature and meaning of health and illness. Additional predictor variables explored included demographics and health status." (1998) Astin conducted the study through written surveys that examined the use of alterative health care in relation to individual "health status, values and attitudes toward convention medicine." (1998) Conclusions of the study state: "they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life." (Astin, 1998)

The work of Robert Frank and Gunnar Stollberg entitled: "Doctor-Patient Interaction in Complementary Medicine: Homeopathy, acupuncture and Ayurveda in Germany" report a study which explored the "perspective of physicians and patients in the interaction between doctors and patients in various settings of complementary medicine: homeopathy, acupuncture, Ayurveda." (nd) This study was conducted through face-to-face semi-structured interviews. Percipients included 49 practicing physicians and 26 patients.

Frank and Stollberg state there is a widely held assumption that "...a particularly personal and harmonious relationship is an important reason for the popularity of complementary medicine. Little empirical research has been conducted on the perspectives of physicians and patients during these interactions." (nd) Specifically of acupuncture, Frank and Stollberg state the following:

1) Communication: Extensive communication is not as crucial in acupuncture. The accounts of the interactions between physicians and patients were homogenous: Some five to ten minutes of conversation are followed by the insertion of needles. In these twenty to thirty minutes, the patients are lying in a separate room, and the receptionist occasionally looks in on them. Afterwards the needles are removed and the patient leaves. As patients' have the impression that there would be the option of a longer conversation with the physician if needed, none of our respondents was dissatisfied with the - compared to other complementary methods - brief conversations. Instead, most of them praised the relaxing effect of the period when they are lying down with needles inserted in their bodies;

2) Decision-making: As for Ayurvedic patients, there is little curiosity about any details of acupuncture or Chinese medicine. Shared or informed decisions, however, would imply that patients and physicians discuss the appropriate points at which needles should be inserted. If the patients have little knowledge about acupuncture, the only decisions to be made are between various (biomedical or complementary) modes of treatment. Patients are usually strongly involved in these choices. However, even in these decisions we find strongly paternalistic patterns." () Findings in this study include those as follows: Even though the physician-patient relationship varies across the different modes of complementary treatment, encounters tend to be patient-centered and paternalistic.

Other findings of the study are stated as follows:

1) Encounters in complementary medicine tend to be patient-centered and paternalistic;

2) the physician-patient relationship varies across the different modes of complementary treatment; and 3) the social standing and the conceptual features of each form of complementary medicine appear to be responsible for these differences. (Frank and Stollberg, nd)

The work of Nahin, Pontzer, and Chesney (2005) entitled: "Racing Toward the Integration of Complementary and Alternative Medicine: a Marathon or a Spring" published in the journal of Health Affairs states: "Optimal integration of effective CAM therapies would also require patient education, since self-care appears to be a current driver of usage. Increased communication between patients, CAM practitioners, and conventional providers is vital to protect patient safety. This is likely to necessitate some organizational change in the practice of both CAM and conventional medicine and in the current system of third-party reimbursement for health care costs."

One reason that so little research exists in this area of study is that there are not presently adequate measures existing to assess the wider benefits of acupuncture. (Gould and McPherson, 2001) in fact, it is stated that acupuncture has resulted in "a broad range of outcomes from physician and emotional change through to wider benefits involving the Patients' lifestyle, outlook and attitude toward their health." (Gould and McPherson, 2001)

SUMMARY of the LITERATURE REVIEWED

The literature reviewed in this study indicates that communication is increased between patients and practitioners during the course of acupuncture and other alternative holistic forms and methods of treatment as compared to communication between patient and doctors in conventional methods of treatment. Frank and Stollberg (nd) state findings that include a variation in the relationship of physician and patient exists across the various forms of alternative treatment and that the differences in these relationships are due to "the social standing and the conceptual features of each form of complementary medicine..." It is likely as noted in this study that the increase of patient-physician interaction is very much market-based and derived from the knowledge that patients desire more communication and interaction from physicians than traditionally and historically experienced with traditional physicians. Lack of study in this area is attributed to the lack of measures by which to assess the layers of evidence existing within the paradigm of this type of alternative treatment form.

LIMITATIONS of the STUDY

The limitations of this study include the inability to find reliable sources to give evidence and reason to the popularity of acupuncture in Southern California- which is still something the researcher desired to focus on.