Social interactions between alternative therapists and patients

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.

INTRODUCTION

Acupuncture is an ancient method of healing that has its roots in China but is increasingly being utilized as well as "growing in popularity and acceptance in the U.S. As a complement or an alternative to western medicine." (Dower, 2003) Dower (2003) defines acupuncture as "a treatment modality and broadly described as a comprehensive approach to health and healing." According to Dower acupuncture "means the stimulation of certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control for the treatment of certain diseases of dysfunctions of the body and includes the techniques of electoacupuncture, cupping, and moxibustion." (Dower, 2003)

The diagnostics utilized within the realm of acupuncture "take into consideration the personal as a whole, not just isolated systems." (Dower, 2003) Upon licensure by the legislature, acupuncture has been recognized as "a comprehensive healing system and the legislative act provides a "framework for the practice of the art and science of oriental medicine through acupuncture." (Dower, 2003) the licensed acupuncturist is authorized "to engage in the practice of acupuncture and also "[t]o perform or prescribe the use of oriental massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, and dietary supplements [but not including synthetic compounds, controlled substances or dangerous drugs] to promote, maintain, and restore health." (Dower, 2003)

BACKGROUND to the STUDY

The American Medical Association states of acupuncture as follows:

Acupuncture is a component of the health care system of China that can be traced back for at least 2,500 years. The general theory of acupuncture is based on the premise that there are patterns of energy flow (qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for disease. Acupuncture is used to correct imbalances of qi flow at identifiable anatomical locations on and just below the skin, the acupuncture points, by the stimulation of a variety of techniques. The most studied mechanism of stimulation of acupuncture points employs penetration of the skin by thin, solid, specially tipped, metallic needles, which are manipulated manually or by electrical current. There are a variety of approaches to diagnosis and treatment in American acupuncture that incorporates medical traditions from China, Japan, Korea, Tibet, Vietnam, and France. " (2002)

The American Medical Association additionally reports: "Acupuncture has been used by millions of American patients and performed by over 5,000 U.S. physicians, dentists, acupuncturists, and other practitioners for relief or prevention of pain and for a variety of health conditions. After reviewing the existing body of knowledge, the U.S. Food and Drug Administration reclassified acupuncture needles from the category of "experimental medical devices" in 1996 and now regulates them just as it does other devices, such as surgical scalpels and hypodermic syringes, under good manufacturing practices and single-use standards of sterility." (2002) Stated in conclusion by the American Medical Association relating to acupuncture is: "In addition to a positive clinical-therapeutic outcome, reported benefits to patients include avoidance of toxic side effects of pharmaceutical drugs, accelerated healing process, improved immunity, stress reduction, neuroendocrine balancing, and a greater sense of well being." (2002)

It is reported in the work of Dower (2003) that some individuals see acupuncturists "as their primary health care providers; others see them for selected health concerns or by referral from and in conjunction with care from another health care practitioner." Various conditions are listed by the World Health Organization as being treatable through acupuncture including respiratory and bronchopulmonary diseases and orthopedic, gastrointestinal and neurologic disorders." (Dower, 2003) Other conditions that California Acupuncturists utilize acupuncture treatment for include "adult post-operative and chemotherapy nausea and vomiting...rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program." (Dower, 2003)

Currently there are reported to be approximately 6,300 acupuncturists in the state of California who are licensed by the California Board of Acupuncture. Approximately 88% of these practice in urban settings and it is shown by licensure data that 86% of the state's acupuncturists are located in the largest 13 urban counties of California. Acupuncturists in the state of California are "trained in acupuncture and oriental medicine as well as western medicine...[and are required to complete] "...a minimum of 2348 hours of education and training, usually in a four academic-year program." (Dower, 2003)

It is reported that recent legislation in the state of California relating to schools that are approved to offer acupuncture that a minimum of 3,000 hours of study must be offered to students and followed a bill that was "hotly debated within the professional community and, while several programs already have close to or more than 3,000 curriculum hours, the new requirements may prove to be challenging to other schools. The effect of the increased hours on program costs and student recruitment is unclear." (Dower, 2003)

The work of Barnes (2008) entitled: "The Acupuncture Wars: The Professionalizing of American Acupuncture" states: "Since the 1970s, when Chinese acupuncture re-entered the awareness of the American public, it has encompassed multiple and sometimes conflicting orientations toward practice, practitioner identity, training, credentialing, and social status. Individuals who once saw themselves as countercultural guerrilla figures must now undergo increasingly complex examination and licensing procedures, along with an educational system that, in certain respects, bears a growing resemblance to biomedical training." Barnes additionally states in this work that "...this process has unfolded within the context of alternating interest, indifference, and rejection on the part of the dominant biomedical culture" and cites Wolpe (1985) Barnes addresses that transition that has occurred in what is termed to be a socialization process called professionalization and refers to the experiential marketplace challenges among members of this profession as the acupuncturist has secured a 'place' "in the medical landscape of the country." (2008) Barnes states that in the initiative of the study of professions, and specifically the acupuncturist profession makes a requirement of the "examination of the social dynamics..." (2008)

There are traditionally and historically two separates strains of acupuncture roots and beginnings and this is only in the country of China since other significant country derivations of acupuncture include those of Japan, Korea, and Vietnam. Acupuncture is considered to be an alternative and holistic form and method of treatment. Acupuncture history in the United States has been rife with challenges to its long-term use however, after a period of time which included the simplification of the technique and the minimization of its claims (Barnes, 2008) Acupuncture however, appearing to pose "no significant challenge to the biomedical model" combined with the obviously proper overseeing professionals, and that being the physician group who are 'best qualified to evaluate, explain and oversee it..." has assisted this profession to firmly root itself within the treatment paradigm of western medicine. (Barnes, 2008)

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)