Academic journal article Health Sociology Review

'You Just Got to Eat Healthy': The Topic of CAM in the General Practice Consultation

Academic journal article Health Sociology Review

'You Just Got to Eat Healthy': The Topic of CAM in the General Practice Consultation

Article excerpt

In New Zealand there has been a trend of increasing referral by GPs to CAM therapy, with nearly 95% of GPs doing so, but a decreasing number of GPs practising some form of CAM, with only 20% doing so (Poynton et al 2006). New Zealand research suggests that only one-third of patients who use CAM disclose this to their medical practitioner (Nicholson 2006). The New Zealand Health Practitioners Competency Assurance Act (2003), which covers general practitioners and other medical practitioners, states that a practitioner cannot be found guilty of a disciplinary offence 'merely because that person has adopted and practised any theory of medicine or healing if, in doing so, the person has acted honestly and in good faith' (Medical Council of New Zealand 2005). The Medical Council of New Zealand's guidelines for medical practitioners who use CAM places the onus on the practitioners 'to inform the patient not only of the nature of the alternative treatment offered but also the extent to which that is consistent with conventional theories of medicine ?' (Medical Council of New Zealand 2005). Underpinning this, and indeed all practice of doctors, is the Hippocratic Oath to 'prescribe regimens for the good of my patients ... and never do harm to anyone'. This can be applied to CAM as to all aspects of medicine.

Early sociological analyses of CAM emphasised the ways in which it was dominated by biomedicine. Willis (1983) used case studies to illustrate different forms of dominance, for example through subordination of occupations to medicine or limitation placed on what other professionals could practice. Larkin (1983) traced the way in which modern medicine evolved through eliminating competing healers such as herbalists and controlling emergent ones. The marginalisation of the therapeutic practices of indigenous peoples through the process of colonisation has been studied (Goldberg 1993). The growing popularity of alternative therapies since the 1960s, particularly in anglophone countries, has been of sociological interest (Saks 2001). Reasons put forward for this rise in popularity include dissatisfaction with orthodox medicine (Sharma 1992), particularly in relation to the treatment of chronic conditions (Kelner and Wellman 1997); a growing public interest in health care generally (Northcott and Bachynsky 1993); interest from the market, particularly the pharmaceutical industry (Collyer 2004); and a reflection of postmodern values such as the rejection of scientific and professional authority (Siahpush 1998).

Willis (1994) argued that complementary medicine and orthodox medicine are becoming less incommensurable. According to Coulter (2004), medicine has been extraordinary for its capacity to turn yesterday's heresy into today's healthcare - but he points out that there are paradigmatic differences between CAM and biomedicine - giving rise to the possibility that biomedicine itself may be transformed by CAM (also see Coulter and Willis 2007). In contrast, Dew (1998) has suggested that CAM may be transformed by forms of accountability, such as EBM and quality assurance programmes, that have taken hold in biomedicine. These positions are not necessarily incompatible, as mutual transformation is a possibility.

This paper does not try to settle the dispute about the reasons for interest in CAM, but provides insights into the relationship between CAM and orthodox medicine in contemporary times. As Tovey and colleagues (2004) state:

To understand the contemporary forms and contents of CAM there is a need to step back from the often hurriedly established demands of policymakers, and to explicitly include in analyses reference to how the arena is marked by complexity and contingency, diversity and dispute and is in a state of constant change.

Although there is research looking at CAM use by practitioners and patients using interview data (Dew 2001; Tovey and Broom 2007), and a great deal of research using data from naturally-occurring physician-patient consultations that looks at a range of other issues (for recent examples see Heritage and Maynard 2006a); there are no examples in the extant literature of studies that explore CAM issues using naturally occurring interactional data. …

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