Healing Traditions: Alternative Medicine and the Health Professions

5. Implications for the Health Professions

Chapter 5 Implications for the Health Professions The immediate message of the foregoing chapters isthat nonbiomedical health belief systems are alive and well; that they are in very common use by all kinds of people; and that health professionals should ask patients about them and expect to find them among their patients' healing resources. The larger message this phenomenon evokes is that patients are authoritative agents of their own health care,1 and this social fact needs to be recognized and taken seriouslyby health professionals . Patients evaluate health care options in a range often much broader in scope than that of the conventional medical system. They make decisions on the authority of their own knowledge and experience —which differ from the knowledge and experience of health professionals—and they do so notwithstandingprofessional disagreement with many of their choices and conclusions. They pursue the therapeutic goals most valued by themselves, whether or not these coincide with the goals most valued by clinicians. Patients, in the end, not health professionals, determine the actions they will take with respect to health and illness, including when, how,and from whom they seek care, and how they pursue the recommendations of their various care providers. "Patient" is a small part of most people's identity , and not generally the one that supplies the main frame of reference within which important decisions about life are made. Conventional medicine has reached a watershed in the confluenceof many streams of change: a rising public disaffection with conventional medicine and its practitioners (related to much deeper social currents; see Freidson 1987; Levin, Katz and Hoist 1979); public demands for a broadening range of participatory rights in the clinical relationship; legal recognition of patients' rights to self-determination in acceptance or rejection of medically recommended treatments; the changed profile of health problems in the population at large; rapid technological 162 Chapters innovation and its attendant ethical dilemmas; the recent and burgeoning corporatization of health care; and the increasing ethnic diversity and multiculturalism in American society, to name but a few of the most obvious considerations. All of these elements have contributed both to shifts in and accentuation of the patient's perspective in relationships with the official health care system. Health professionals and patients alike will benefit, and the quality of care improve, by a refraining of the customary provider-patient relationship to recognize patients' authoritative agency and engage it as a resource in identifying and working toward common goals. Health Care Pluralism The multiplicity of vernacular healing systems to whichpeople ofevery ethnicity, cultural background, educational exposure, and social class have recourse create de facto health care pluralism in the United States (as in other complex societies). Recent estimatessuggest that at least one in every three Americans uses alternative healing resources at some time (Eisenberg et al. 1993),and these resources showno signsofdiminishing in popularity. The reactions of health professionalsto vernacular healing systems range from irritation and reflex condemnation, to general uneasiness, to reasoned and informed selective disagreement, to cautious and selective endorsement, to active participation both as referring practitioners and as clients. Whatever the preferences and responses of health professionals, however, the existence and popularity of vernacular health belief systems is a fact of modern life that needs to be recognized as a relevant factor in health care, and one with bearing upon clinicalconcerns. It is useful to bear in mind a few summary facts about this phenomenon . In general, patients' use of vernacular healing modalities is the result of reasoned choices and an effort to multiplytherapeutic options to obtain optimal care for their felt needs. Conventional medicine does not and cannot provide everything that people need in order to cope with all aspects of the experience of illness(Hufford 1988a), or to meet their desires to achieve or maintain optimal health. It ought therefore to be expected that people will seek elsewhere to attain desired healthrelated ends for which medicine does not provide. To the extent that they find them helpful, patients generally feel committed to and satisfied with their vernacular healing systems (as with the conventional system). This holds true irrespective of health professionals' opinions of the systems, and regardless of whether or not health professionals agree with their attribution of causal relations between the therapeutic practices and changes in health status. Simple argument invoking Implications for the Health Professions 163 medical or scientific authority is unlikelyto be successfulin persuading participants in vernacular health belief...