Hollenberg Daniel
Department of Public Health Sciences, University of Toronto, 12 Queen's Park Crescent West, Room 103K, McMurrich Building, Toronto, Ont., Canada M5S 1A8.
Soc Sci Med. 2006 Feb;62(3):731-44. doi: 10.1016/j.socscimed.2005.06.030. Epub 2005 Jul 19.
The development of "integrative health care" (IHC) settings combining various aspects of Western biomedicine and complementary/alternative medicine (CAM) is a relatively recent phenomenon among biomedical and CAM professions. While IHC is recognised internationally and occurs in many different contexts (e.g. clinic or hospital), patterns of interaction between biomedical and CAM practitioners, and the nature of IHC settings, are largely unknown. This paper presents findings from a research study of two newly established IHC settings in Canada. The main research question was: how are biomedical and CAM practitioners integrating or not integrating with each other at the level of professional interaction in IHC settings? Using a case study design, in-depth interviews were conducted with 13 biomedical and eight CAM practitioners during 2002-2003, and ethnographic observation and document analysis was conducted at each site. Drawing from closure theory of the professions, comparative analysis of the sites revealed that biomedical practitioners enact patterns of exclusionary and demarcationary closure, in addition to the use of "esoteric knowledge", by: (a) dominating patient charting, referrals and diagnostic tests; (b) regulating CAM practitioners to a specific "sphere of competence"; (c) appropriating certain CAM techniques from less powerful CAM professions; and (d) using biomedical language as the primary mode of communication. CAM practitioners, in turn, perform usurpationary closure strategies, by: (a) employing their own "esoteric knowledge" in relation to biomedicine and other CAM professions; (b) appropriating biomedical language and terminology; (c) increasing their professional status by working with biomedicine; and (d) referring among CAM practitioners to increase patient flow. The findings suggest that when attempts are made to integrate biomedicine and CAM, dominant biomedical patterns of professional interaction continue to exist. Despite continued patterns of social closure, biomedical and CAM practitioners continue to provide a certain form of integrative care that may be of benefit to patients, albeit not as integrative as current models of integration would prefer.
结合西方生物医学和补充/替代医学（CAM）各方面的“综合医疗保健”（IHC）机构的发展，在生物医学和CAM行业中是一个相对较新的现象。虽然IHC在国际上得到认可，且出现在许多不同的环境中（如诊所或医院），但生物医学和CAM从业者之间的互动模式以及IHC机构的性质在很大程度上仍不为人所知。本文介绍了对加拿大两个新设立的IHC机构进行的一项研究的结果。主要研究问题是：在IHC机构的专业互动层面，生物医学和CAM从业者是如何相互整合或未相互整合的？采用案例研究设计，在2002年至2003年期间，对13名生物医学从业者和8名CAM从业者进行了深入访谈，并在每个机构进行了人种学观察和文件分析。根据职业的封闭理论，对这些机构的比较分析表明，生物医学从业者除了使用“深奥知识”外，还通过以下方式实施排他性和划界性封闭模式：（a）主导病历记录、转诊和诊断测试；（b）将CAM从业者规范到特定的“能力范围”；（c）从实力较弱的CAM行业挪用某些CAM技术；（d）将生物医学语言用作主要沟通方式。反过来，CAM从业者通过以下方式实施篡夺性封闭策略：（a）运用他们自己关于生物医学和其他CAM行业的“深奥知识”；（b）挪用生物医学语言和术语；（c）通过与生物医学合作提高他们的专业地位；（d）在CAM从业者之间进行转诊以增加患者流量。研究结果表明，当试图整合生物医学和CAM时，主导的生物医学专业互动模式仍然存在。尽管社会封闭模式持续存在，但生物医学和CAM从业者继续提供某种形式的综合护理，这可能对患者有益，尽管不像当前的整合模式所期望的那样综合。
