Waxler-Morrison N E
School of Social Work, University of British Columbia, Vancouver, Canada.
Soc Sci Med. 1988;27(5):531-44. doi: 10.1016/0277-9536(88)90377-2.
In Sri Lanka, as in India, two formally structured systems of medicine exist side by side. While Western-style biomedicine is believed to be useful, Ayurvedic medicine is well established and commonly used. Underlying one explanation for the persistence of such plural medical systems is a functional theory, suggesting that each system is used for different treatments, diseases, or for the ideological, linguistic or social characteristics of the physician. In part, Ayurvedic and Western medicine may persist because their practitioners provide distinctly different services. We tested part of this functional explanation by sending trained 'pseudo-patients' to 764 Ayurvedic and allopathic physicians across Sri Lanka. 'Patients' reported symptoms of common cold, diarrhea or back pain, and recorded after leaving the clinic many aspects of history-taking, diagnostic procedures and physician-patient interaction. Medicines prescribed were later analyzed by a laboratory. We found, basically, no significant differences between the medical practices of sampled Ayurvedic and Western-style physicians, with one exception. While both types spend 3-4 min asking four questions and doing two or three physical examination procedures, and while both prescribe, overwhelmingly, only Western medicines, the allopathic physicians give drugs, that, from the point of view of Western medicine, either 'help' or 'harm' and Ayurvedic physicians prescribe 'neutral' medicines. While we have not directly tested the entire functional explanation we suggest that a structural explanation of the persistence of two systems of medicine may be more valid. Ayurvedic and Western medicine continue in Sri Lanka because they, as institutions, are linked to the social, economic and political structure of the society. Thus, survival is based, not on what a physician does in his practice but upon the power of his medical profession to control medical territory.
在斯里兰卡，如同在印度一样，两种正式构建的医学体系并存。虽然西式生物医学被认为是有用的，但阿育吠陀医学也已确立并被广泛使用。对于这种多元医学体系持续存在的一种解释背后是一种功能理论，该理论认为每个体系用于不同的治疗、疾病，或用于医生的意识形态、语言或社会特征。在一定程度上，阿育吠陀医学和西医可能持续存在是因为它们的从业者提供截然不同的服务。我们通过向斯里兰卡各地的764名阿育吠陀医生和西医发送经过培训的“假患者”来检验这种功能解释的一部分。“患者”报告了感冒、腹泻或背痛的症状，并在离开诊所后记录了病史采集、诊断程序和医患互动的许多方面。随后由实验室对所开的药物进行分析。我们基本上发现，抽样的阿育吠陀医生和西医的医疗实践之间没有显著差异，只有一个例外。虽然两种类型的医生都花3 - 4分钟问四个问题并进行两到三项体格检查程序，而且两者绝大多数都只开西药，但从西医的角度来看，西医开的药要么“有帮助”要么“有危害”，而阿育吠陀医生开的是“中性”药物。虽然我们没有直接检验整个功能解释，但我们认为对两种医学体系持续存在的结构解释可能更合理。阿育吠陀医学和西医在斯里兰卡持续存在是因为它们作为机构与社会的社会、经济和政治结构相关联。因此，其存续并非基于医生在实践中所做的事情，而是基于其医学专业控制医疗领域的权力。
