Adapting to a 'Biomedical World'

Adapting to a ‘Biomedical World’ The Relationship between Doctors of Korean Medicine (KM) and Biomedical Doctors in the Process of ‘Western- Korean Cooperative Medical Treatment’ (WKCT) in Hospital Settings by In Hyo Park Dissertation Submitted to the Faculty of Sociology at Bielefeld University for the Degree of Doctor of Philosophy (Dr. phil.) First Supervisor: Prof. Dr. Dr. Thomas Gerlinger Second Supervisor: Prof. Dr. Lutz Leisering Bielefeld, 26 January 2017 ii To Prof. Dr. Gunnar Stollberg (1 October 1945 Berlin – 25 March 2014 Berlin) iii Acknowledgement The main idea of this thesis traces back to the time when I recognized differences of attitudes between biomedical doctors and KM doctors towards physical therapists in a “co-operative” hospital in Busan, South Korea, while taking part in a practical training as an apprentice therapist during the study in the department of physical therapy 9 years ago. Since the late Prof. Dr. Gunnar Stollberg – my ex-doctoral supervisor – expressed interest in my experience and the existence of two different kinds of medical doctors in South Korea, their relationship in actual clinical settings has been the main theme for my doctoral research, followed by fieldwork in Busan in 2011 and 2012. However, I never realized that it would take such a long time to finish the thesis by the year of 2017. Meanwhile, I have struggled with writing in order that the findings of this study would not remain as a historical report about the past, but still as a current report describing the actual relationship between KM and biomedical doctors. In acknowledging a variety of help and support I received for this thesis, first, I would like to express my deepest thanks to my first doctoral supervisor Prof. Dr. Dr. Thomas Gerlinger and the second supervisor Prof. Dr. Leisering, both of whom continuously encouraged me with optimism and confidence with patience, as well as providing theoretical and methodological insights with me to finish the thesis. I also would like to thank my wife Sook-kyoung, my daughter Jeong-yun, my parents and my parents in law, and my sister Sae-young and brother in law Kyeong-han, as well as my friends Andrés who gave me enormous inspiration for the thesis, Kyeong-won and Seok-ah who gave me energy to go on writing, Jae-jin and Shin- yeong who kindly allowed me to finish the final draft in their home during my last stay in Bielefeld. I have also been indebted to Mr. Richard Forsythe for his thorough proofreading. As of finishing this thesis, I feel that I have started to undertake the track of connecting the disciplines of sociology and anthropology with the fields of medical health science, dealing with the relations between medical professionals, and merging the cultural aspects of health and illness with qualitative research methods. I herewith resolve to devote myself to academic pursuits by recognizing that this thesis in not the end, but the beginning of the road. This thesis is respectfully dedicated to the memory of the late Prof. Dr. Gunnar Stollberg, who made me reify my uncertain ideas and encouraged me to keep on conducting the thesis to the day of his passing. iv Summary Background and Purpose of the Study With the re-emerging importance of traditional medicine (TM) and the growing interest in complementary and alternative medicine (CAM) since the late-twentieth century, their relations with modern biomedicine have been widely discussed within the concept of medical pluralism. As a case study, this work examines the current South Korean medical system in which traditional medical practitioners are acknowledged by the state as Korean medicine (KM) doctors, holding an equal legal status with biomedical doctors. It aims to analyze the relationship between KM and biomedical doctors in clinical practices in which they are mutually involved with their patient management under the name of ‘Western-Korean Cooperative Treatment’ (WKCT). Concerning the main research questions, this study first seeks to find the crucial mediating factors that enable two different styles of doctors to work together despite their different viewpoints on health and illness. Moreover, it also tries to examine their power relations in the process of the WKCT in clinical practices. Conceptual Framework – Biomedical Dominance in Situations of Medical Pluralism The concept of ‘medical pluralism’ as “the co-existence in a society of differing medical traditions, grounded in different principles or based on different world-views” (Cant, 2004: 184) was raised to describe and analyze various forms of the relationship between modern biomedicine and TM/CAM in the discipline of medical anthropology (e.g. Leslie, 1976, 1977, 1980; Dunn, 1976), medical sociology (e.g. Baer, 1995; Cant and Sharma, 1999) and medical history (e.g. Ernst, 2002; Jütte, 2013). Under the concept of medical pluralism, various studies have explored the relationship between biomedicine/biomedical doctors and traditional indigenous forms of medicine/medical practitioners in each society, with the range of conflict, coexistence and cooperation. Among them, critical medical anthropologists (e.g. Baer, Singer & Susser, 2003; Singer, 2004; Baer, 2011) have a particular interest in the issues of biomedical dominance over traditional indigenous medicine in situations of medical pluralism, arguing that the unequal status of biomedicine and traditional forms of medicine within a certain medical system reflects the unequal situations in a wider society to which the medical system belongs, while they usually indicate biomedical doctors’ superior legal status over traditional healers or their patients’ higher socio-economic status compared with those v patients of traditional healers as evidence of biomedical dominance. This study examines the South Korean case of KM and biomedical doctors’ working relationships in clinical settings where two different kinds of medical doctors are jointly involved in the process of diagnosis and treatment for identical patients, while comparing it with the previous research regarding the debates on biomedical dominance over other forms of medical traditions within the notion of medical pluralism. In this study, I focus on whether there is any kind of situation that can be classified as biomedical dominance despite their equal legal status as medical doctors and – if so – how such a dominant situation is exerted in the process of the WKCT in the clinical practices. Research Method In order to examine the actual process of the WKCT in clinical settings and analyze the relationship between KM and biomedical doctors in this process as an empirical inductive study, I conducted qualitative interviews with 24 interviewees (twelve KM doctors, two students in a KM school, six biomedical doctors and four hospital administrators) in four different styles of WKCT hospitals (a medium-scale KM-oriented hospital, a large-scale KM- oriented hospital, a medium-scale biomedicine-oriented hospital and a large-scale biomedicine-oriented hospital) in the city of Busan in 2011 and 2012. During the interviews, I mainly focused on the concrete process of the WKCT in clinical settings, the working relationship with their counterparts and external factors having an effect on the process of the WKCT. This was followed by the coding process, inspired by the Grounded Theory approach. Historical Background and Current Features of the South Korean Medical System Characterized as a dualized professional medical system of KM and biomedicine, the South Korean medical system can be understood within the historical context of the inflow of ‘Western’ biomedicine and its settling down process as an orthodox medicine on the one hand and the modernization process of traditional medicine in response to the prevalence of biomedicine on the other, from the ‘Open Port Period’ (1876-1910) over the Japanese colonial period (1910-1945) to the post-colonial period (1945-). During this modern era, biomedicine has occupied a prominent position as the mainstream medicine predominating over traditional medicine. Meanwhile, traditional medicine has experienced competition, conflict, subordination and re-acknowledgment from the state, as well as coexistence and cooperation in the face of the relationship with Western biomedicine. As a result, a peculiar vi dualized medical system has been developed since the beginning of the post-colonial period with the establishment of the Medical Service Act (MSA) in 1951, acknowledging both biomedical doctors and KM doctors as medical doctors with an equal legal status while strictly separating their medical jurisdictions. Under this circumstance, the biomedical sector enjoys its position as the mainstream medicine – in terms of its size and leverage – in the current South Korean medical system, whereas the KM sector is also in range with the biomedical sector as an important part of the professional medical sector. The strict separatism of the MSA into the KM and biomedical sectors has resulted in the need for their cooperative medical actions in clinical settings, shaping clinical practices as the concept of ‘Western-Korean Cooperative Medical Treatment’ (WKCT) despite the constant conflicts between KM and biomedical doctors over their medical territory. Findings of the Fieldwork Based upon interviews with physicians and hospital administrators in four WKCT hospitals, the following research findings were discovered concerning the actual process of the WKCT and the relationship between KM and biomedical doctors. - Actual meaning

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