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Family Medicine and Primary Care: Open Access Shuval JT. J Family Med Prim Care Open Acc 2: 119. Review Article DOI: 10.29011/2688-7460.100019 Practicing Alternative Medicine in Israeli Hospitals Judith T. Shuval* Department of Sociology and Anthropology, Hebrew University of Jerusalem, Israel *Corresponding author: Judith T. Shuval, Department of Sociology and Anthropology, Hebrew University of Jerusalem, Israel. Email: [email protected] Citation: Shuval JT (2018) Practicing Alternative Medicine in Israeli Hospitals. J Family Med Prim Care Open Acc 2: 119. DOI: 10.29011/2688-7460.100019 Received Date: 05 July, 2018; Accepted Date: 23 July, 2018; Published Date: 01 August, 2018 Abstract There is growing evidence that alternative health care practitioners and conventional physicians are working together in col- laborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of non-conformists who seek to at- tain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense the issues involved concern processes of accommodation and social change. In an effort to examine the dynamics of the processes involved, data were collected twice: In 2000-2001, in an extensive re- search undertaking when CAM was beginning to show its presence in hospital settings and again in 2015 when a more modest second round of supplementary research was undertaken in an effort to observe changes over time. In 2000-2001 data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem 19 persons were interviewed including 10 alternative practitioners working in a variety of fields and 9 conventional medical practitioners who worked with them (6 physicians and 3 nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of in- teraction with others in the hospital and problems encountered. In 2015-2010 in-depth interviews were carried out with CAM practitioners and policy makers in the Israel Ministry of Health and in a variety of health care institutions. These interviews focused on the role and functions of CAM in Israeli hospitals over the intervening period. Observations were carried out in selected hospital settings. An in-depth literature search regarding research and policy statements on the role of CAM in Israeli hospitals during the intervening period provided an overview of empirical changes. The paper discusses the early modes of entry into Israeli hospitals, the dilemmas faced and the mechanisms used to overcome barriers. The findings of the first wave of interviews suggest a dual process of simultaneous acceptance and margin- alization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no cases accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. Considerable increases in the number, activity and visible presence of alternative practitioners in the hospitals occurred by 2016. These are discussed along with the mechanisms utilized to expand their presence in Israeli hospitals. 1 Volume 2; Issue 02 Citation: Shuval JT (2018) Practicing Alternative Medicine in Israeli Hospitals. J Family Med Prim Care Open Acc 2: 119. DOI: 10.29011/2688-7460.100019 Keywords: Alternative; Complementary Medicine; Integrated Ayervedic medicine, yoga, naturotherapy, massage techniques, Practice; Hospitals; Israel; Bio-medicine Bach flowers, Feldenkrais, anthroposophy, Dwina, osteopathy, Alexander technique, Paula and others. While this list is not Introduction comprehensive, these are the forms of CAM practice which have been incorporated into the clinics of the public medical care system In recent years, more and more people in Western societies and in many of the private clinics in Israel. Traditional forms of seek alternative or complementary health care (CAM) even though health care, which may also be viewed as a form of CAM, will not they continue to use conventional medicine. So much so, that it be considered in this paper. seems useful to view CAM as an important component of the overall health care system. Before discussing the research findings There is as yet no formal licensing system regarding CAM and analysis, we will present some definitions of the central practice in Israel. In 1988, the Israeli Minister of Health appointed concepts considered in the paper. a public committee to examine all aspects of “natural medicine,” including “homeopathy, acupuncture, reflexology, chiropractic, We will use the term “Conventional Medicine” to refer to etc.” [3]. Although the committee submitted its report in 1991, the commonly established form of Western medicine taught in to date, few of its recommendations have been implemented. The most medical schools which exercises a dominant, often exclusive Israel Medical Association issued a number of public declarations monopoly over legitimate medical care in many societies. Other during the following decade seeking to assert the unquestioned names for this include allopathic, Western, and mainstream hegemony of conventional medicine. medicine. Hospital medicine may be viewed as the ideological, The Ministry of Health, despite prolonged deliberations, epistemological and institutional core of conventional medicine. has not been able to reach a formulation regarding licensing and Within its structure, physicians exercise control from positions regulation acceptable to the relevant interested parties, including of power and determine policy on both a macro and micro level. the Israel Medical Association, CAM professional associations, Despite the increasingly invasive stance of third parties on the the sick funds and others. This absence of regulation legitimizes policy and financial levels, physicians maintain their professional the monopoly of the conventional medical system by denying autonomy and remain the critical decision makers on the access to medical practice by non-physicians. immediate level of hospital practice [1]. They are therefore gate- The result has been that in Israel, the Doctors’ Ordinance keepers defining the boundaries of the medical domain with regard of 1976 remains the sole jurisdictional mechanism through which to the admission or non-admission of non-bio-medically trained CAM practice attains legitimacy. This ordinance provides that personnel and practices. only licensed physicians may engage in medical care but that With regard to alternative modes of health care, many physicians may supervise the clinical work of unlicensed health physicians prefer to use the term “Complementary Medicine” care providers. It is the latter provision that provides legitimacy for to refer to unconventional modes of health care. This stance CAM practice by non-physicians in Israel [4]. reflects a medico centric view which implies greater validity and centrality to conventional medical procedures and a lesser status Increased Use of CAM to unconventional practices which “Complement” them. The term There are many reasons suggested in the literature for the “Alternative” is viewed by some in the medical establishment as growth of CAM since the 1980s in many countries, including offensive and challenging to their exclusive hegemony. At the same Israel. We will refer to those most frequently cited [5-10]. time, many alternatives see their mode of practice as an alternative or enrichment to the arsenal of techniques and procedures of Increased use of CAM has been explained by objections of contemporary health care practice. consumers to the invasiveness and excessive use of technology of bio-medicine. Consumers are increasingly aware of iatrogenic In order to avoid the pitfalls associated with both of these effects of modern medicine and prefer to ingest fewer drugs. Many terms, we will use the term “CAM” (Complementary and Alternative object to the traditional dominance of doctors often seen in the Medicine) to refer to the combined array of non- conventional physician-patient relationship. In a period of hyper-differentiation health practices commonly in use in Western societies. in biomedicine, when it is practiced in large organizations where there is minimal attention to the individual and to her/his social The National Centre of Complementary and Alternative and psychological needs, CAM offers a non-invasive, holistic Medicine (NCCAM in the U.S.) defines CAM as “a group of alternative that is increasingly attractive to many, in particular to the diverse medical and health care systems, practices, and products better educated, more affluent segments of the population. There is that are not presently considered to be part of conventional more awareness among consumers of the relationship of lifestyle to medicine” These have also been referred to as holistic, natural, morbidity especially when bio-medicine is unable to provide relief unorthodox, fringe and unconventional [2]. or cure. It has also been noted that in the post-modern period, with The principal forms