Models of Health and Models of Interaction in the Practitioner–Client Relationship in Acupuncture

Abstract

The doctor–patient relationship has been widely studied in biomedicine. However, little research has focused on similar provider–client relationships in holistic healthcare forms. Based on ethnographic research with acupuncture clients and practitioners, the authors found that participants used specific models of health to understand and develop subsequent models of interaction, and in doing so, provided a clear critique of biomedicine. This article offers a brief overview of major models of healthcare, including biomedical, biopsychosocial, and holistic. The authors present current models of interaction that have been used to understand the biomedical doctor–patient relationship, and discuss the utility of both sets of models as they relate to the ethnographic observations. Although a particular model of health (biomedical or holistic) does not necessitate a particular model of health interaction (paternalism, consumerism, or collaboration), participants' attempts to tie these 2 realms together are important to understanding practitioner–patient relationships in all healthcare situations.

ACKNOWLEDGMENTS

Funding for this research was provided by the University of Iowa's Graduate Merit Fellowship. An earlier version of this article was presented at the Annual Convention of the National Communication Association, Miami, FL, November 2003. We would like to thank Mark Goold and two anonymous reviewers for all of their insightful comments and suggestions on earlier drafts as well as all of the practitioners and clients at GFAC for sharing their lives and their work.

Notes

¹At the field site where this research was conducted, participants used the term client instead of patient. In this article, we will refer to this relationship as practitioner–client instead of doctor–patient. Although this language is usually used to describe a consumeristic relationship, we did not find that acupuncture relationships were necessarily consumeristic.

²Ordinarily, we would use the terms biomedical and holistic, but because these are also the terms used for the models of health, we used the closest synonyms of allopathic and alternative. We recognize that both of these terms are not exactly accurate, as alternative implies that the therapies are alternative to some preferred or dominant form, and allopathy can imply only a comparison to homeopathy.

³For writing on models of interaction in biomedical health settings, see Beck (2001), Beisecker and Beisecker (1993), Emmanuel and Emmanuel (1992), Roter (2000), Roter and Hall (1993), or Szasz and Hollender (1956).

⁴This research project was approved in 2002 by the Institutional Review Board of the University of Iowa.

⁵All names of people and institutions have been changed to maintain privacy.

⁶Clients began to treat the first author as a clinic staff member and would often ask her to collect their payments or schedule future appointments.

⁷For a much more comprehensive explanation of Chinese medical theory, see Kaptchuk (2000).