Critical Evaluation of G. J. Andrews on the Consumption of Private Complementary Medicine - Article Example

Critical evaluation of G. J. Andrews’ article on the consumption of private complementary medicine. Introduction The increasing popularity of complementary medicine in developed countries over the last 15 years has prompted the interest of researchers. This article by G.J. Andrews, who is a qualified geographer and lately also professor of Health, Aging and Society at McMaster University in Ontario, examines the use of private complementary medicine by older people located in the British counties of Devonshire and Buckinghamshire. It takes a consumer studies approach, and considers the factors which prompt this group of people to seek out complementary medicine in their local areas. It is underpinned by some ground-breaking studies on emergent trends in health care for older people in Canada such as Kelner and Wellman, (2001) and Welman et al (2001) which found older patients critical of the “paternalistic and patronising experiences” that they had in contacts with orthodox geriatric medicine. There is also some reliance on notions of place, and the “placelessness” of some modern locations such as shopping malls and housing estates which have become commodified by uniform planning and commercialisation, as theorised by Relph (1976). Aims of the Study. The aim of this study appears to be partly to devise and test a methodology for teasing out the way that place and settings influences the consumer behaviour of older individuals who seek out complementary medicine. As such it sets out to span multiple academic disciplines including planning, geography, gerontology and complementary medicine. Concepts like “consumer geography” and “macro-level” spaces such as towns and “micro-level” settings such as clinics and homes indicate the economic and geographic elements in this endeavour. Beyond this there is some consideration of “how older users articulate belief systems associated with complementary medicine” but this does not seem to be very thoroughly theorised, and it is not exactly clear how this would be quantified or defined. The aims therefore appear to be mainly methodological and descriptive, rather than empirical or analytical. Methodology The method chosen for this study is a combination of questionnaire and interview. Pilot questionnaires and pilot interviews were conducted first of all and then the full questionnaire was administered, followed finally by the interviews. The author notes that the dual method was not chosen for triangulation purposes, but rather in order to provide “different, and complementary breadths and depths of focus” (Andrews, 2003, p. 340). 400 questionnaires were given out using the patients in 20 volunteer therapist locations. 144 were returned, giving a response rate of 36%. Therapist locations were chosen through personal contacts which the author had built up during research on a previous large scale project. The final sample consists of 34 male and 110 female patients, with an average age of 73 and a predominantly middle class, retired professional demographic profile. The data collected in the questionnaire was mostly of a qualitative nature. Semi structured interviews of about 30 to 45 minutes in length were carried out with a subset of 20 patients, ten in each of the two counties, either in the patients’ own homes, or in a waiting room at the therapists’ clinics. These were audiotaped, and additional record sheets were filled out “to take note of all contextual, and other general observations” (Andrews, 2003, p. 341). The author also spent several days in each county engaged in non-participant observation of the general day to day running of the therapist practices. This amounts to an ethnographic style of research, in which the author attempts to immerse himself into the environment which he is studying, and to see it from the point of view of the various participants in that context, in the hope of gaining an all-round understanding of people’s lives (Taylor, 2001, p. 2). The author himself notes that the method is based on the principles of grounded theory which produces theory through a continuous interplay between analysis and data (Glaser and Strauss, 1967). Findings The author studied many aspects of older people’s visits to complementary medicine therapists of various kinds. One significant finding was that patients who attended larger practices which offered a wide range of different therapies, tended to have a wider experience of complementary medicine types. The author concludes from this that market forces are at work here, in which an increased availability brings about increased demand, and therapists who co-locate in the same complex of buildings benefit from increased attention from interested potential customers who might first attend for other kinds of therapy. It appears also that therapists advise patients about other therapies and this also increases demand for the services on offer. Larger towns sustained larger centres, and these in turn attracted patients from further afield. The author mentions, but does not fully pursue, the dimension of home visits for the delivery of complementary medicine, and suggests that this may be an area of significance, especially for older patients. Factors such as the safety of the home environment, the elimination of stressful travel arrangements, and the longer lasting benefits of herbal treatments in comparison with orthodox treatments are cited by older patients as benefits of complementary medicine which is delivered in the patient’s own home (Andrews, 2003, p. 344). Another finding was that patients clearly contrast complementary medicine with orthodox medicine and often compare them, but that they wish to avail themselves of both at the same time, and they wish to see orthodox medicine adopting some of the most highly valued elements of complementary medicine (Andrews, 2003, p. 347). These highly valued elements are described using direct quotation from the patient interview responses and include factors such as the greater sensitivity and interest shown by complementary therapists, the more holistic approach to care, and the personalised tailoring of treatments (Andrews, 2003, p. 345). The paper concludes with some remarks about how difficult is to fit the older peoples’ experience of complementary medicine into current theories of medical geography, because of the fluid nature of their interaction with different services, and argues for more research that takes into account some further inter-disciplinary dimensions including cultural ones. As indicated in the preliminary pages of the article, there is very little in the way of quantitative data provided, and the findings are impressionistic and descriptive. There does appear to be an element of market forces operating in the complementary medicine sector, and in the largely small town and rural setting, with this mainly middle class cohort of respondents the results are very positive with respect to the experience of complementary medicine. The aspect of geographical and cultural dynamics is no doubt interesting to geographers but it does not offer very much by way of contribution to medical fields. Most of the findings appear to be self-evident or direct and predictable results of the highly selective patient sample. Critical evaluation. There is not very much that is new in this study, but there is quite a considerable amount of confirmation of information that has been reported elsewhere. The observation that the majority of complementary medicine patients are sufferers of chronic diseases was noted by others in connection with inflammatory bowel disease (Verthoef et al., 1998) and asthma (Wysong, 1998). In some ways this article raises interesting questions but at the same time succeeds in avoiding any deep discussion of them. A major flaw in the design of the study lies in the highly selective sample chosen for the interviews. The study describes a largely wealthy and well educated cohort of retirees who are free to choose complementary therapies in their own environment or at a short distance, and within easy reach by private or public transport which they can well afford. The anecdotal evidence from the transcripts of interviews indicates general satisfaction with complementary medicine, and implied criticism of orthodox medicine. The author notes this, but does not bring into debate the restrictions that operate in orthodox medical practices in the UK due to the fact that by far the majority of them are publicly funded. The author notes that the patients tend not to deconstruct their use of complementary medicine, but it seems that there was an opportunity missed for them to do just that in this study, if only the interview and questionnaires had been more probing. In fact there are very few actual figures or facts reported in this article, making it difficult for the reader to work out what exactly was discussed in these interviews. Another flaw in the design is that there was no direct correlation between questionnaires and the interviews, making it difficult to make precise judgements about which patients were reporting exactly which points. There may have been differences between different sub groups of respondents, but the way the data was presented precluded any such analysis. Conclusion In summary, then, this article amounts to little more than field notes on the changing behaviour of a subset of older UK residents with respect to the growing complementary medicine provision in the UK. The author acknowledges that there are some issues about the cost of private complementary therapies, but this is seen against the evident appreciation of exclusive and tailor-made provision that is part of the attraction of this kind of service. In fact this dynamic may represent the unique selling point of complementary medicine and it merits further exploration. It is difficult to see what direct application this article could have in clinical practice. There is confirmation of the business case for joint delivery of different therapies in one location, which might be of use to planners and private providers, but it is not clear how far this model is transferable to urban contexts or working class areas. In general the public/private dynamic is not very well explored in this article, and this is another area that could be researched further. There is plenty of food for thought in the juxtaposition of ideas relating to postmodern culture and the sense of place, since it makes medical professionals think more deeply about the hidden messages that are conveyed by the location of service delivery. Clearly location of care is going to become increasingly important as the demographics of Western countries changes towards a generally ageing profile. Above all this article prompts health professionals to listen to the needs and wishes of patients and consider ways of offering care that is more patient-centred and holistic. If professionals who are responsible for designing new premises have a better appreciation of the structure and location of clinics will improve this aspect of patient care, then this article will have achieved its aim. References Andrews, G. J. (2003) Placing the consumption of private complementary medicine: everyday geographies of older peoples’ use. Health and Place 9, pp. 337-349. Glaser, B.G. and Strauss, A.L. (1967) The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine. Kelner, M. and Welman, B, (2001) The therapeutic relationships of older adults: comparing medical and alternative patients. Health and Canadian Society 6 (1), pp. 87-109. Relph, E. (1976) Place and Placelessness. London: Pion. Taylor S. (Ed.) (2001) Ethnographic Research: A Reader. London: Sage and Open University. Verthoef, M., Scott, C., and Hilsden, R. (1998) A research study on the use of complementary therapies among patients with inflammatory bowel disease. Alternative Therapies in Health and Medicine 4, pp. 68-71. Wellman, B., Kelner, M., and Wignor, B. (2001) Older adults’ use of medical and alternative care. Journal of Applied Gerontology 20 (1), pp. 3-23. Wysong, P. (1999) Many asthma patients using alternative medicine: conventional medicine seen as not treating the whole person. Medical Post. Read More