Effective Communication with Patients

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professional duties. In other words, the relational identity seems to be complementary with the enactment layer in the context of diagnostics.

4.2.2 Effective communication with patients

Another reason for using biomedical test results has to do with the physician-patient communication. When being asked the same question why biomedical check-up results are employed in the Chinese medical practice, Thomas answered:

Biomedical tests are for confirming, maybe for making patients more confident …. If you just tell them, “Ok, I will give you this formula and everything will be fine,” they‟ll still think it‟s not enough. They still want to know where the exact problem is in terms of scientific Western standards. When I say scientific Western, I put it together because Chinese medicine, of course, is also scientific but, for many people, science is related only to Western medicine. (Personal interview, December 16, 2009)

Apart from being practically convenient, biomedical diagnostic tests thus become a strategic mean for effective communication with patients. Thomas claimed that Chinese medicine is as much scientific as Western medicine. However, he also perceived it is common to attribute the term scientific merely to Western medicine. The disparity between the practitioner‟s identification of Chinese medicine and his perception of how the society views Chinese medicine is obvious. Under these circumstances, the practitioners learn to adapt their medical practice to the societal context.

In addition, I observed that all four participants used both Chinese medical and biomedical terms when communicating with patients. Most of the times, diagnoses were introduced using

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biomedical terms first and then followed by explanations from the Chinese medical perspective.

Sometimes the latter ones were simply absent. For example, after the examination of a female patient P20, Dr. Lee indicated that she had Meniere‟s disease, or vertigo. Then he took Harrison’s Principles of Internal Medicine, a biomedical textbook, and let P20 read about this disease. Only then did Lee add, “In Chinese medicine, it is called zu tai yin tan jue tou teng (足太 陰痰厥頭痛).” Thereafter, he handed to P20 his own article Vestibular Vertigo Treatment in Chinese Medicine (耳性眩中醫療法), which introduces the disease from both Chinese and Western medical perspectives (participant observation, November 11, 2009).

When asked about the biomedical terminology, all four practitioners emphasized that it is not important what kind of terms are used. Clear explanations and patients‟ comfort were named as top priorities in their communication with patients. As Thomas said, “Both [terminologies] are fine. I mean, as long as diagnosis is correct. The point of the explanation is to make a patient understand” (personal interview, November 11, 2009). The four practitioners also acknowledged the fact that people in Taiwan are more familiar with biomedical terminology. Lin indicated that

“the most important is to make lay people understand…. If a patient has high blood pressure, we say „high blood pressure.‟ Why do we use the term „high blood pressure?‟ Because it is often introduced on TV” (personal interview, December 15, 2009). Mike explained further:

We have to work with Western medicine for a lot of reasons. Well, for one, to make patients feel comfortable. Because they are so familiar with Western medicine just as it is presented in the media.… But it depends also on a patient. So, I mean, you need to be able to explain it to the patient in the way they would feel understanding and comfortable about what you‟re

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saying. (Personal interview, December 17, 2009)

Along with the biomedical terminology, the practitioners employed additional materials for explaining diagnoses, such as anatomical charts or medical books. For example, in the consultation area, one can find a big nervous system diagram rather than acupuncture point chart as expected in a Chinese medical clinic (see Figure 4). Thus, artifacts that can be originally ascribed to Western medicine are also used in Yusheng Clinic for providing clear explanations and improving communication with patients.

Figure 4. Picture of the spinal nervous system chart.

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Previous studies (see Hsu & Wang, 2005; Hsu et al., 2007) indicated that Western medicine has the predominant voice in Taiwanese media. The practitioners in Yusheng Clinic were aware of this situation. They adapted themselves to the situation by integrating biomedical terminology into the Chinese medical practice. The aforementioned discussion regarding communication with patients uncovered a new factor influencing professional identity construction. The employment of biomedical terminology seems to be imposed by social circumstances. Nevertheless, it is also perceived as a way of implementing one of the professional obligations – effective communication with patients.

In the context of diagnostics and communication with patients, practitioners‟ professional ideal of being a good physician rather than a Chinese medicine physician was emphasized. For example, during a break between consultations, Lee asserted, “The patient is one and the same.

The medicine is not separable into Western and Chinese. The difference lies only in terminology”

(participant observation, November 25, 2009). Mike echoed Lee‟s notion, “There is no Western and no Chinese medicine; there is only one medicine. We have to think what is the best for the patients” (personal interview, December, 17, 2009). Thomas also expressed similar opinion, “The most important is not to make difference between Western and Chinese medicine, but to be a good doctor and to do your job properly.” He also added, “Being a good doctor means being with the patient, being with people” (personal interview, December 16, 2009).

One may ask: Can employment of biomedical diagnostic results be seen as a part of the practitioners‟ enacted identity? Or is it merely a strategic tool for adopting themselves in Taiwan‟s health care system dominated by Western medicine? Based on the discussion above, I argue that the integration of biomedical diagnostics and terminology into the medical practice of

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Yusheng Clinic is more than simply an adaptation or surviving strategy in Taiwan‟s health care system. Although such integration might have been informed by situatedness in the society which is more familiar with Western medicine, it is also rooted in the internalized image of being a good physician. The internalized professional obligations justify and warrant the introduction of biomedical diagnostics and terminology into the practice and thus create new features in professional self enactment of the Chinese medical practitioners.

In sum, the usage of biomedical diagnostics and terminology became inseparable attribute of the medical practice in Yusheng Clinic. The practitioners of Yusheng Clinic tried to attenuate the tension between Chinese and Western medicine, as induced by the latter‟s hierarchically superior status, by appealing to physicians‟ professional obligations. However, as Harre and Van Langehove (1991) pointed out, when the content of a position is defined merely in terms of rights, duties and obligations, positioning process is usually unstable. The following discussion highlights how positioning of Western medicine alters when it comes to the context of treatment.