Practicing in Both Worlds: Why two General Practitioners Decided to Become Traditional Chinese Medicine Practitioners

Abstract

In New Zealand, little is known about Western medicine practitioners, such as general practitioners (GPs), who have also trained in traditional Chinese medicine (TCM). The aim was to identify the reasons why two GPs decided to study TCM and become integrated health care practitioners. Data from two Auckland-based integrated (combined GP and TCM) health care practitioners were analyzed for the present study. Individual face-to-face interviews were conducted. An inductive thematic approach was used to analyze the data. One main theme emerged. Both participants discussed how they perceived certain limitations in relation to their practice within the Western medicine model and that TCM allowed them to provide a holistic form of treatment. Being an integrated health care practitioner was perceived by participants as allowing them to treat the whole person rather than just the symptoms of a condition. TCM was also perceived to be beneficial as it allowed participants to provide alternative methods in treating their patients.

‘In New Zealand, acupuncture is the most well-known and utilized form of TCM treatment.’

There has been an increase in the use of complementary and alternative medicine (CAM) in many Western countries, including New Zealand.^1-3 Internationally, acupuncture is one of the most well-known and utilized forms of CAM treatment. ⁴ Acupuncture falls within traditional Chinese medicine (TCM). ⁵ Several treatment modalities fall within TCM, which include acupuncture, Chinese herbal medicine, tuina (massage), tai chi, cupping, and moxibustion. ⁵ TCM has been practiced in China for centuries and is integrated into the Chinese health care system alongside Western medicine.^6,7

In New Zealand, acupuncture is the most well-known and utilized form of TCM treatment. ⁴ One possible reason for this is that the New Zealand government funds acupuncture treatment for injury-related conditions through the Accident Compensation Corporation (ACC). ⁴ In 2015, 58 681 of the claims that ACC received resulted in acupuncture treatment, with 53% of these claims being lodged by a general practitioner (GP).^4,8 ACC funds acupuncture for injury-related conditions based on its efficacy in the management of musculoskeletal pain, and also for its management in the treatment of certain mental health conditions. ⁹

In some Western countries, GPs are also trained in TCM-based acupuncture.^10,11 A recent publication ¹¹ cited that there were 80 000 physicians who also practice acupuncture in Europe. However, it was not noted whether these practitioners were TCM-trained or whether they were practicing Western medical acupuncture (WMA). While WMA is an adaptation of TCM-based acupuncture, it is not underpinned by TCM philosophy. WMA focuses on nerve stimulation and is practiced by GPs and physiotherapists (who have completed a short course in WMA compared to a 3- to 5-year degree in TCM). ¹²

In New Zealand, little is known about Western medicine practitioners, such as GPs, who have also trained in TCM. Hence, the present study was a substudy to an earlier study involving 10 TCM practitioners (two of whom were also combined GPs) that was designed to examine differences associated with practicing TCM in New Zealand compared to China. ⁴ The aim of the present study was to identify the reasons why the two GPs from the larger Patel and Toossi study ⁴ decided to become TCM practitioners.

Data from two participants from the larger Patel and Toossi study ⁴ were analyzed for the present study. Recruitment information detailing the larger study is described elsewhere. ⁴ Data for these two participants were selected as they were the only practitioners who began their careers in Western medicine as GPs. Participant 1 was born in the Middle East, where she completed her medical training. She worked as a GP for 3 years before studying TCM, and she has now been practicing TCM for 9 years. Participant 2 has been working as a GP for nearly 40 years and practicing TCM for 30 years. She originally began her career in Western medicine as a nurse, and she was born in New Zealand where she completed her medical training. Both participants completed their TCM training in China. Both participants provide integrated health care to their patients by combining both Western medicine and TCM treatment modalities. Participants were individually interviewed by the first author. Interviews were audiotaped and transcribed verbatim. Interviews ranged in length from 40 to 55 minutes. Ethics approval was obtained from New Zealand College of Chinese Medicine Research and Ethics Committee.

An interview schedule was developed for the original practitioner study ⁴ comprising 3 main topic areas: (1) differences associated with practicing TCM in New Zealand compared to China, (2) whether TCM is a first or alternative treatment option for individuals in New Zealand, and (3) factors that influenced individuals to become TCM practitioners. Participant demographic information was also collected. Topic Area 3, which focused on identifying factors that influenced individuals to become TCM practitioners, is the basis for the present study.

Auerbach and Silverstein’s 4-step process to thematic analysis was used to analyze the interview transcripts. ¹³ The first step involved reading and rereading text for each transcript several times under each topic area. The second step involved the identification of repeating ideas, whereby participants used similar words or experiences to convey the same idea. The third step in the analysis process involved the coding of repeating ideas, which resulted in the naming of themes. A theme is best described as an organization of repeating ideas that communicates what participants are trying to convey. The final step in the analysis process involved verifying the trustworthiness of the findings, and it involved members of the research team individually reading transcripts to verify or dispute themes. This step was designed to reduce individual researcher bias.

One main theme emerged: Beyond Western medicine. This theme is detailed below and quotes are provided that help illustrate participants’ reasons for choosing to study TCM and become integrated health care practitioners.

Theme: Beyond Western Medicine

This theme involved both participants discussing how there were certain limitations in relation to their practice within the Western medicine model that led to their decision to study TCM and become TCM practitioners. The following quotes illustrate this.

Prior to being a TCM practitioner, I was a Western medicine practitioner. I saw that Western medicine and its conventional prescription drugs and interventions couldn’t come up with solutions for many of the problems that the patients suffered. (Practitioner 1)

There were conditions that I couldn’t attempt to solve with what I know of conventional medicine, and I knew that there were alternative methods that could help, even though some of them were considered bizarre by Western medicine. So, I was interested in finding out about other alternative ways. (Practitioner 1)

I’m a Chinese medicine practitioner by choice, but I’ve been trained in the Western model. I started nursing and went on to train as a doctor. When I was nursing, I looked after whole people, and when I went and trained as a doctor, I looked after the bits. I didn’t like the way I’d lost the person and I’d ended up basically training in treating different bits of the body in different departments. (Practitioner 2)

I became intrigued by a different way of practicing and found that there was a system of medicine which embraced the whole and which gave me back the ability to look after the whole person, rather than the symptoms and the pieces that I looked after as a Western medicine doctor. (Practitioner 2)

Western medicine and Chinese medicine have different tools, different glasses in viewing the same body. (Practitioner 1)

The findings of the present study are similar to previous research that has examined why Western medicine–trained practitioners decided to study TCM and integrate TCM treatment modalities within their Western medicine practice.^3,4 Western medicine–trained practitioners who also practice TCM perceive TCM to be a holistic form of treatment, which takes into account how physical, emotional, psychological, and social factors can affect the health and illness of individuals.^10,11 The underlying principle of TCM is to treat and heal from the root cause rather than just symptom management. ¹¹

Research indicates that patients who seek CAM treatment, such as that of TCM-based acupuncture, do so because it is perceived to be a therapeutic resource that can help treat and manage conditions (ie, musculoskeletal pain) that conventional pharmaceutical treatments cannot help sufficiently.^3,11 The integration of TCM with Western medicine has been successful in treating and managing a number of conditions, such as chronic pain, depression, and female reproductive disorders.^14-16 With the eventual regulation of Chinese medicine in New Zealand, TCM has a promising future as a valid treatment modality.

A qualitative interview approach strengthened the present study, as participants openly discussed the reasons why they chose to study TCM and become integrated health care practitioners. A limitation of the present study is that data were only obtained from two participants. Hence, generalizing findings to similar practitioner populations should be done with caution.