Ethnography and health care
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7273.1400 (Published 02 December 2000) Cite this as: BMJ 2000;321:1400
All rapid responses
Although some of our medically qualified colleagues have joked with
us about the colonisation of the British Medical Journal by qualitative
social science we were pleased to see further exposition of one of its
principal methods - namely, ethnography - in your pages (1). Indeed, one
of us was shown this article by a consultant anaesthetist colleague -
currently one of the participants in an ethnographic study - evidence of
the far reaching impact of the Education and Debate section of the
journal!
We are cited in the article as not having given ethnography
sufficient emphasis in our writing on qualitative methods. We believe
this is unfair. We devoted a whole paper to ethnography and observational
methods in the series of papers on different qualitative methods which
appeared in the BMJ in 1995 (2), and described the approach in the
subsequent books based on that series (3,4). In discussing ethnography we
stressed that it was more than the ad hoc mixing of methods, and attempted
to indicate the principles and methodological perspectives behind the
approach. We also alluded to the links between ethnography and
anthropology. These connections are evident in the examples of
anthropologically informed health research cited by Savage. Spradley
suggests that ethnography is "a culture-studying-culture…It seeks to build
a systematic understanding of all human cultures from the perspective of
those who have learned them. Ethnography is based on the following
assumption: knowledge of all cultures is valuable" (5). Understanding
health care cultures seems to us to be particularly important given their
impact on the ways that the rest of society makes sense of issues of
'health', 'illness', 'disease'. Such an understanding is also vital for
managing and changing health systems.
Catherine Pope,
Department of Social Medicine, University of Bristol, Canynge Hall,
Whiteladies Road, Bristol BS8 2PR
Nicholas Mays,
Social Policy Branch, New Zealand Treasury, 1 The Terrace, Wellington, New
Zealand
1. Savage J. Ethnography and health care. BMJ 2000;321:1400-2.
2. Mays N, Pope C. Observational methods in health care settings. BMJ
1995;311:182-4
3. Mays N, Pope C. Qualitative research in health care. London: BMJ Books,
1996
4. Pope C, Mays N. Qualitative research in health care. (Second edition)
London: BMJ Books, 1999
5. Spradley J. The ethnographic interview. New York: Holt, Rinehart and
Winston, 1979:9
Competing interests: No competing interests
I was interested to read Maurice Lessof's letter as I am currently
engaged in research for my PhD thesis of exactly the nature he is calling
for.
I am doing an ethnographic study on 2 different therapies: homeopathy
and Tai Chi. I am researching these therapies in various different
settings including general practice and private practice. My aim is to
gain an understanding of how therapies differ in different contexts. I am
also interested in the changing experiences of patients over time with
these therapies and the ways in which they move in and out of traditional
and alternative healthcare.
Even on the basis of early findings it seems clear that it is wrong
to assume that by talking about homeopathy, for example, we are talking
about one unified standard treatment. Therapies differ according to the
therapists offering them and the institutional settings in which they are
provided. This brings into question some of the assumptions surrounding
the calls for evidence into the workings of such therapies, and in
particular the priority given to the collecting of RCT data. (Assumptions
for example that effectiveness can be measured over the short term; that
alternatives can be seen as a standardised technique or technology that
can be applied like a surgical procedure or drug; and that the location or
context of treatment is immaterial.)
I hope to be in a position to report the findings of this research at
a future date but would be interested to hear from others engaged in
similar research.
Competing interests: No competing interests
EDITOR - A House of Lords Committee suggests more research into
complementary and alternative medicine. It is to be hoped that that
research will devise controls for
the personality of the operator and will assess what factors other than
the actual therapeutic intervention are important in leading to patient
satisfaction. It is clear that
there are many factors other than medicines which can influence the
effectiveness of therapeutic interventions (1).
Homoeopathy provides a therapeutic process which lends itself to
trials of this kind, provided that neither the patient nor the therapist -
nor the pharmacist - can know
which patients are receiving a definitive therapy and which are receiving
a placebo. The use of multiple centres could also help to assess factors
other than the prescription itself which determine patient satisfaction.
One hypothesis which needs to be formally tested is that the time and
personal attention given to a patient can influence the outcome
significantly and that the particular
disorders or complaints for which this is true can be subject to analysis.
At a time when a general practitioner may have only a few minutes to
listen, to examine, and to
advise a patient, those who visit a homoeopathist or acupuncturist for the
first time may be given an hour or more as a routine. A comparison
between interview
conditions and patient reactions in a range of general practice and
alternative medicine establishments could be salutory. It is time to
study the differences and,
hopefully, to learn from that experience.
Maurice Lessof
8, John Spencer Square,
London N1 2LZ
Reference
1. Savage, J. Ethnography and health care. Brit. med. J. 2000, 321,
1400-2.
Competing interests: No competing interests
DUH?
I have worked in cross cultural medicine all my life.I think that the
point of the article is that one must consider the patient's ethnic
background when one practices medicine.
My main problem in this article is that it is written in academic
jargon that is almost impossible for non academicians to understand.
Competing interests:
None declared
Competing interests: No competing interests