Use Of Qualitative Research Methods To Explore The Process Of Chinese Medicine Practitioners Diagnosing And Treating Diseases

This thesis presents a qualitative study on the clinical practice of Chinese Medicine (CM) doctors/practitioners. Clinical practice of Chinese Medicine practitioners includes two parts, diagnosis and treatment. This study explored CM doctors and their patients in China and CM practitioners in the UK, through the knowledge, beliefs and attitudes during the practice procedure.ObjectiveFirstly, this study aims to explore the clinical practice of CM doctors/practitioners and their experience, knowledge, diagnosis and treatment principles. The second goal of this study is interpreting the impact of CM diagnosis and treatment on patients in clinical practice. Thirdly, this study compares the clinical practice of CM doctors in China and CM practitioners in the UK. Additionally, determining the use of qualitative research methods to verify data from different sources and the rigour in qualitative research based on this study are also discussed.MethodologySnowballing and convenience methods of purposive sampling were used in this study. This study seems more confident with the results because a triangulation method of different data collecting sources was used. Semi structured interview with 14 CM doctors and their 18 patients from China and 10 CM practitioners from UK and 41 observations of routine clinical practice between doctor and patient from China and one focus group with 9 CM practitioners from UK were conducted and analyzed by using Framework Analysis and RQDA software.SettingThis study was divided into two parts. One part was conducted in five upper first-class hospitals in Beijing, four of which are CM hospitals and one of which is an integrative medicine hospital. The other part was conducted in private settings in London.FindingsA wide range of clinical practice of CM doctors was identified:integrating WM and CM, CM classic theories, therapeutic effects, experience, scientific evidence, development and challenge and patient-doctor relationship. And there are three common themes and five different themes were identified about doctors in China and practitioners in the UK. They are therapeutic effects, classic theories and experience in common and cultural background, environment, policy, understanding and patients for their different aspects. Research findings are based from two levels analysis, one is from data of doctors and patients in China, and the other is comparing data between China and the UK.Although CM has already accumulated a lot of ancestors'experience and developed its own special system, CM doctors need to face the challenge from WM and the doubt from modern Chinese people. CM doctors now are familiar with working in the formal CM hospitals, in order to survive in this medicine line or improve their professional life they found it conscientious that managing both CM and WM. CM doctors were often struggling with maintaining CM dominant status before WM. Patients' opinions of, and attitudes to CM focused on effectiveness, expense and doctor-patient relationship.CM doctors in China are very different from CM practitioners in the UK, learning experience, education background, understanding CM, particularly environment for their practice. CM doctors/practitioners often seem owns perceptual knowledge more than rational knowledge and depend on experience more than scientific evidence. However, they also felt a professional duty to inform parents about safety, and that CM paid more attention to patient-centered-care (PCC). Although culture-related CM clinical practice was the main difference between CM doctors from China and CM parishioners from UK, government health care policy could guide CM to go further. Apart from micro viewpoints, CM doctors'/practitioners' own knowledge, experience and understanding were often influential which suggesting CM doctor/practitioner should be trained authentically and systematically rather than impulsively or temporarily.Finally, methodological finding in this study:the question is no longer whether qualitative methods are valuable but how rigour can be ensured or enhanced. For the sake of avoiding bias, the subjectivity can be used creatively through the research process. In order to improve the validity researchers can use multiple ways to understand reality. With the purpose of keeping reliability we should not expect researchers to arrive at the same themes or categories if reality is assumed to be multiple and constructed. Four important factors to keep the rigour in qualitative research should be remembered, internal validity/credibility, external validity/transferability, reliability/dependability and neutrality/conformability.ConclusionAttempts to reconcile the CM and WM during the clinical practice procedure by'integrating'and maintaining CM medical dominance, may expand market or converting CM to fit modern scientific developing. Studies with a greater range of practitioners, less professionally biased settings and using multiple methods including quantitative methods are now needed.