| The clinical practice of holistic medicine was the focus of this fourteen month ethnographic research project, that combined physician and staff interviews with observation of clinical encounters to illustrate the translation of medical theory into practice. HMI culture, from physical clinic structure to ideology to practice was created and reproduced through the interaction of physician-educators and their clients. HMI physicians claimed legitimacy from the biomedical establishment, therefore structuring their clinic to exploit the social authority granted them even as they challenged the system. HMI physicians' distal placement of disease etiology, which resulted from their reinterpretation of medical knowledge, increased their authority with patients to stipulate behavior change as critical to the therapeutic protocol. The fluid nature of medical theory adopted, employed and sometimes rejected indicated a dedication to a philosophical stance which transcended medical knowledge. The source of knowledge, rather than the content of that knowledge was most important at HMI. The pluralistic clinical environment resulting from HMI physicians' use of multiple, and sometimes opposing theories and practices, while retaining biomedicines' focus on physiological disease generated a clinical practice that incorporated some aspects of the dominant medical model, while rejecting others. This process was fluid in nature; trial and error, acceptance of theory followed by experimental practice and then acceptance or rejection of a diagnostic and treatment methodology. Analysis from a Foucauldian perspective introduces the dynamics of knowledge and power, specifically bio-power that acts as a transformative agent in the lives of those who are members of this clinic's culture. Foucault establishes a link between knowledge in power in the sense that knowledge cannot be contextualized without including the effects of the power that knowledge produces in the analysis. HMI physicians altered their relationship with medical knowledge through reconceptualizing valid sources of medical information. Through centralizing the concept of individualism within their practice, HMI physicians secured their autonomy in relation to institutionalized medicine, expanding their freedom of practice. By fragmenting systems of medical information and re-assembling their body of medical knowledge that formed the basis of their clinical practice, the nature of their authority with their patients changed. |
