We recruited patients randomly using the Madison telephone listings. Our inclusion criteria required that they were aged 18 years or older, used both alternative and conventional medicine in the past year, and were willing to meet for an unpaid hourlong interview. Out of 237 phone numbers randomly chosen from the telephone book, 29 were disconnected, and 58 went unanswered after at least 3 attempts. Of the remaining 150, 25 fit inclusion criteria, 19 agreed to an interview, and 17 were actually interviewed. The location of the interview was open to the participants’ choice and included home, office, and a public place, such as a restaurant or library. The semistructured format allowed free-flowing interviews aimed at probing health beliefs, choices, and practices. We were specifically interested in how patients thought about both alternative and conventional health services, how and why they made their health care choices, and how they personally valued various aspects of CAM and conventional medicine that came to light during the interview. Although our initial goal was to interview 20 patients, we stopped after 17 because we felt we had reached the point of data saturation (we ceased to learn new things with our interviews).
Results
During the 37 interviews in the practitioner and patient categories, a number of points emerged. Issues contrasting conventional and alternative health care rose to prominence during the interviews. Respondents noted differences of style, cost, training, institutional structure, and philosophy, orientation, and world-view. Vague, subtle, implicit, and subjective differences were described as well as obvious, clear, and objective differences. Among the medley of points that surfaced, a number of issues were raised repeatedly. After discussion and deliberation we organized that data into 4 major thematic categories: holism, empowerment, access, and legitimization. Nearly every idea, talking point, or issue that we noted—several hundred in all—fit comfortably within at least one of these major themes. Some of the more salient ideas and issues are shown in Table 3. A number of points, issues, or subthemes related to more than one of the themes and provided important interconnections or overlaps.
Holism
Patients and practitioners of alternative therapy stressed the importance of a grounded integrated whole-person approach. Patients noted that they preferred to be treated as whole people rather than as composites of numerous biomedical attributes. Practitioners stressed the multidimensional nature of their work and contrasted their integrated approach from what they considered the mechanistic reductionist methods of biomedicine. One practitioner said, “I think conventional medicine tries to fix a problem…rather than get to the heart of the issue.” One patient described it as “healing and staying healthy in a proactive sense.” Another said it was “amazing, your mind and body working together.” The importance of incorporating emotional, physical, psychological, and social factors in both diagnosis and therapy was repeatedly stressed.
Empowerment
Our participants told us that conventional biomedical practitioners often disempower their patients by acting in condescending, disparaging, chauvinistic, or paternalistic manners. In contrast, alternative healers were characterized as facilitating rather than directing the healing process, relying on self-empowerment and personal responsibility for health. One patient said, “I have to be part of the process for it to work.” Another defined conventional medicine as: “You broke it, so let’s fix you.” A third, describing her interaction with conventional physicians said, “And every time I bring it up they blow it off. So I didn’t get very far when I voiced my concerns.” A fourth went so far as to say, “I think the doctors’ way of being is phasing out because people are getting more responsible for their health care.” Most respondents felt that personal empowerment was important for health and told us that alternative healers tend to focus on personal empowerment more than their conventional biomedical counterparts.
Access
The thematic category we called “access” combines issues of insurance coverage with physical, economic, and social availability. As a whole, patients noted that conventional health care was relatively accessible because it was paid for by insurance that was usually available through employment. Additionally, conventional medicine was noted to be physically available in most areas; CAM services were often harder to locate and visit. Alternative medicine was described as expensive from an out-of-pocket perspective and less economically accessible from the patient’s point of view. Several patients noted that they tried conventional methods before moving on to alternative healing. When asked why, one said “I thought I would exhaust the route of things that are free.” Another noted the relative high cost of alternative therapy by saying, “So basically out of sheer monetary restraints, I’ll go back to the physician.” Alternative providers were in consensus that “Most people pay out of pocket…. It is a detriment for people to pay out of pocket.”