title: Healing Pluralism and Responsibility: An Anthropological Study of Patient and Practitioner Beliefs

authors: Miskelly, Philippa Ann

subjects: medical pluralism

abstract: Combining the use of alternative and complementary therapies and orthodox medicine is an increasing phenomenon.  This thesis examines the implications of mixing and matching plural healing modalities against a backdrop of patient and practitioner responsibilities.   

From an anthropological perspective, the predominant use of qualitative methodology is an integral part of this research project.  Central to this study is the views of a variety of participant categories - patients who use both alternative and orthodox healing methods; non-medical alternative and complementary practitioners; medical doctors who integrate orthodox and CAM therapies into their daily practise; and orthodox general practitioners.  Interviews with these participants took place over an eighteen-month timeframe and involved face-to-face interviews, telephone interviews, and focus group research.   Social constructionist theory, which forms part of the compendium of interpretive theoretical approaches adopted under the medical anthropology paradigm, has been used in order to expose the beliefs patients and practitioners hold about their own responsibilities, and those of the other participant categories.

This study reveals a palimpsest of complex, contradictory and competing discourses in relation to patient and practitioner expectations and responsibilities.  One important finding relates to the significance of neo-liberal and individualistic ideologies. This thesis concludes that the rhetoric from complementary and alternative practitioners, and their integrative colleagues, is heavily imbued with ideas about self-responsibility, particularly in relation to patient lifestyle choices and therapeutic compliance.   Patients and orthodox general practitioners share some of these views but in general adopt a more collective approach to health care responsibilities.  While patients are prepared to accept some responsibility for their illnesses and health keeping practises, they express strong reliance towards the orthodox health model as well as those doctors who practise integrative medicine.   However the same cannot be said of their attitudes towards CAM modalities where considerable ambivalence is evident towards both practitioners and the therapies themselves.   

The role of the state, and its responsibilities for the structure of the health care system in New Zealand, is also clearly influential in the construction of belief systems.  This is especially so because the rhetoric underlying neo-liberal and individualistic discourses now permeates the direction of health policies.   Increasing levels of surveillance, both at bureaucratic and individual levels, also attests to the influence of neo-liberalism and individualism.    This study exposes the tensions between the rhetoric of self-responsibility and the lived experiences of patients and health practitioners, which in many cases is more collective in its focus than is initially apparent.

text: Healing Pluralism and Responsibility: An Anthropological Study of Patient and Practitioner Beliefs Combining the use of alternative and complementary therapies and orthodox medicine is an increasing phenomenon.  This thesis examines the implications of mixing and matching plural healing modalities against a backdrop of patient and practitioner responsibilities.   

From an anthropological perspective, the predominant use of qualitative methodology is an integral part of this research project.  Central to this study is the views of a variety of participant categories - patients who use both alternative and orthodox healing methods; non-medical alternative and complementary practitioners; medical doctors who integrate orthodox and CAM therapies into their daily practise; and orthodox general practitioners.  Interviews with these participants took place over an eighteen-month timeframe and involved face-to-face interviews, telephone interviews, and focus group research.   Social constructionist theory, which forms part of the compendium of interpretive theoretical approaches adopted under the medical anthropology paradigm, has been used in order to expose the beliefs patients and practitioners hold about their own responsibilities, and those of the other participant categories.

This study reveals a palimpsest of complex, contradictory and competing discourses in relation to patient and practitioner expectations and responsibilities.  One important finding relates to the significance of neo-liberal and individualistic ideologies. This thesis concludes that the rhetoric from complementary and alternative practitioners, and their integrative colleagues, is heavily imbued with ideas about self-responsibility, particularly in relation to patient lifestyle choices and therapeutic compliance.   Patients and orthodox general practitioners share some of these views but in general adopt a more collective approach to health care responsibilities.  While patients are prepared to accept some responsibility for their illnesses and health keeping practises, they express strong reliance towards the orthodox health model as well as those doctors who practise integrative medicine.   However the same cannot be said of their attitudes towards CAM modalities where considerable ambivalence is evident towards both practitioners and the therapies themselves.   

The role of the state, and its responsibilities for the structure of the health care system in New Zealand, is also clearly influential in the construction of belief systems.  This is especially so because the rhetoric underlying neo-liberal and individualistic discourses now permeates the direction of health policies.   Increasing levels of surveillance, both at bureaucratic and individual levels, also attests to the influence of neo-liberalism and individualism.    This study exposes the tensions between the rhetoric of self-responsibility and the lived experiences of patients and health practitioners, which in many cases is more collective in its focus than is initially apparent.

year: 2006

title: Emergent strategy and the measurement of performance: The formulation of performance indicators at the micro-level

authors: Lowe, Alan

subjects: accounting

abstract: This paper presents some evidence on an aspect of the design of a strategic control system, at the micro level within a single organisation. The research we report used an ethnographic approach to provide an understanding of strategy formulation. Our aim is to contribute to an area of literature which is of increasing significance but relatively underdeveloped in terms of the application of, in depth, field research techniques. We take an intensive look at the manner in which performance measures are formulated, at the micro level, within a single organization. The paper presents, as an in-depth case analysis, the experience of a fisheries holding company in New Zealand. The paper recounts the experiences of managers within the organization of the process of identification of such things as, critical success factors and key performance indicators (KPI’s) and, more broadly the formulation of a strategic performance measurement system. A number of themes emerged during the research including as apparent reluctance to reduce a reliance on financial measures, the significance of functional boundaries which resulted in disagreements and misunderstandings, the importance of communication and the problems resulting from some managers apparently seeking to avoid attempts to fix responsibility.

text: Emergent strategy and the measurement of performance: The formulation of performance indicators at the micro-level This paper presents some evidence on an aspect of the design of a strategic control system, at the micro level within a single organisation. The research we report used an ethnographic approach to provide an understanding of strategy formulation. Our aim is to contribute to an area of literature which is of increasing significance but relatively underdeveloped in terms of the application of, in depth, field research techniques. We take an intensive look at the manner in which performance measures are formulated, at the micro level, within a single organization. The paper presents, as an in-depth case analysis, the experience of a fisheries holding company in New Zealand. The paper recounts the experiences of managers within the organization of the process of identification of such things as, critical success factors and key performance indicators (KPI’s) and, more broadly the formulation of a strategic performance measurement system. A number of themes emerged during the research including as apparent reluctance to reduce a reliance on financial measures, the significance of functional boundaries which resulted in disagreements and misunderstandings, the importance of communication and the problems resulting from some managers apparently seeking to avoid attempts to fix responsibility.

year: 2003-05

title: Rototuna, 2024

authors: Apiata, Hāwea

abstract: Bilingual poetry in response to the public sculpture 'Te Ohomauri o Matariki' by Dion Hitchens in collaboration with James Ormsby.

text: Rototuna, 2024 Bilingual poetry in response to the public sculpture 'Te Ohomauri o Matariki' by Dion Hitchens in collaboration with James Ormsby.

year: 2024-03-29