Positive Health Online

This article has different strands which, while seemingly unconnected, have what may be perceived as a commonality – something about a mismatch between an ideal and reality – in truth a failure of integration, on one level or another. See if you agree.

Strand 1: I am currently working on a co-authored book, with a highly gifted American therapist. She is doing her writing in Florida, while I am in Greece. As this collaborative effort continues, by means of the magic of email, files containing bits of, and whole, chapters, fly back and forth in the ether as we polish, correct, add to and generally complete a mammoth task (this being Part 1 of a two volume text book, the first dealing with upper body, and the second with the lower).

Recently, as we were tidying up an anatomy segment my co-author raised the question of the use of the words 'superior' and 'inferior' – something along the lines of there being a sense, in some quarters of the USA, that these words implied 'better' or 'worse', rather than proximal and distal.

We decided to stick with these accepted terms rather than trying to invent new ways of describing the anterior superior iliac spine, for example.

We had shortly before this sorted out the way in which techniques would be described, and had decided that in this first volume the 'practitioner' would be male, and the 'patient' female, and that these roles would be reversed in the second volume.

A little while before this decision had been made, we had debated the correct designation of the individual providing the treatment. My preferred word is 'operator' ('The operator stands at the head of the table, etc.) but in the USA this sounds like someone operating a crane, or some such equipment. So we were reduced to choosing between 'doctor', 'therapist' or 'practitioner' – and you now know (above) which we chose.

The problem over the patient's designation was far more complicated and potentially emotive. Should she ('she' in this volume, 'he' in the next) be a patient, client, individual, person or (heaven forbid) customer? There may or may not have been other choices (I do not recall) but eventually we chose 'patient'.

There have been other debates – for example is it 'adherence', 'compliance' or 'concordance" with which most patients fail? Which of these words would upset fewer people as we discuss whether or not people will do what is good for them – which we know many won't, whatever we call it?

Why am I telling you all this? Because the time and energy devoted to sorting out what we perceive to be the least offensive term, in each of these instances, has been truly astonishing, and the decisions we have made will almost certainly upset some 'people' , 'readers', ' individuals' anyway!

What has this to do with integration? Probably not a lot but I feel better for sharing the whole business with you, and it does sort of tangentially lead to discussion of gender issues in complementary health care settings.

It also raises questions about language and understanding between (and often within) professions, which remain stumbling blocks to integration.

Strand 2 : When I am teaching bodywork methods to groups of health care professionals there is a truly remarkable gender split. In groups of physiotherapists and massage therapists, for example, the predominance is female, usually around 80%:20% (I have taught groups in the USA where there were as few as 2 males in a group of 40 students/practitioners). Why?

However, when I am teaching osteopathic and chiropractic groups there is far more equal gender distribution, and at times the classes are actually male dominated (particularly in chiropractic). Why?

When I am lecturing on topics such as chronic fatigue, or fibromyalgia the split is again heavily weighted towards the female end of the spectrum. Why?

In case you are awaiting words of wisdom to explain this disparity, you will be disappointed. I have no idea why these inequalities prevail. The differences seem to apply irrespective of geographical location – the same variations being apparent in classes in the UK, USA, Israel, Ireland and Sweden.

Does this gender 'non-integration' impact on the quality of health care provision by different professions? I am certain that it does not result in any difference in the technical quality of treatment provided, but have a sense that it may alter something about the intangible atmosphere in which different professions operate (and this leads to questions as to what is causal, and what is an effect?).

Strand 3: And then there is the inter-professional non-integration. Why do groups of osteopaths (in some countries – not all) insist that no chiropractors are allowed to attend their programmes of post-graduate instruction – or chiropractors exclude physios; or physios exclude osteopaths and chiropractors, etc. – and why do all these groups exclude massage therapists, who are arguably amongst the most sensitive bodyworkers of all? Why do many medically trained homoeopaths and acupuncturists denigrate lay homoeopaths and acupuncturists who have often had a great deal more training than that offered on MD short courses, in these subjects.

I could expand this list exponentially, but you get the idea I am sure.

We are not integrated in our use of language – or even for the need of a great deal of the politically correct word-juggling which goes on. Some think it absolutely vital, while others think it largely a waste of time.

And this is only the tip of a 'language' iceberg which divides, rather than connects, health care professionals of different persuasions.

We are not integrated (or at least balanced) in gender terms, and this may not matter, but seems uncomfortable somehow.

And in the field of complementary health care, integration is demonstrably absent between different professions, and often within them as well.

What chance a complementary/mainstream integration until we sort some of these imbalances out?

Perhaps the strands of this article are not all connected – but then again perhaps they are.