Realizing Holism in Traditional Chinese Medicine (TCM) Consultations through the Voice of TCM (VOTCM): An Interactional Analytical Approach.

In recent years, doctor-patient communication in the context of traditional Chinese medicine (TCM) has attracted increasing attention. Highly influenced by ancient Chinese philosophy, TCM is unique in its exemplification of Chinese wisdom, particularly with respect to how the idea of zhengtǐguan () (lit. whole body concept), realized as "the idea of the whole" or simply "holism," is valued and realized in TCM consultations. Adopting an interactional analytical approach, our study aims to illustrate how TCM doctors and patients co-construct a medical consultation that can exemplify the idea of holism. Based on a spoken corpus of Mandarin Chinese totaling 443 minutes in length, this paper identifies instances of what can be labeled as the voice of TCM (VOTCM) in a typical TCM consultation that reflect the idea of holism and describes and analyzes the communicative routines that are specific to these TCM consultations. It is observed that the steps and strategies involved in the consultation not only illustrate the collaborative co-construction of holism but also point to the holistic aspect of TCM philosophy, particularly topics related to the different body parts and the lifeworld. The diagnostic explanations provided by doctors and the co-topical talks between doctors and patients at various stages of the consultation also play an important role in the co-construction and realization of holism.

Use of Questioning between Traditional Chinese Medicine Practitioners and Patients to Realize TCM Philosophy: Holism, Five Elements and Yin-Yang in the Context of Doctor-Patient Communication.

Adopting a broad discourse analytic approach, the present study investigates authentic interactions between Traditional Chinese Medicine (TCM) practitioners and patients in Hong Kong so as to identify specific characteristics of communication in this context, particularly how patients develop and internalize their understanding of illnesses in terms of 'balance' via the question-answer (Q-A) routine. Findings can improve our understanding of the role of doctor-patient negotiations and the effects of a practitioner's questioning style on the patients' ability to 'internalize' their understanding of their body conditions in the TCM context. While questioning is considered an important communication technique when soliciting patients' problems during consultations, its value in terms of understanding patients' concerns about issues other than their illnesses has not been explored. Based on consultations of 8 hours in length, our study finds that the use of questions not only can create a space wherein patients can discuss their illnesses and primary concerns, but also enable patients to gain a holistic understanding of their body conditions. This paper informs readers about the techniques that TCM practitioners can use to structure their conversations while delivering patient-centered care, including lexical, grammatical, and cultural resources.

Delivery of patient-centered care in complementary medicine: Insights and evidence from the Chinese medical practitioners and patients in primary care consultations in Hong Kong.

INTRODUCTION: Traditional Chinese Medicine (TCM) has become increasingly popular around the world, and has been accepted by people not only in China and Southeast Asia, but also in Western countries. Despite its historic role in the Chinese society, there has been limited research on exploring the nature of TCM practitioner-patient interactions in the Chinese context. As indicated by a major study regarding the Hong Kong context1, there is a need to investigate the role of TCM practitioner and promote interdisciplinary research to ensure safety and synergy of TCM and Western medicine in primary care. This study aims to address this gap by investigating the nature of TCM consultations and their communication patterns in Hong Kong. METHODS: Based on 10 h of conversations (in Cantonese) between TCM practitioners and their patients in the diagnostic interviews, the study explored how the doctor-patient relationship was negotiated in the course of the consultation, while both the TCM practitioners and the patients were constantly trying to manage and maintain common ground. Particular attention had been paid to the identification of specific linguistic and discourse strategies that TCM practitioners had employed to establish doctor-patient rapport, so that a better understanding of patient-centred care in the TCM context could be obtained. The participants were recruited from a local university operated clinic which shared the characteristic of TCM practitioners in Hong Kong. RESULTS: A range of linguistic strategies that TCM practitioners used to deliver patient-centred care have been identified. These strategies are also helpful in shaping a joint decision-making process that will lead to better patient understanding and compliance with the doctors' treatments. CONCLUSIONS: This study demonstrates empirically how TCM practitioners utilize a range of linguistic resources and communication strategies to shape the ongoing discourse so that their patients can have a better understanding of their illnesses. For an example, it is found that TCM practitioners and their patients were constantly trying to manage and maintain common ground by using a range of grammatical markers, including sentence-final particles (SFPs) and discourse markers (DMs), to negotiate the epistemic commitment so that the patient would have good compliance with the practitioner's suggested treatment. It is also observed that various types of interrogatives have been used by the TCM practitioners to elicit information from the patients as well as to encourage them to talk and make a response. Furthermore, it is found that TCM practitioners would deliberately enquire about the patients' everyday experiences because what they eat, do, and encounter all have an important impact on their body conditions. By exploring into the patients' daily routines in the social talk, the practitioner can help maintain and promote the overall balance of the patient's body, and help them monitor and enhance their health conditions by modifying their daily habits and behaviours. With the adoption of these linguistic and communication strategies, the TCM practitioners are shown to have placed the patients' needs as their top priority. Previous studies in the field have already proved that co-construction of the treatment plan between the doctor and the patient is extremely important, and that a patient-centred approach can largely reduce adverse events leading to avoidable patient harm. The specific strategies identified in the current study can enhance the TCM practitioners' communication with patients, creating an environment that will surely optimise safety for both patients and clinicians.