title: Entering the well-guarded fortress: alternative practitioners in hospital settings.
abstract: There is a growing evidence that alternative health care practitioners and physicians are working together in collaborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level, the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of non-conformists who seek to attain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense, the issues involved concern processes of accommodation and social change. Data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem during 2000. Nineteen persons were interviewed including 10 alternative practitioners working in a variety of fields and nine biomedical practitioners who worked with them (six physicians and three nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of interaction with others in the hospital and problems encountered. The findings suggest a dual process of simultaneous acceptance and marginalization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no way accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. There is a division of labour expressed by focusing on the biomedical practitioners on the diagnosis and treatment of specific disease entities, while the alternative practitioners work in the illness context, concentrating of feelings and affective states involving the alleviation of pain, suffering and efforts to improve the quality of life.
authors.affiliation: School of Public Health, Hebrew University of Jerusalem, Jerusalem 91120, Israel. msshuval@mscc.huji.ac.il
authors.forename: Judith T
authors.initials: JT
authors.lastname: Shuval
authors.forename: Nissim
authors.initials: N
authors.lastname: Mizrachi
authors.forename: Emma
authors.initials: E
authors.lastname: Smetannikov
mesh_terms: D000720:Ancillary Services, Hospital / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D000529:Complementary Therapies / Q000145:classification / Q000458:organization & administration* / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D006040:Goals; D006302:Health Services Research; D006694:Holistic Health; D006769:Hospitals, General / Q000458:organization & administration*; D006801:Humans; D007325:Institutional Practice / Q000706:statistics & numerical data*; D007400:Interprofessional Relations; D007407:Interviews as Topic; D007557:Israel; D010348:Patient Care Team; D036301:Qualitative Research; D011788:Quality of Life; D000078329:Workforce