title: Epistemological challenges in contemporary Western healthcare systems exemplified by people's widespread use of complementary and alternative medicine.
abstract: Modern Western public healthcare systems offer predominantly publicly subsidized healthcare traditionally based on biomedicine as the most important basis to cure persons who suffer from disorders of somatic or psychiatric nature. To which extent this epistemological position is suitable for this purpose is under scientific debate and challenged by some people's personal understandings of health and illness, their individual illness experiences and their decision-making. Current studies show decreasing levels of patient trust in Western public healthcare and a widespread patient-initiated use of complementary and alternative medicine which is often linked to unmet patient-defined healthcare needs. Patients'/complementary and alternative medicine users' understandings of their afflictions are often based on elements of biomedical knowledge as well as embodied and experience-based knowledge. We believe this points to the need for a phenomenologically and socially based understanding of health and illness. In this article, we analyze challenges in contemporary healthcare systems, exemplified by people's widespread use of complementary and alternative medicine and based on three ways of understanding and relating to unhealth: disease (the biomedical perspective), illness (the phenomenological perspective), and sickness (the social perspective). In public healthcare systems aiming at involving patients in treatment processes, acknowledging the coexistence of differing epistemologies may be of great importance to define and reach goals of treatment and compliance.
authors.affiliation: UiT the Arctic University of Norway, Norway.|Karlstad Hospital, Sweden.|University Hospital of Örebro, Sweden.
authors.forename: Anita
authors.initials: A
authors.lastname: Salamonsen
authors.affiliation: Karlstad Hospital, Sweden.|University Hospital of Örebro, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Ahlzén
mesh_terms: D000529:Complementary Therapies / Q000523:psychology*; D003657:Decision Making; D003695:Delivery of Health Care; D006801:Humans; D019359:Knowledge; D057240:Patient Preference; D035502:Trust
keywords: complementary and alternative medicine; experiencing illness and narratives; health policy; patient–physician relationship; phenomenological approaches