Medical Communication: From Theoretical Model To Practical Exploration. Tao Wang
3: The lay expertise model
The contextual model recognized the value of scientific knowledge, but did not deny the complexity of scientific knowledge dissemination, and the lay expertise model recognized the importance of lay knowledge or local knowledge in solving scientific and technological problems. This model is also called as “the local knowledge model” or “the reflexivity model”. The lay expertise model emphasized that the dissemination of scientific knowledge should be based on the existing layman knowledge structure in the community, recognizing the value of local knowledge owned by the public, rather than simply assuming that the public should accept scientific knowledge without doubt, which resulted in the loss of public trust in science. The lay expertise model was a controversial scientific knowledge dissemination model. First of all, we need to admit that in addition to the knowledge created by scientists in the laboratory through formal scientific research, in some developing countries with long history, they have accumulated considerable practical experience in long-term production and life practices, and gradually matured and transformed them into relevant knowledge after years of accumulation. It was not formed by the traditional scientific methods recognized by scientists today, but it was proved to be effective in practice. It is one of the important ways to improve the public’s scientific literacy to certify and theorize these layman’s or informal skills and knowledge through scientific methods so that they can enter the field of formal education and communication.
This model was very popular in the culture with local knowledge system. For example, traditional calendars in China (Lunar calendar), traditional Chinese medicine (TCM, Chinese medicine), and Tibetan traditional medicine (Tibetan medicine) were regarded as representatives of local knowledge. These folk knowledge with non-standardized features were derived from long-term production and living practice. They were controversial but effective in many cases, so it had been inherited and played an important role in people’s daily life. The lay expertise model considers exactly how to incorporate the influence of indigenous knowledge into the process of scientific communication. In fact, more and more countries have realized the importance of disseminating the indigenous knowledge of the mainstream society through the formal education system. For example, the National Science and Technology Development Bureau of Thailand started in 2002 to study how to use modern science to explain the formation process and methods of local foods, herbs, and handicrafts. The research results were submitted to the government to formulate corresponding policies to promote the social and economic development.
Let’s see what it looks like if only a lay expertise model is applied to medical communication. In the previous paragraph, we mentioned that TCM was the representative of local knowledge in China. Traditional Chinese medicine came into being in primitive society. During the Spring and Autumn Period and the Warring States Period, the theory of traditional Chinese medicine was formed basically, and then it was summarized and developed in successive dynasties. Traditional Chinese medicine carries the experience and theoretical knowledge of ancient Chinese people’s struggle against diseases. It is a medical theoretical system gradually formed and developed through long-term medical practice under the guidance of ancient simple materialism and spontaneous dialectics. Based on Yin Yang and five elements, Chinese medicine regards the human body as a unity of Qi, form, and spirit. It explores the etiology, disease, location, analysis of pathogenesis, changes in the organs, meridians, joints, Qi, blood, and body fluid, and it judges the positive and negative growth and decline of the disease through the method of “look, listen, question and feel the pulse”, which are the four points of diagnosis and consultation. If we incorporate the knowledge influence of TCM into the process of medical communication, it is the lay expertise model in medical communication. It should be said that traditional Chinese medicine is the quintessence of traditional medicine, and there are many successful cases and experiences that can be learned and carried forward. However, how to disseminate and whether all the knowledge of traditional Chinese medicine is suitable for medical communication is also worth exploring. For example, TCM advocates the two concepts of the same treatment for different diseases and the same treatment for different diseases. Same treatment for different diseases refers to the principle that different diseases have the same pathogenesis in the course of their development, so they are treated by the same method. Different diseases can be treated in the same way, depending neither on the etiology nor on the syndrome. The key lies in identifying whether different diseases have the same pathogenesis. Only when the pathogenesis is the same, can the same treatment be adopted. Different treatment of the same disease refers to the fact that the treatments of the same disease will be different because of different stages, pathogenesis, symptoms, seasons of onset, and physique of individuals during the process of the disease. These two concepts have been handed down from generation to generation in Chinese traditional medicine for thousands of years and are highly respected by the Chinese medical profession. But a large part of traditional Chinese medicine pays attention to experience, which is not well understood and mastered by the general population. If we vigorously publicize different treatment for same diseases and the same treatment for different diseases among the general public, many people may not understand, or misunderstand them. Taking cold for instance, traditional Chinese medicine classifies it into wind-cold type and wind-heat type. Wind-cold cold is caused by the external attack of wind-cold evil and the loss of lung-qi; wind-heat cold is caused by the evil offence of wind-heat and the lung-qi failing to keep on good terms. Wind-cold and wind-heat medicines are completely different, but ordinary people cannot distinguish between wind-cold and wind-heat. They have the idea of treating different diseases with the same treatment, so they think they can use the same drug to deal with them. But they do not know that the same drug may have completely different effects on two types of cold. The wrong drug may also aggravate the symptoms and the course of cold. Therefore, the accuracy and comprehensibility of the content should also be taken into account when applying the lay expertise model to medical communication.
Although the local knowledge model emphasizes the public’s possession of layman’s knowledge and demonstrates the equal relationship between the public and scientists to a certain extent, which has been supported by many scholars, it has also been criticized by many scholars. This model gives priority to local knowledge over modern scientific knowledge, so it is considered as “anti-science”. At the same time, it distinguishes scientific knowledge from layman knowledge, which in fact may exacerbate the tension between the public and scientists.
1.2.4.Model 4: The public participation model (the public engagement model)
The public participation model requires that the public participate in the discussion of scientific and technological issues in a democratic system to ensure the democratization and openness of public policy decision-making, at the same time, to improve the public’s scientific literacy in the process of participating in the discussion, and to ensure the public’s understanding of science, technology, and research. In the process of participation, the public will be aware of the relationship between science and society. This model emphasizes that the public should take the initiative to participate in the setting up of the scientific agenda, and engage in dialogue with the scientific community, so as to establish a democratic mechanism for public participation in scientific decision-making. So this model is also called the democratic model or the dialogue model. Durant, who proposed the deficit model, also saw the limitations of the deficit model in his later period. He believed that the missing model and the democratic model could coexist as two models of public understanding of science.
Since the second half of the 20th century, the development of science and technology has not only improved human life, but also brought anxiety and fear to the public. The development and application of nuclear energy, genetically modified food, cloning technology, and many other frontier technologies have caused widespread social controversy. Health and safety risks and ethical challenges associated with these technologies have created a crisis of public trust in science. Therefore, the government and scientists are gradually aware of the importance of developing scientific dialogue. The public participation model, which emphasizes the two-way dialogue between experts and non-experts, is widely considered to be superior to the deficit model. In brief, the deficit model is more likely to be suitable in some areas, such as formal science education, while the democratic model or public participation model is more suitable in other areas, such as