Abstract Objectives: This critical ethnographic study examines how ethnic minority patients in Southwest China negotiate between traditional healing systems and biomedical care within hospital settings. This research addresses a gap in understanding the lived processes of medical pluralism, in which patients engage with both healthcare paradigms concurrently or sequentially. The study aims to inform culturally safe healthcare policies by centering patient voices that are often marginalized within biomedical systems. Methods: Employing Carspecken’s critical ethnography framework, the study integrated more than 500 hours of participant observation conducted across rural hospitals in Guizhou, Yunnan, Sichuan, and Chongqing with 58 semi-structured interviews. Purposive sampling recruited 12 hospitalized patients from diverse ethnic minorities to capture power dynamics. Researchers (five nurses and four doctors) maintained reflexivity journals to mitigate clinical bias. Data collection included 12 community feedback sessions designed for co-construction and dialectical analysis, linking individual experiences to structural inequities through habitus mapping and critical discourse analysis. Ethical rigor included anonymization and a minority advisory board. Results: Three themes emerged from the analysis. First, cultural anchoring revealed a deep trust in traditional medicine and adherence to non-negotiable cultural logics, often guiding initial care-seeking behaviors. Second, systemic conflicts at biomedical interfaces included irreconcilable value clashes, profound epistemic marginalization, and the institutional devaluation of traditional knowledge, exacerbating vulnerabilities. Third, patients exercised nuanced negotiation strategies including assertive refusal, strategic compromise, protective concealment, and reliance on kinship networks - highlighting their agency amid structural constraints, while underscoring the failure of healthcare environments to ensure cultural safety. Conclusion: The study reframes medical pluralism in Southwest China as a power-laden negotiation—not mere coexistence—where deeply held cultural logics surrounding the body, gender, and tradition collide with biomedicine protocols, thereby exacerbating marginalization. Institutional inflexibility and absent cultural safety mechanisms transform clinical spaces into sites of disempowerment. The findings emphasize the urgent need to shift responsibility from overburdened kinship networks to healthcare institutions through structural reforms, policy integration, and culturally safe practices. Future research should expand sample size and employ longitudinal designs to further explore the impacts of policy intervention.
Lei et al. (Fri,) studied this question.