A little more substance, a little less ritual

Western medicine is all about efficiency. We use standardized medical tests as an integral part of the differential diagnosis, follow clinical protocols to carry out medical procedures, and collect and aggregate clinical data from medical research to justify and select treatments and to gauge expectations. Leveraging medical data from multiple sources and thousands of patients is crucial for a sound public health policy and clinical guidelines. The system is geared to save time and to increase utilization of resources.

If unchecked, however, the drive towards efficiency may involve some risks. We certainly do not want our doctors to fit whatever ails us into a statistical disease model automatically. We want further considerations based on our unique clinical presentation. This approach calls for more attention – read “time” — on the doctors’ part, though not necessarily more lab tests. Unfortunately, time is a commodity that is rare in today’s fast-paced medical environment. Inadequate amount of time allocated for each patient– overbooking– is a major drawback of any gains in efficiency. By taking more time to listen to the patient and to consider other possible explanations for the patient’s symptoms, many medical mistakes can be avoided. As an added benefit we could achieve a better patient / doctor relationship, and hence a better compliance with a treatment plan, and sometimes even an unintended but powerful therapeutic placebo effect.

With acupuncture we often get the opposite. Acupuncture practitioners tend to spend a significant amount of time with each patient (up to 60 minutes), but their utilization of time — in my opinion — may not be optimal. Acupuncturists can and should leverage their unique set of skills more efficiently. For example, many acupuncturists are extremely skilled in palpation (examination by touch) that is often part of the differential diagnosis. Acupuncturists are also trained to think about the body systemically and may gain valuable insights about body functions through this approach. These are their strengths. On the other hand, in order to truly utilize their hands-on skills in diagnosing and treating, say, musculoskeletal problems, acupuncture practitioners need to also have a thorough knowledge and understanding of anatomy and pathology, and be able to perform muscle and neurological testing. Few acupuncturists are proficient in this technique. Instead they rely excessively on the ancient Chinese diagnostic model in their assessment of the orthopedic problems. As a result, it is not unusual for a patient to be taken through a long ritual of having his/her pulse taken and tongue examined, only to have an acupuncture treatment at the end that is very general – not really specific enough to the injury itself.  Of course, the patient can actually feel better from the treatment—acupuncture does have a very strong non-specific effect. I just think that the time can be better spent on the injury-specific diagnosis and treatment that is potentially more efficacious. The remaining time can be used for advising the patient regarding therapeutic exercises, activity levels, and, possibly, on a referral.

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