consumer's guide

[Guest guest]

I just got a mailing from the CA acupuncture board. It included this

consumer's guide to Acupuncture, which is mailed to anyone who requests

info from the board. It says some interesting things, which I assume are

official board policy regarding interpretation of existing law.

 

It begins by annoying me with a paragraph about " energy flows " , but picks

up from there.

 

diagnosis: it says our dx is " ... determined in part ... [by] performing

a physical exam, and ordering laboratory texts, x-rays and MRI's,if

necessary. " Since these diagnostic methods are not used to determine a

TCM dx, it seems that the board is endorsing the position of CSOMA and the

other pro orgs. Which is that L.Ac.'s are allowed to make western dx in

their scope of practice. I interpret this statement in this way because

the only diagnostic use of such western tests is to make a western dx.

there are other reasons besides diagnostic that one can use these tests

for, such as tracking the progress of a patient who has been dx using only

TCM methods. But this consumer pamphlet explicitly reassures the public

that we use these tests for diagnostic purposes, just like any other

primary care provider. this would also seem to underscore the CSOMA

position that we have inadequate training to meet this standard. And

some CCAOM approved programs outside CA grant degrees for 2000 hours of

school, far less than even the current CA standard.

 

I went to 2 years of naturopathic school and did pretty much the

equivalent in hours of anatomy and physio, biochem, cadaver lab, pathology,

physical diagnosis, x-ray and lab dx as the first two years of

conventional medical school. I have found this knowledge invaluable in my

practice and think I am pretty good at western dx. However, I never got

any real clinical training in this area and would never base my treatment

on my assumed western dx. I would definitely refer out for a dx. Even

ordering an x-ray requires specialized knowledge. I wouldn't even

consider ordering an MRI. No one ever taught me how to do that. Lab

tests are more familiar to me and I have worked closely for many years

with doctors who specialize in functional testing and therapeutics. I

know there are others out there who have a lot of experience ordering MRI'

s and such, perhaps having worked with orthopods, etc. But our various

personal experiences are something quite different than the public

impression that it is part of standard training of all CA acupuncturists.

 

If we are supposed to have these skills at the master's level, shouldn't

they at least be acquired by the doctoral level? Or is this

interpretation just wrong? In Oregon, we specifically excluded lab test

and western diagnosis from our law as counsel advised that we could be

held responsible for failing to perform any necessary action within our

scope of practice. since our lack of training in this area would cause us

(in general) to be unable to perform the necessary tasks, it was decided

it would be foolhardy to authorize them in our scope. Personally, I enjoy

the broad interpretation of the CA law, but I am not sure it serves the

public good without some form of competency standards.

 

Herbs: it says we are the only licensed, tested, fully trained providers

of herbal therapy in the state of CA. It advises consumers to seek us out

instead of relying on health food stores, a position I have long advocated

in print. It is nice to see it in the official publication of the board.

I hope we can live up to such a ringing government endorsement.

 

We are referred to as a low risk profession, worth a try for just about

anyone. this pamphlet has the state seal on it and looks pretty official.

all in all, I call it good PR for those in practice, even if it

inadvertently raised some issues we have discussed so frequently here

(like scope of practice, education and terminology).

 

 

Chinese Herbs

 

 

" Great spirits have always been violently opposed by mediocre minds " --

Albert Einstein

[Guest guest]

I agree, Todd. This stuff concerns me. The practitioner organizations

have been pushing for Western diagnostic tests in the scope of practice,

and further biomedical training in the schools, but I see no push for

medical Chinese language, classical source texts, more-in-depth pulse

diagnosis, or how to do more specific and complex pattern

differentiation. I think the biomedical stuff misses an important

point. While it is important to be able to read lab reports, and

provide for basic lab tests, we shouldn't have to shoulder the liability

of a biomedical diagnosis, with all of its consequences. If I wanted

to do this stuff, I'd go to a medical school and do it right.

 

What makes our profession unique if we are half-baked in Chinese

medicine, and try to fill in the gaps with what everyone else does?

 

 

On Sunday, June 16, 2002, at 01:10 PM, wrote:

 

> I just got a mailing from the CA acupuncture board. It included this

> consumer's guide to Acupuncture, which is mailed to anyone who requests

> info from the board. It says some interesting things, which I assume

> are official board policy regarding interpretation of existing law.

>

> It begins by annoying me with a paragraph about " energy flows " , but

> picks up from there.

>

> diagnosis: it says our dx is " ... determined in part ... [by]

> performing a physical exam, and ordering laboratory texts, x-rays and

> MRI's,if necessary. " Since these diagnostic methods are not used to

> determine a TCM dx, it seems that the board is endorsing the position

> of CSOMA and the other pro orgs. Which is that L.Ac.'s are allowed to

> make western dx in their scope of practice. I interpret this statement

> in this way because the only diagnostic use of such western tests is to

> make a western dx. there are other reasons besides diagnostic that one

> can use these tests for, such as tracking the progress of a patient who

> has been dx using only TCM methods. But this consumer pamphlet

> explicitly reassures the public that we use these tests for diagnostic

> purposes, just like any other primary care provider. this would also

> seem to underscore the CSOMA position that we have inadequate training

> to meet this standard. And some CCAOM approved programs outside CA

> grant degrees for 2000 hours of school, far less than even the current

> CA standard.

>

> I went to 2 years of naturopathic school and did pretty much the

> equivalent in hours of anatomy and physio, biochem, cadaver lab,

> pathology, physical diagnosis, x-ray and lab dx as the first two years

> of conventional medical school. I have found this knowledge invaluable

> in my practice and think I am pretty good at western dx. However, I

> never got any real clinical training in this area and would never base

> my treatment on my assumed western dx. I would definitely refer out

> for a dx. Even ordering an x-ray requires specialized knowledge. I

> wouldn't even consider ordering an MRI. No one ever taught me how to

> do that. Lab tests are more familiar to me and I have worked closely

> for many years with doctors who specialize in functional testing and

> therapeutics. I know there are others out there who have a lot of

> experience ordering MRI's and such, perhaps having worked with

> orthopods, etc. But our various personal experiences are something

> quite different than the public impression that it is part of standard

> training of all CA acupuncturists.

>

> If we are supposed to have these skills at the master's level,

> shouldn't they at least be acquired by the doctoral level? Or is this

> interpretation just wrong? In Oregon, we specifically excluded lab

> test and western diagnosis from our law as counsel advised that we

> could be held responsible for failing to perform any necessary action

> within our scope of practice. since our lack of training in this area

> would cause us (in general) to be unable to perform the necessary

> tasks, it was decided it would be foolhardy to authorize them in our

> scope. Personally, I enjoy the broad interpretation of the CA law, but

> I am not sure it serves the public good without some form of competency

> standards.

>

[Guest guest]

Z'ev:

 

Good points. You and Todd articulate what seems to be the central

problem of our generation: how to manage the development and

possible integration of two culture's divergent medical

sensibilities. From what I've read in the new Volker book, the

transition in China doesn't seem to be going much more smoothly; and

the political issues---there as well as here---always seem to be

decisive and outweigh the theoretical and practical ones.

 

 

Jim Ramholz

 

 

 

 

Z'ev wrote: I agree, Todd. This stuff concerns me. The practitioner

organizations

have been pushing for Western diagnostic tests in the scope of

practice,

and further biomedical training in the schools, but I see no push

for

medical Chinese language, classical source texts, more in-depth

pulse

diagnosis, or how to do more specific and complex pattern

differentiation. I think the biomedical stuff misses an important

point. While it is important to be able to read lab reports, and

provide for basic lab tests, we shouldn't have to shoulder the

liability

of a biomedical diagnosis, with all of its consequences. If I wanted

to do this stuff, I'd go to a medical school and do it right.

 

What makes our profession unique if we are half-baked in Chinese

medicine, and try to fill in the gaps with what everyone else does?

[Guest guest]

I like Volker's point of view that Chinese medicine has a constantly

shifting flowing perspective. . . .and that the political attempts to

shoehorn it into one perspective is like a square peg in a hole. Having

said that, I do understand the need in China of developing a coherent

systematic approach to Chinese medicine that can serve as a national

health care system.

 

Volker's book is the best breath of fresh air I've read about our

profession in years.

 

 

On Sunday, June 16, 2002, at 10:16 PM, jramholz wrote:

 

> Z'ev:

>

> Good points. You and Todd articulate what seems to be the central

> problem of our generation: how to manage the development and

> possible integration of two culture's divergent medical

> sensibilities. From what I've read in the new Volker book, the

> transition in China doesn't seem to be going much more smoothly; and

> the political issues---there as well as here---always seem to be

> decisive and outweigh the theoretical and practical ones.

>

>

> Jim Ramholz

>

>

>

>

> Z'ev wrote: I agree, Todd. This stuff concerns me. The practitioner

> organizations

> have been pushing for Western diagnostic tests in the scope of

> practice,

> and further biomedical training in the schools, but I see no push

> for

> medical Chinese language, classical source texts, more in-depth

> pulse

> diagnosis, or how to do more specific and complex pattern

> differentiation. I think the biomedical stuff misses an important

> point. While it is important to be able to read lab reports, and

> provide for basic lab tests, we shouldn't have to shoulder the

> liability

> of a biomedical diagnosis, with all of its consequences. If I wanted

> to do this stuff, I'd go to a medical school and do it right.

>

> What makes our profession unique if we are half-baked in Chinese

> medicine, and try to fill in the gaps with what everyone else does?

>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

>

>

>

[Guest guest]

, " " <

zrosenbe@s...> wrote:

but I see no push for

> medical Chinese language, classical source texts, more-in-

depth pulse

> diagnosis, or how to do more specific and complex pattern

> differentiation.

 

I agree. There is clearly no room in the current doc program to

meet both these goals. However, this may be because the

majority of the active members of the combined pro orgs are

asian and already read chinese or korean and have ample

access to classical texts. Many were already highly educated in

Asia, thus their main concerns are scope of practice, not the

issues you raise. Many of these asians were allowed an MD

style practice in china, thus they want that here, too. the fact is

that the asian and white L.Ac. communities have partially

divergent needs and goals. I mean to make asians do a doc

program that emphasizes teaching a language they already

speak and to study texts they have been reading for years does

seem somewhat ludicrous. so this program was clearly set up

to meet the needs of non-asians. that is the crux of this whole

conflict.

 

I think the biomedical stuff misses an important

> point. While it is important to be able to read lab reports, and

> provide for basic lab tests, we shouldn't have to shoulder the

liability

> of a biomedical diagnosis, with all of its consequences.

 

the board pamphlet makes it appear that this is ALREADY both

our right and responsibility in CA. that is my concern.