Speaking of Unschuld

[Guest guest]

Dear All,

 

The recent conversation about Volker Scheid's

book and the realization dawning on more and more of us engaged in the study

of Chinese medicine that there is more to it than meets the eye (a positive

development, thanks in no small part to all of you on this list) bring to mind

something that Paul Unschuld said to me in a conversation at his home a couple

of weeks ago.

 

I had the great good fortune of spending a week with him and his extraordinary

wife, Ulricke, with whom he has worked closely over the years. The

conversation I'll quote from was one of several that we had while in his

office at home as well as the one in the institute that he directs at the

University of Munich. A couple of the more fascinating chats took place during

hikes in the foothills of the Bavarian Alps, not more than an hour's drive

from his house. These conversations will all be made available in the form of

an interview in an upcoming issue of CAOM, just as soon as I can get all of

the notes put together. But I wanted to share this one bit with you all, as it

has been so thought provoking ever since I heard him say it.

 

He related to me a recent incident from his hectic life as one of Germany's

leading academics in the field of medicine. He was invited to deliver the

keynote address to the twenty fifth anniversary observation of the German

society for continuing medical education. You all know what these kinds of

events are like: lots of back slapping and too much to drink and smiles and

warm fuzzy feelings that make us feel wonderful to be ourselves, no matter

what society we're in. Paul, who has a devilish sense of humor, to which I

suggest everyone who reads him or hears him pay attention, decided to give his

hosts more than they'd bargained for.

 

He stepped up to the microphone as the last of the desert spoons were tinkling

into the saucers and began by informing his colleagues that there were three

fundamental criteria for the definition of a profession.

 

1. The knowledge on which the members of the profession base their

professional services comes into being from the members of the profession

themselves.

 

2. The members of the profession determine when and how to apply that

knowledge.

 

3. The professional themselves set their own standards for compensation for

their services.

 

After the audience had had no more than two or three sips of coffee, he

continued by pointing out to the assembly that as German Medical Doctors none

of them met the three criteria and could not, therefore, be rightfully called

or known as professionals.

 

Paul told me that he thoroughly expected to be booed off the podium and was

prepared for a long, lonely ride home that night. But to his surprise the

crowd loved it. And rather than boos his remarks were greeted with applause.

Evidently he struck a chord with these German doctors, because he was

literally overwhelmed with subsequent invitations to speak at gatherings of

doctors.

 

We talked about his three criteria as they relate to the field of traditional

Chinese medicine and he pointed out that one of the primary factors

underlying the contemporary professionalization of acupuncture is the fact

that it has been largely developed in compliance with these three criteria.

 

I pointed out that with the expanding advent of third party payers in the

field that the third criteria was already under attack.

 

By the way, the interview with Paul Unschuld is one of what we hope will be an

ongoing series of interviews with some of the field's leading authorities. The

idea is to give everyone in the field a clear understanding of the background

and personal development of the individuals who have played such an important

role and who continue to exert enormous influence over the profession of

acupuncture, Chinese, and other forms of medicine that nominally come from

various places in the Far East.

 

The first of these will be with Andy Ellis and will appear in the Sept. issue.

 

 

I'd love to have input from anybody who cares enough to speak up as to who

else we should make sure to interview.

 

Thanks to all of you,

 

Ken

[Guest guest]

<1. The knowledge on which the members of the profession base theirprofessional services comes into being from the members of the professionthemselves.>

 

I think one could argue that this first point is in jeopardy as well. It seems to me that the majority of current research being done is not being done by acupuncturists, at least not in this country.

 

Sean

[Guest guest]

, <yulong@m...> wrote:

> 1. The knowledge on which the members of the profession base their

> professional services comes into being from the members of the

profession themselves.

>

> 2. The members of the profession determine when and how to apply

that knowledge.

>

> 3. The professional themselves set their own standards for

compensation for their services.

 

 

Ken:

 

Can you go into Unschuld's reasoning behind these three? I suspect

it is becuase of German regulations and something to do with

language, but am not sure.

 

 

Jim Ramholz

[Guest guest]

In many ways,

The third party payer scenario, in my opinion, a trojan horse to the

heart of our profession, in terms of power, autonomy, and the very

principles on which we stand.

 

At the same time, I understand the need for more economic reward for

many practitioners' work. It is not easy to make a living at Chinese

medicine.

 

However, not having the choice over who you treat, how much you

charge, the diagnosis and even the herbs is quite a straight-jacket.

Also, most companies underpay the acupuncturist, and pile them up with

paper work. It also takes the responsibility for an individual's

health out of the hands of the patients as well, limiting their free

choice.

 

At one time here in California, a few individuals attempted to

develop group insurance from within the profession, but were swamped by

the big guys.

 

I am not surprised, actually, at the response of German physicians to

Unschuld's speech. After all, most physicians I know here in the U.S.

are unhappy at what they perceive to be the loss of autonomy and

independence economically and socio/politically. Some of the more

enlightened physicians I know are trying to develop cash practices, or

at least limit themselves to private insurance.

 

I know there are pros and cons to such complex issues as HMO's PPO's and

insurance versus cash practice, and it depends on setting, specialty,

market and the experience of the practitioner. However, I don't think

we'd be doing ourselves a favor by giving economic control to outside

forces.

 

 

 

On Sunday, July 14, 2002, at 04:49 AM, <yulong wrote:

 

> We talked about his three criteria as they relate to the field of

> traditional

> Chinese medicine and he  pointed out that one of the primary factors

> underlying the contemporary professionalization of acupuncture is the

> fact

> that it has been largely developed in compliance with these three

> criteria.

>

> I pointed out that with the expanding advent of third party payers in

> the

> field that the third criteria was already under attack.

[Guest guest]

In regard to Unschuld's point no. 3 below, I have recently

taken myself out of the PPO in Maryland. The average PPO reimbursement

per visit (licensed acupuncturist--not M.D. acupuncturist) is $36 regardless

of the length of the treatment or how many modalities are used, and we

may not bill the patient for the balance. So I exited with

a carefully written letter and cc's to the state insurance commissioner,

state acupuncture board, local aom schools, etc. With this, I have taken

back control of my fees, although several patients will not be back.

I got so weary of people more concerned with "is it covered?" than they

were about their health, to say nothing of the pitiful reimbursements.

I don't think that what we do can fit into the insurance system as it is.

I'm aware of the dilemma, but I think we should let the insurance industry

know that we are not interested. It may be better to continue outside

the system. I wonder if doctorates will change this for the better.

Frances

yulong wrote:

Dear All,

The recent conversation about Volker Scheid's

book and the realization dawning on more and more

of us engaged in the study

of Chinese medicine that there is more to it than

meets the eye (a positive

development, thanks in no small part to all of you

on this list) bring to mind

something that Paul Unschuld said to me in a conversation

at his home a couple

of weeks ago.

I had the great good fortune of spending a week with

him and his extraordinary

wife, Ulricke, with whom he has worked closely over

the years. The

conversation I'll quote from was one of several that

we had while in his

office at home as well as the one in the institute

that he directs at the

University of Munich. A couple of the more fascinating

chats took place during

hikes in the foothills of the Bavarian Alps, not

more than an hour's drive

from his house. These conversations will all be made

available in the form of

an interview in an upcoming issue of CAOM, just as

soon as I can get all of

the notes put together. But I wanted to share this

one bit with you all, as it

has been so thought provoking ever since I heard

him say it.

He related to me a recent incident from his hectic

life as one of Germany's

leading academics in the field of medicine. He was

invited to deliver the

keynote address to the twenty fifth anniversary observation

of the German

society for continuing medical education. You all

know what these kinds of

events are like: lots of back slapping and too much

to drink and smiles and

warm fuzzy feelings that make us feel wonderful to

be ourselves, no matter

what society we're in. Paul, who has a devilish sense

of humor, to which I

suggest everyone who reads him or hears him pay attention,

decided to give his

hosts more than they'd bargained for.

He stepped up to the microphone as the last of the

desert spoons were tinkling

into the saucers and began by informing his colleagues

that there were three

fundamental criteria for the definition of a profession.

1. The knowledge on which the members of the profession

base their

professional services comes into being from the members

of the profession

themselves.

2. The members of the profession determine when and

how to apply that

knowledge.

3. The professional themselves set their own standards

for compensation for

their services.

After the audience had had no more than two or three

sips of coffee, he

continued by pointing out to the assembly that as

German Medical Doctors none

of them met the three criteria and could not, therefore,

be rightfully called

or known as professionals.

Paul told me that he thoroughly expected to be booed

off the podium and was

prepared for a long, lonely ride home that night.

But to his surprise the

crowd loved it. And rather than boos his remarks

were greeted with applause.

Evidently he struck a chord with these German doctors,

because he was

literally overwhelmed with subsequent invitations

to speak at gatherings of

doctors.

We talked about his three criteria as they relate

to the field of traditional

Chinese medicine and he pointed out that one

of the primary factors

underlying the contemporary professionalization of

acupuncture is the fact

that it has been largely developed in compliance

with these three criteria.

I pointed out that with the expanding advent of third

party payers in the

field that the third criteria was already under attack.

By the way, the interview with Paul Unschuld is one

of what we hope will be an

ongoing series of interviews with some of the field's

leading authorities. The

idea is to give everyone in the field a clear understanding

of the background

and personal development of the individuals who have

played such an important

role and who continue to exert enormous influence

over the profession of

acupuncture, Chinese, and other forms of medicine

that nominally come from

various places in the Far East.

The first of these will be with Andy Ellis and will

appear in the Sept. issue.

 

I'd love to have input from anybody who cares enough

to speak up as to who

else we should make sure to interview.

Thanks to all of you,

Ken

 

 

 

 

 

 

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]

In , " " <zrosenbe@s...> wrote:

<<< It is not easy to make a living at Chinese medicine. >>>

 

What is the average income for a acupuncturist in California? I

think nationally it's only about 20K. Somebody else might remember

the exact figure.

 

If that's the case, a more extensive CM curriculum and larger

student loans for basic education would be financially prohibitive.

As you mentioned, the situation is widespread and not limited to our

field. Many MDs have a difficult time paying their professional

expenses and student loans. A recent news article told that many

gynecologists were leaving Nevada because malpractice insurance is

outrageously costly. Consequently, fewer doctors remain to deliver

babies.

 

 

<<< However, I don't think we'd be doing ourselves a favor by giving

economic control to outside forces. >>>

 

Do many acupuncturists in California accept insurance? It appears

that the only way to exercise our own control is in the choice to

either risk joining an HMO, or risk developing a cash practice

without insurance. I've personally chosen not to take insurance in

order to practice the way that I want to; and am doing well without

it. But I fear that sometime in the future I may have to break down

and do it.

 

Perhaps economics is, of necessity, the final or strongest

determiner.

 

Jim Ramholz