Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 I was recently informed that PCOM is debating the inclusion of a GYN specialty in their DAOM program. The main issue centers on physical exam. The contention is that a DAOM must be able to do a pelvic exam to practice this specialty. The question is whether this is legal in CA or anywhere else (we determined it was ILLEGAL in OR years ago). Is it necessary or even desirable? Is it possible to actually get enough training in this type of physical exam in the context of the current DAOM program to do a proper pelvic or other physical exam. I raised these questions to about half of the DAOM students at PCOM and discovered something that will be disturbing to some (but which I have long predicted). The answer was not if they have to waste their time studying the chinese language and classics. If this is an integrative med program, they want to be fully trained in western diagnostics to be on par with MD's. All of these folks feel they have ALREADY done lots of advanced work in TCM. Many of them are native speakers of an asian language and have done some chinese studies on their own. However, the feelings about studying chinese range from lukewarm to negative, as far as I can tell (and the chinese series has not yet even started). There is fairly much unanimity about the emphasis on classical study. They all want the western med stuff instead and this is most definitely the orientation of the DAOM clinic director. I always said this was going to be about title and prestige. to be honest, I am not so sure these folks are wrong and the school will have to eventually accommodate its students. Other schools do not require chinese or classics as part of their DAOM and that will be attractive to the majority of students. Ironically, the main proponents of language and classical study (like myself for the former, at least), have no intention of returning to school and those who do return have very different motivations than those who designed the program. Its starting to look more and more like the study of language and classics in DAOM programs will be the exception rather than the rule. It is just perceived as academic and not clinical and how sad that is. Personally, I have no interest in doing a pelvic exam and neither did generations of TCM docs. In fact, it was the absence of invasive physical exam that was one of the major lures for me away from naturopathy and to CM. But no surprise here. Chinese Herbs FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 , wrote: > different motivations than those who designed the program. Its > starting to look more and more like the study of language and classics > in DAOM programs will be the exception rather than the rule. It is > just perceived as academic and not clinical and how sad that is. > Personally, I have no interest in doing a pelvic exam and neither did > generations of TCM docs. In fact, it was the absence of invasive > physical exam that was one of the major lures for me away from > naturopathy and to CM. But no surprise here. I have been considering enrolling the the DOAM program at PCOM after I graduate the Master's program. The main selling points for me were forcing myself to learn medical Chinese, being guided in the study of the Classics, and getting advanced clinical training with patients specific to what is being studied. I also considered the idea of the title as a positive, as well as future-proofing myself against changing licensing standards that will be coming. I have no passion for Western medical information, but I take it as it comes. To this end, I hope the program does not change in the direction that you are predicting. Brian C. Allen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 A) It is not necessary for a Licensed Acupuncturist/DOM specializing in obstetrics/gynecology to do pelvic exams. When and if they are necessary, they can and should be carried out by trained and licensed professional Western medical practitioners. I have specialized in gynecology for 25 years and have never once felt the need to do such and exam myself, although I often refer patients for such exams. There is nothing in the practice of gynecological acupuncture or internally administered Chinese medicinals for gynecological problems which is based on an pelvic examination. The points or herbs used are still (or at least should be) the same. Pelvic exams can only help make a disease diagnosis, and we primarily predicate our treatments on the patient's pattern(s). In fact, many contemporary Chinese practitioners are led astray by making erroneous treatment assumptions due to the influence of such Western medical exams. Many years ago, a female physician's assistant (PA) taught me how to do such exams (on her an several other willing women), but I never felt comfortable or adequately trained to do such in my practice. Acupuncturists specializing in ob/gyn should probably see a pelivc exam performed and should be familiar with all relevant terms and equipment. But we need and should not be trained in actually doing these. B) In the State of Colorado, it is either in our law or our written administrative rules that no Lic. Ac. is allowed to touch a patient's genitalia for any reason. Period. End of discussion. C) Such an ability would only inadvertently lead to an increase in sexual impropriety claims against practitioners. Why go there? Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 I agree although some complaints are more dermatological than gynecological. I usually feel the woman's description is adaquate to make a diagnosis. doug > > B) In the State of Colorado, it is either in our law or our written administrative rules that no Lic. Ac. is allowed to touch a patient's > genitalia for any reason. Period. End of discussion. > > C) Such an ability would only inadvertently lead to an increase in sexual impropriety claims against practitioners. Why go there? > > Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 In a message dated 2/25/04 7:23:05 PM, writes: << Is it possible to actually get enough training in this type of physical exam in the context of the current DAOM program to do a proper pelvic or other physical exam. I raised these questions to about half of the DAOM students at PCOM and discovered something that will be disturbing to some (but which I have long predicted). The answer was not if they have to waste their time studying the chinese language and classics. If this is an integrative med program, they want to be fully trained in western diagnostics to be on par with MD's >> you raise many interesting questions in this post about possible directions for the DAOM programs at PCOM. Having just participated in 'physical exam' class this afternoon at PCOM-NY I can say that what feels like a waste of time is not being able to experience these classes at a deep enough level. I imagine that is at the root of at least some of the resistance you say you are hearing to studying such things as Chinese language and Classics. It's just that you can't do everything, and having to take all these western medical classes feels like a waste unless we come out feeling competent to actually perform and make use of these various exams. For me it has nothing to do with desiring prestige by being more 'western'. I just say, if you are going to teach me something, teach me at a level where I can really sink my teeth into it. Too many of the PCOM classes are just a brush-through, a little acquaintance with this or that. In the best of worlds maybe students will be able to choose either a 'clinical' program or an 'academic' program. Personally, though I feel I have the potential for great skills in medicine, I know I have very little aptitude for languages. It is hard to learn foreign languages as an adult. If I come to a place in my studies where I really have an internal 'need to know' then maybe I would be motivated enough to tackle taking Chinese. But I don't want to have to do it just because someone else thinks I should. -RoseAnne S. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 If we are primary care practitioners then there is no reason to not train in doing pelvic or any other exam. Bob how would you know if someone has fibroids or other growth and she uses you as her primary care provider without doing a pelvic? If we are to get Dr level training and want to do primary care then we must know all that is needed to be one. What's the big deal with doing a pelvic? Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 > If we are primary care practitioners then there is no reason to not train in doing pelvic or any other exam. Bob how would you know if someone has fibroids or other growth and she uses you as her primary care provider without doing a pelvic? If we are to get Dr level training and want to do primary care then we must know all that is needed to be one. What's the big deal with doing a pelvic? > Alon > No better or worse then doing a Prostate exam?! Teresa> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 Dear Alon, and others, To me, the big deal about doing a pelvic exam (or a prostate exam for that matter) is that, unless we are doing them often, many times a day the way the GYNs and Urologists are, we are not going to become very expert at them. We may overlook something and cause patient harm through negligence. I would rather my patients see these specialists, even if we are " primary " . Primary doesn't mean we are expert in everything. Can anyone honestly say they will do several pelvic exams and protstate exams a day in their acupuncture/oriental medicine practice? Julie - " alon marcus " <alonmarcus Wednesday, February 25, 2004 2:03 PM Re: Re: physical examination > If we are primary care practitioners then there is no reason to not train in doing pelvic or any other exam. Bob how would you know if someone has fibroids or other growth and she uses you as her primary care provider without doing a pelvic? If we are to get Dr level training and want to do primary care then we must know all that is needed to be one. What's the big deal with doing a pelvic? > Alon > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 I am assuming that somebody becoming a GYN specialist will be seeing women daily and therefore may be doing them daily and becoming good at it. Pelvics are not that to learn and do. The only question I have is about peps. If one is going to be a primary care taker for a women he/she needs to do peps etc. I just think that when learning a specialty, such as in china, one needs to know it. And i have to disagree with bob as i have seen herbs given based on pelvic exam especially in the treatment of growths Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2004 Report Share Posted February 25, 2004 , " Teresa Hall " < Teresa.bodywork4u@w...> wrote: > > > > > > If we are primary care practitioners then there is no reason to not train > in doing pelvic or any other exam. we are only primary care in CA and perhaps FL and NM.. However, the soon to be released report from the little hoover commission will finally clarify the matter of L.Ac. being primary care in CA. As I understand it, there was NEVER any legislative intent to confer to us the right to make western diagnosis as primary care providers. The intent was that we can practice without referral, but our primary care was meant to be in the form of TCM and we are only expected and allowed to make referrals for patients who we SUSPECT of needing a WM dx. We are absolutely prohibited from making western dx and prescribing therapy upon that basis. This area has been somewhat gray for many years, though I believe a close reading of the CA law is not vague at all on this point. Nowhere are we explicitly granted the right to make western dx. Therefore it is not in our scope. CSOMA and the asian language associations have long argued differently, but it appears they will be ruled incorrect in the coming months. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2004 Report Share Posted February 26, 2004 > RA6151 > Wed Feb 25, 2004 5:10:45 PM US/Pacific > , > Re: physical examination > > > In a message dated 2/25/04 7:23:05 PM, writes: > > << Is it possible to actually get enough > training in this type of physical exam in the context of the current > DAOM program to do a proper pelvic or other physical exam. I raised > these questions to about half of the DAOM students at PCOM and > discovered something that will be disturbing to some (but which I have > long predicted). The answer was not if they have to waste their time > studying the chinese language and classics. If this is an integrative > med program, they want to be fully trained in western diagnostics to be > on par with MD's >> > > you raise many interesting questions in this post about possible > directions for the DAOM programs at PCOM. Having just participated in > 'physical > exam' class this afternoon at PCOM-NY I can say that what feels like a > waste of > time is not being able to experience these classes at a deep enough > level. I > imagine that is at the root of at least some of the resistance you say > you are > hearing to studying such things as Chinese language and Classics. > It's just > that you can't do everything, and having to take all these western > medical > classes feels like a waste unless we come out feeling competent to > actually > perform and make use of these various exams. For me it has nothing to > do with > desiring prestige by being more 'western'. I just say, if you are > going to teach > me something, teach me at a level where I can really sink my teeth > into it. > Too many of the PCOM classes are just a brush-through, a little > acquaintance > with this or that. > In the best of worlds maybe students will be able to choose either > a > 'clinical' program or an 'academic' program. Personally, though I > feel I have the > potential for great skills in medicine, I know I have very little > aptitude > for languages. It is hard to learn foreign languages as an adult. If > I come to > a place in my studies where I really have an internal 'need to know' > then > maybe I would be motivated enough to tackle taking Chinese. But I > don't want to > have to do it just because someone else thinks I should. > > -RoseAnne S. > > Chinese Herbs FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2004 Report Share Posted February 26, 2004 I think there are some kinds of physical exam we should do. In school - my supervisor (from China), showed us how to do a breast exam for a patient who's MC was breast lumps. We needed to find out if the lumps were d/t Blood or Phlegm stasis, and physical exam was the only way to do so. Palpation is also useful for feeling palpable fibroids and other tumours. I think it would be interesting to learn how to do the exam to find gross problems, but realistically, I would be more than happy to refer for internal pelvic / rectal exams though. We would be unlikely to use it enough to be proficient, and you could just use the report to modify your treatment strategy if needed. Geoff > __________ > > Message: 13 > Wed, 25 Feb 2004 13:03:05 -0800 > " alon marcus " <alonmarcus > Re: Re: physical examination > > If we are primary care practitioners then there is no reason > to not train in doing pelvic or any other exam. Bob how would > you know if someone has fibroids or other growth and she uses > you as her primary care provider without doing a pelvic? If > we are to get Dr level training and want to do primary care > then we must know all that is needed to be one. What's the > big deal with doing a pelvic? Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2004 Report Share Posted February 26, 2004 > we are only primary care in CA and perhaps FL and NM.. However, the soon to > be released report from the little hoover commission will finally clarify the > matter of L.Ac. being primary care in CA. As I understand it, there was NEVER > any legislative intent to confer to us the right to make western diagnosis as > primary care providers. The intent was that we can practice without referral, > but our primary care was meant to be in the form of TCM and we are only > expected and allowed to make referrals for patients who we SUSPECT of > needing a WM dx. We are absolutely prohibited from making western dx and > prescribing therapy upon that basis. This area has been somewhat gray for > many years, though I believe a close reading of the CA law is not vague at all > on this point. Nowhere are we explicitly granted the right to make western dx. > Therefore it is not in our scope. CSOMA and the asian language associations > have long argued differently, but it appears they will be ruled incorrect in the > coming months. > > > >- Every time I get an insurance patient... I need to make a western diagnosis. I spent one year post graduate with Dr. Fred Lerner, and in his class he said that we do need to make a werstern diagnosis. And further more, I cannot simply go along with a werstern MD's diagnosis, for the sake of going with it. There has been a number of times that I have discovered more Dx. then the Doc did. I doubt if I would have known what I was seeing, if I had not taken Fred's class. Quite frankly, I do not think I would be as successful as I am... if I had not taken his class. Which brings up what is successful? For me it is about getting results. Perhaps there is big differences in muscle skeletal Dx. versus internal medicine Dx.. Even with internal medicine I refer for blood work and make or confirm a Dx. based on the readings. Todd- where are you getting your information that we cannot Western Dx.? For heavens sake every time I call ASHP they are calling me Doctor. Quite frankly, I am more then a doctor... I am a healer. In health, Teresa Teresa Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2004 Report Share Posted February 26, 2004 The problem is TCM 'clinics' are very public. Often someone waiting just around the corner for the next treatment with no sound barrier and very little visual barrier. Chinese have a different concept of privacy (overcrowding is tolerated and knowing everyone else's business is the order of the day there just as it is here) BUT they are still as prudish as we are. Hence the 'hands off' approach below the belt ;-) Sammy. +>>>>>>I thought we are talking about the future. As we practice at this point there may not be a place for a specialist in GYN, but if we grow as a profession then things may change. The question is what kind of vision do we have for such a future. Should it be model after modern practices such as in Korea and China or should it be model after an Alternative practice " model. Should i as a practitioner of NM medicine be limited in the kind of physical diagnosis, and laboratory diagnosis i can use? Should i even look for specific lesion since TCM has very little knowledge of such lesions? Can I integrate ultrasound findings in my practice to see Fluid accumulation that are deeper than my fingers? Well i strongly believe we should. GYN is not different than NM medicine, except for sexual hang-ups in this country Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2004 Report Share Posted February 26, 2004 No better or worse then doing a Prostate exam?! >>>Agreed, or that matter, lets say you see somebody that is fatigued, blood-def etc. Why should you do a rectal and see if there is blood in stool? Should you insist on MD checkup? if not how can you do primary care until you can safely tell if there is a life thretening condition responsible for this patient's fatigue? Lets face it if we want to be primary care (and i think that is the only way we will survive as a profession) we need to learn all that such a practitioner must do and know. If one is doing GYN for example, and in WM GYN is one of the primary care disciplines, then such a practitioner should be able to live upto the responsibilities. Doing a rectal and prostate exams is basic physical examination. It one of the easiest ways to screen for CA. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2004 Report Share Posted February 26, 2004 Nowhere are we explicitly granted the right to make western dx. Therefore it is not in our scope. >>>Why can you order labs? imaging? what do you get by ordering them if not information for diagnosis and safe practice. Also, the question is what are we going to push for the future. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2004 Report Share Posted February 26, 2004 Please be aware tht some malpractice carriers do not cover for GYN, and to look at your policy before practicing it. David Molony In a message dated 2/25/04 7:22:48 PM, writes: > I was recently informed that PCOM is debating the inclusion of a GYN > specialty in their DAOM program. The main issue centers on physical > exam. The contention is that a DAOM must be able to do a pelvic exam > to practice this specialty. The question is whether this is legal in > CA or anywhere else (we determined it was ILLEGAL in OR years ago). Is > it necessary or even desirable? Is it possible to actually get enough > training in this type of physical exam in the context of the current > DAOM program to do a proper pelvic or other physical exam. I raised > these questions to about half of the DAOM students at PCOM and > discovered something that will be disturbing to some (but which I have > long predicted). The answer was not if they have to waste their time > studying the chinese language and classics. If this is an integrative > med program, they want to be fully trained in western diagnostics to be > on par with MD's. All of these folks feel they have ALREADY done lots > of advanced work in TCM. Many of them are native speakers of an asian > language and have done some chinese studies on their own. However, the > feelings about studying chinese range from lukewarm to negative, as far > as I can tell (and the chinese series has not yet even started). > > There is fairly much unanimity about the emphasis on classical study. > They all want the western med stuff instead and this is most definitely > the orientation of the DAOM clinic director. I always said this was > going to be about title and prestige. to be honest, I am not so sure > these folks are wrong and the school will have to eventually > accommodate its students. Other schools do not require chinese or > classics as part of their DAOM and that will be attractive to the > majority of students. Ironically, the main proponents of language and > classical study (like myself for the former, at least), have no > intention of returning to school and those who do return have very > different motivations than those who designed the program. Its > starting to look more and more like the study of language and classics > in DAOM programs will be the exception rather than the rule. It is > just perceived as academic and not clinical and how sad that is. > Personally, I have no interest in doing a pelvic exam and neither did > generations of TCM docs. In fact, it was the absence of invasive > physical exam that was one of the major lures for me away from > naturopathy and to CM. But no surprise here. > > > Chinese Herbs > > > FAX: > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2004 Report Share Posted February 26, 2004 We needed to find out if the lumps were d/t Blood or Phlegm stasis, and physical exam was the only way to do so. >>>Same goes for uteri lumps. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2004 Report Share Posted February 27, 2004 , acuman1@a... wrote: > Please be aware tht some malpractice carriers do not cover for GYN, and to > look at your policy before practicing it. more like MOST. look closely. I do not think any cover OB w/o a significiant extra cost. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2004 Report Share Posted February 27, 2004 Please be aware tht some malpractice carriers do not cover for GYN, and to look at your policy before practicing it. >>>>At this point i wander if it is legal anywhere Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 29, 2004 Report Share Posted February 29, 2004 In a message dated 2/27/04 3:47:14 AM, writes: > , acuman1@a... wrote: > > Please be aware tht some malpractice carriers do not cover for GYN, and to > > look at your policy before practicing it. > > > more like MOST. look closely. I do not think any cover OB w/o a > significiant > extra cost. > > New Healthcare Mgt Group I know does. DAVE Quote Link to comment Share on other sites More sharing options...
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