Physical Exam (Used to be herbs for nodules, breast lumps)

[Guest guest]

Bob, I couldn't agree with you more. I teach physical exam and my motto for

my students is that you can't treat what you don't exam. While there is a

malpractice role in this, it is just basic medicine. How do you know if a

patient is getting better or worse from your treatments? This is the basic

question a medical practitioner of any specialty needs to answer. And the

only way to answer that is through physical exam. Now, in our profession

that obviously includes TCM techniques, but we live in western society,

therefore it must also include other exam techniques.

 

 

 

As an example and hopefully to start a discussion, I believe that treating a

cold without listening to the chest, feeling the lymph nodes, and looking at

the throat is malpractice. We need to listen to the chest to rule out

walking pneumonia, something very easy to do. Looking at the throat can rule

out, for the most part, strep throat which can progress to rheumatic fever.

And feeling the nodes is simply good medicine. So we need to do these exams

to rule out red flags. That doesn't mean we can't treat some of these

conditions with TCM, but we know we better do it well and quickly, and if we

don't see results rapidly, they need to go their doctor.

 

 

 

Finally, I tell my students that every biomedical physical exam can be

useful to TCM. If someone has a red throat, they have heat. If there are

white or yellow patches in the throat, it is probably toxic. If the lungs

have extra sounds, there is probably phlegm.

 

 

 

My two cents.

 

 

 

**************************************************************************

 

Dr. Greg Sperber, BMBS, DAOM, MBA, L.Ac.

 

California Licensed Acupuncturist

 

Diplomate in Oriental Medicine (NCCAOM)

 

Greg

 

***************************************************************************

 

All,

 

" As I am not in the habit of doing breast examinations, I couldn't say

with absolute certainty the size of the lumps treated. I have always

taken for granted the patient telling me that they had lumps. Right or

wrong, this is the state of our profession. "

 

I agree, this is the state of our profession. But it definitely is wrong.

 

Twenty or so years ago, I had a student. He came to see me one day

because he said one of his testicles hurt. I did a CM pattern

discrimination and diagnosed cold in the lver channel. I gave him an

herbal Rx and the pain was better as long as he took the herbs. I did

not palpate his testicles due to embarassment. By the time he was

diagnosed with testicular cancer, it had metastasized to his abdomen.

The good news is that he is alive and well today. He's even an

acupuncturist. The bad news is that he lost a testicle and went

through some pretty rough chemo. His parents also tried to sue me for

every thing I and my family had. The only bright spot there was that I

didn't have anything for a lawyer to win. So they couldn't find a

lawyer to prosecute the case. This was before we had mandatory

malpractice insurance here in CO.

 

What I learned from this: If we are going to practice medicine, we

have to behave like doctors, and that always means palpating any areas

in which the patient says she or he has symptoms. If the knee hurts,

we have to visually inspect and palpate the knee. If there is a breast

lump, we have to palpate the breast. If that means having a chaperone

in the office, so be it. In the Netherlands, they have a saying that

goes something like this: Soft doctors make bad sores. The meaning is

that a doctor has to do what a doctor has to do without being

squeamish, prudish, or embarassed by it. Otherwise, patients may

suffer even greater disease. In China, all my teachers in clinic

always palpated any area of concern. If we're not willing to visually

inspect and palpate a woman's breast who says she has a lump or lumps,

then we need to stop treating women with breast problems unless there

is a confirmed diagnosis by another licensed health care privider.

However, even then, I think we need to look and feel for ourselves in

order to really understand the patient's situation. What if the other

practitioner was wrong or the patient's situation had changed since then?

 

I have felt several women's breast cancer tumors who lived in denial.

They had large, plaque-like tumors like a piece of a turtle shell,

just like what Zhu Dan-xi describes. They had all refused to go to

Western doctors for fear of the true diagnosis (and prognosis).

Instead, they had gone to macrobiotics, homeopaths, acupuncturists,

etc., none of whom had palpated their breasts. All these women are now

dead. By the time they were diagnosed, their tumors were very advanced

with lots of metastases. According to Zhu, by the time I palpated

their tumors, their cases was already hopeless. All were relatively

young, married, and had children. Such tragedies.

 

If this really is the state of our profession (and I think Thomas is

right that it is), we need to change this. If we don't awarding

ourselves doctorates won't make us doctors.

 

My two cents.

 

Bob

 

 

 

 

 

 

[Guest guest]

Dr. Sperber,

This is fine, but the examples Bob used were that of missing a testicular cancer

because

he didn't examine or breast cancer because no one would examine even to the

point of

obvious cancerous growths. Hearing phlegm, seeing redness is not the same as

palpation

for cancer. I agree that we should know and use the red flags but that is not

the same as

claiming that we can detect cancers. If, if a woman or man is not willing to go

to a doctor

who will do the exam or a man who will not do the same for a tesicular exam,

then yes, OK

have the acupuncturist do it. But, unless this is a speciality, what real

information are we

sending them away with?

doug

 

 

, " Dr. Greg Sperber " <greg wrote:

>

> Bob, I couldn't agree with you more. I teach physical exam and my motto for

> my students is that you can't treat what you don't exam. While there is a

> malpractice role in this, it is just basic medicine. How do you know if a

> patient is getting better or worse from your treatments? This is the basic

> question a medical practitioner of any specialty needs to answer. And the

> only way to answer that is through physical exam. Now, in our profession

> that obviously includes TCM techniques, but we live in western society,

> therefore it must also include other exam techniques.

>

>

>

> As an example and hopefully to start a discussion, I believe that treating a

> cold without listening to the chest, feeling the lymph nodes, and looking at

> the throat is malpractice. We need to listen to the chest to rule out

> walking pneumonia, something very easy to do. Looking at the throat can rule

> out, for the most part, strep throat which can progress to rheumatic fever.

> And feeling the nodes is simply good medicine. So we need to do these exams

> to rule out red flags. That doesn't mean we can't treat some of these

> conditions with TCM, but we know we better do it well and quickly, and if we

> don't see results rapidly, they need to go their doctor.

>

>

>

> Finally, I tell my students that every biomedical physical exam can be

> useful to TCM. If someone has a red throat, they have heat. If there are

> white or yellow patches in the throat, it is probably toxic. If the lungs

> have extra sounds, there is probably phlegm.

>

>

>

> My two cents.

>

>

>

> **************************************************************************

>

> Dr. Greg Sperber, BMBS, DAOM, MBA, L.Ac.

>

> California Licensed Acupuncturist

>

> Diplomate in Oriental Medicine (NCCAOM)

>

> Greg

>

> ***************************************************************************

>

> All,

>

> " As I am not in the habit of doing breast examinations, I couldn't say

> with absolute certainty the size of the lumps treated. I have always

> taken for granted the patient telling me that they had lumps. Right or

> wrong, this is the state of our profession. "

>

> I agree, this is the state of our profession. But it definitely is wrong.

>

> Twenty or so years ago, I had a student. He came to see me one day

> because he said one of his testicles hurt. I did a CM pattern

> discrimination and diagnosed cold in the lver channel. I gave him an

> herbal Rx and the pain was better as long as he took the herbs. I did

> not palpate his testicles due to embarassment. By the time he was

> diagnosed with testicular cancer, it had metastasized to his abdomen.

> The good news is that he is alive and well today. He's even an

> acupuncturist. The bad news is that he lost a testicle and went

> through some pretty rough chemo. His parents also tried to sue me for

> every thing I and my family had. The only bright spot there was that I

> didn't have anything for a lawyer to win. So they couldn't find a

> lawyer to prosecute the case. This was before we had mandatory

> malpractice insurance here in CO.

>

> What I learned from this: If we are going to practice medicine, we

> have to behave like doctors, and that always means palpating any areas

> in which the patient says she or he has symptoms. If the knee hurts,

> we have to visually inspect and palpate the knee. If there is a breast

> lump, we have to palpate the breast. If that means having a chaperone

> in the office, so be it. In the Netherlands, they have a saying that

> goes something like this: Soft doctors make bad sores. The meaning is

> that a doctor has to do what a doctor has to do without being

> squeamish, prudish, or embarassed by it. Otherwise, patients may

> suffer even greater disease. In China, all my teachers in clinic

> always palpated any area of concern. If we're not willing to visually

> inspect and palpate a woman's breast who says she has a lump or lumps,

> then we need to stop treating women with breast problems unless there

> is a confirmed diagnosis by another licensed health care privider.

> However, even then, I think we need to look and feel for ourselves in

> order to really understand the patient's situation. What if the other

> practitioner was wrong or the patient's situation had changed since then?

>

> I have felt several women's breast cancer tumors who lived in denial.

> They had large, plaque-like tumors like a piece of a turtle shell,

> just like what Zhu Dan-xi describes. They had all refused to go to

> Western doctors for fear of the true diagnosis (and prognosis).

> Instead, they had gone to macrobiotics, homeopaths, acupuncturists,

> etc., none of whom had palpated their breasts. All these women are now

> dead. By the time they were diagnosed, their tumors were very advanced

> with lots of metastases. According to Zhu, by the time I palpated

> their tumors, their cases was already hopeless. All were relatively

> young, married, and had children. Such tragedies.

>

> If this really is the state of our profession (and I think Thomas is

> right that it is), we need to change this. If we don't awarding

> ourselves doctorates won't make us doctors.

>

> My two cents.

>

> Bob

>

>

>

>

>

>

[Guest guest]

I know a chiropractor 'doctor' that doesn't take blood pressure so he

doesn't get sued in case a patient has a heart attack. I'm sure that

would make great $ense to a jury of 12 reasonable people.

 

Geoff

 

, " "

wrote:

>

> Dr. Sperber,

> This is fine, but the examples Bob used were that of missing a

testicular cancer because