By Kimberly M. Davis
Practicing Oriental Medicine in the U.S. needs to be about educating the patient as much as it does about treating the patient. As practitioners of TCM we have spent years learning a way of thinking about medicine that is essentially different and foreign to most of the western world. For this reason it is often of no surprise to us that our patients don’t understand what we are doing and how we are making decisions about how to best care for them. However, in order to get our patients to comply with our instructions, heal, and return to us for proper follow up it is imperative that as we treat them, we also educate them.
Certainly we can’t provide them a 4 year education in Chinese medicine, but we can and should educate them as well as treat their maladies. Often a first-time patient will come to us out of desperation or curiosity. If we do not sufficiently educate our patients at that visit, we may never see them again and may fail to fully open the door to the healing they desire.
As a student of Pacific College of Oriental medicine, rarely does a day go by that I don’t see missed opportunities for educating our patients. Patients who don’t understand our methods are patients who answer our questions inappropriately. It’s not necessary to give a time consuming explanation of every pattern or treatment you use, but it is necessary to give the patient some inkling of why we do what we do and what we are looking for.
Early on in each patient visit we ask a series of 10 questions. Frequently patients have no idea why we ask these questions or what we’re looking for. Simply telling them a bit more about what we’re looking for may be of tremendous help. For example, a first time patient might be asked, “How is your digestion?” To most Americans, “poor digestion” simply refers to any food that gives them indigestion. Most patients will answer my digestion is fine or telling you about a specific food that upsets the stomach. In reality we’re looking for more information than they are likely to provide by simply asking this question. Instead we might want to consider asking more probing questions such as “Do you feel you eat too much?” “Are you hungry all the time?” “Do you find you burn through the food you eat or do you find that regardless of what you eat you still seem to gain weight?”
Asking more probing questions such as these will help patients focus in on what we’re looking for. A simple explanation of why we’re asking a question or what a pathology looks like might also help patients elicit the responses we need. Doing so might also help patients discover that what they perceive as normal may just not be so. Take the example of bowel movements. Many of our patients may experience one every few days and believe this to be completely normal. Instead of just writing this down and using it to identify a pattern, I would suggest we tell them why having a more regular bowl movement would be advantageous. We should also explain to them how we will help them achieve this goal. An explanation might be something like “these needles I’m inserting on the legs will help with this or that’s exactly what this herb formula is intended to do.”
Still another area that needs to be addressed with education is herbs. Many patients assume that herbs, like pharmaceuticals, should be taken until the bottle is empty or taken indefinitely. Most often this is not our intention. We should be sure to explain to patients that as herbs build up in the body they may get the desired effect and that overdoing it will not be helpful and may indeed be counterproductive. Herbs may need to be discontinued at some point, either temporarily or permanently. We need to make sure patients know, that as their condition changes or improves, the herbal formulas they require will change as well. Therefore it is important to for them to get our advice as recommended. They should be advised against procuring additional bottles of herbs and taking them indefinitely or without adequate practitioner monitoring.
As student practitioners we should consider a clinic visit from the patients view as well as our own. Often students have a list of steps to check off that takes them away from the perspective of the patient. Every effort should be made not only to follow the clinic protocol but to notice what is happening from the patient’s perspective. Patients may not understand what a specific treatment is or what “Qi” or “dampness” is. A simple comment like “Qi is what we call the energy that moves things in the body” may be all it takes to give the patient a little better idea of what we’re talking about. Sometimes there is a tendency to talk over the patient’s head using our Chinese medical terminology. Doing this is really inappropriate, doesn’t impress the patient and often alienates them. Instead we should be using every visit to gradually educate them so they are better prepared to take responsibility for there own health. If we accomplish this, we will not experience fewer patient visits, but instead have patients visiting us when they should. Additionally we will find our patients recommending us to others as caring knowledgeable professionals who take the time to educate and explain things to patients in a manner they can understand and appreciate.