Do we need to know Western medical diagnosis as TCM docs? Is not knowing puting our patients at risk?

Hey Lorne

I think that the question is too simplisticaly worded, way too black and white. Did you mean should we all be western MD's to practice better. We all learn basic western anatomy, physiology and pathology in school anyway, did you mean more than this general level of knowledge. Obviously it helps us communicate with our patients better if we can use and understand the same lingo that their MD's use or that they find on the internet, especially if we specialize in something like fertility with lots of very specific medical terms that your patients throw at you.
As well I don't think anyone would argue that more knowledge is a good thing, but at what point is enough enough. Yes if we were all MD's, ND's, DTCM's, ayurvedic doctors and homeopaths that would be awesome. But we are not, and there is not enough time in one lifetime to accumulate all the "necessary" medical knowledge out there. When do we just focus on using the knowledge of a very sophisticated, flexible and effective medical system that we we all trained in to treat our patients?

Kaleb

I was going for the KIS principle (Keep it simple) and not trying to complicate the question.

Personally, I think we can provide a better service if we have a good working knowledge of CLINICAL western medicine. I not discussing the academics of what we learn in school. I am asking about how can knowing western medicine not only make us more effective in clinic (using TCM) but also keep our patients from unnecessary harm.

I think our medicine is deep. And I treat using TCM. Recently I have had some conversations with TCM students. Somewhat idealist and think they should not and do not need to know western med. They believe they are better off not being "contaminated"by western medicine and their patients can be completely and fully taken care of with TCM.

I am wondering what others views are. Should we pretend that we are in the year 1500 AD or 2008 AD? My personal views are obvious from the post... but if not I will state them here more clearly.

I believe TCM can treat many conditions well. I also think western med offers incredible diagnostic tools. I like to take advantage of the modern technology. I still to prefer to treat with TCM unless I know western medicine offers a better treatment option that is also safe I also think that I have helped many of my patients from unnecessary complications. I will post one of the stories in another reply.

Basically, I do not treat TCM as some dogma. I ask myself "what is in the best interest of my patient". Knowing what western medicine can also offer (diagnostics and treatment) allows me to help my patients be more informed and therefore they can make more informed choices. I look for the best practices of both medicines. I practice using TCM though. But it has been my experience that although we can treat many people and conditions better than western medicine.... western medicine docs can also treat many people and conditions better than I. Often, yhe integrated combined results works best and the people I see really appreciate having both modalities involved in their care.

Lorne
www.acubalance.ca
www.prodseminars.com

this topic comes up frequently in TCM user groups...
often the arguments "For" leave something out (IMO)

like this...
Lorne said:
I believe TCM can treat many conditions well. I also think western med offers incredible diagnostic tools. I like to take advantage of the modern technology...
I look for the best practices of both medicines...

isn't this saying that patients should take advantage of both systems and that neither system should discourage someone from benefitting from the other?
It doesn't really argue that a TCM practitioner needs to know much about modern medicine. Clinical experience should inform a practitioner that the patient's condition is serious and refer out...but it doesn't really require that one have much working knowledge of biomedicine.
When "taking advantage of the modern technology" what do you use from this to guide your decisions? Don't these lab test results by their very nature guide a practitioner to a biochemically defined decision?

So, I absolutely agree that modern medicine has a huge value and many. many people are alive today because of this "modern miracle". But what I never get from the argument is why one person should pursue clinical expertise in 2 systems that are perhaps antithetical?

I agree with the proposition that there is so much to be learned and understood in Chinese medicine that those wishing to become great need to focus their time and effort learning this medicine and leave biochemical allopathic thinking to those trained in that paradigm.

joe

Hi Joe,

It comes from clinical experience. Knowing that a condition can be serious and what steps the patient needs to take to be properly assessed can make the difference. I need to clearly state that I am the biggest proponent of TCMers developing their skills. I believe this so much that I founded www.prodseminars.com. We must master our medicine. I also think do no harm and also practice patient centered medicine. Thus having a very good clinical knowledge of western medicine will also benefit your patients. Just like in TCM there are many average or less than average practitioners. The same is true for medical doctors. The cases that come to mind for me should have been caught by their MD but it was not and as a result their medical care was mismanaged. It was my clinical knowledge of western med not my TCM that turned the cases into a happy ending. I have to say this one more time... We need to learn and master our TCM skills. I have a different opinion from those who think they should practice as TCM purist and do not want their patients to seek out western medical care. If I was seeing a menopause woman with break through bleeding. I would not only diagnose and treat her with TCM but I also would refer her to her MD to be assess to make sure that she does not have ovarian or uterine cancer. I work in Canada where the test would be covered by our system but again the students i was talking with are also Canadians so that cannot be the reason.

Lorne
www.acubalance.ca
www.prodseminars.com

HI Lorne
Maybe due to my lack of communication skills I didn't present my position clearly....sorry.

I agree that clinical experience will lead my understanding of a case and signal me to refer out. Your example is perfect...any abnormal bleeding should be screened by an MD. I always verify with my patients that they have/are consulting their MD for their condition. Even recalcitrant insomnia might be a red flag for a more serious condition. My question is: do I really need to have advanced biomedical knowledge to know that abnormal bleeding needs to be screened? I don't feel that I do...I know to refer without any detailed understanding of the biomedically defined pathophysiology of that condition as I am not going to apply any treatment based on that. I just need to recognize red flags and be open to refer...if I sounded like I thought otherwise, I misrepresented my position....or perhaps I misinterpreted the question.
Wasn't the poll question about whether TCM practitioners needed advanced clinical biomedical training?
My position is that we only need to recognize red flags like your example. (this might be strong support for specialization to be more in tune with red flags of some given conditions)

As far as Pro d Seminars...when I stated that I believe that TCM practitioners should dedicate their study and clinical focus to TCM, I did not imply that you weren't supporting deep knowledge of TCM. I was only giving my reasoning as to why I believe we should leave biomed training to biomed practitioners and focus our efforts to the deep wellspring of this medicine. I don't believe that any biochemical analysis from a lab should guide one's TCM clinical decision making...ever. Kudos to you for creating a venue where practitioners can continue their studies!

As for your statement:
I have a different opinion from those who think they should practice as TCM purist and do not want their patients to seek out western medical care.
I believe that any practitioner who would resist (much less fail to encourage) patients from benefitting from modern medicine is flirting with the real meaning of malpractice. My own father would have passed decades ago without emergency care and modern surgery...to fail to guide our patients to make proper use of this resource is inexplicable IMO.

I do believe that we should practice as TCM purists, but incorporate MDs when appropriate. When I refer someone to their MD, I am not saying goodbye...only bringing another skilled practitioner into the mix...I still work with the patient...doing what I do.

I respect that your path has brought you to different conclusions than mine has brought me...I am fine with agreeing to disagree...who knows, in 5 more years both of our opinions might be opposite of today

Joe

just before hitting "post"....I guess my ideal would be large hospitals offering both systems and patients being helped by ALL.

I agree with your post Joe. It is an integrative model. We are fortunate at www.acubalance.ca to have over 10 MD's some specialist that we can call, or email for advice and immediate referral out. Actually 5 of them post on our clinic forum to provide a western perspective and the TCMers at Acubalance provide the TCM side.

I am in favor of integration. It takes a lot of time and energy to make it work though. The two modalities do not always agree (obviously). So why I think we need to know western med too is because when our two medicines disagree on what is best for the patient how do you then guide your patient's best interest. For me, knowing what test can be performed, how the patient would be treated based on test results, and the possible treatment outcome allows me to help coach my patient. By me being more informed it allows me to help my patient be more informed.... and therefore make an informed decision. In most cases your point about just referring out will work. But you point about "Even recalcitrant insomnia might be a red flag for a more serious condition." is not taught in TCM is it? So although it is common sense to you it is not to all who practice unless taught or picked up in clinical practice.
I am not having a philosophical discussion for others who are reading our post. I am talking practical applications in clinic. So I am not suggesting auditing western med classes. My western knowledge has come from discussion from MD's TCM courses that discuss the biomedical side (Jane Lyttleton does s great job of this in her course), and the desire to learn from patients who come to me with their lab test and recommendations from their MD's. Clinically it is imporatnat because you will see a red flag or reason to refer out (I am usually still treating them with TCM... they just need western med too) in order for the patient to receive better care than i can offer alone with TCM. As I had mentioned in an earlier post some docs are less than average or because of our medical system are too busy and too tired to diagnose and treat effectively so we need to become our patients health advocate. Clinically, I have had to contact their MD to request a test they were unwilling to give or have them seek a second western opinion for them to receive the care they needed. So my point clinically, is that we should keep our eyes and ears open and learn about what other modalities offer. And if you specialize as many now a days do in reproductive health then your patients will benefit from you also having more than a superficial understanding of the western medical approach to infertility.

The Poll came about as the students I was in discussion with were complaining that they had to learn anything about western medicine in their TCM programs. It should only be TCM and zero on western medicine except anatomy for point location and safety of needling. I think that is just not going to make them effective practitioners and I am just too busy to have to treat all the new grads patients in my city :o)

Lorne
www.acubalance.ca
www.prodseminars.com

I think it is very important to at least recognise "red flags". I have been very fortunate to practice as a midwife and TCM acupuncturist for 20 years providing care for pregnant women on our NHS, so happily it is available to all, and there are 3 of us in our hospital which is very unusual. If I may give an example from obstetrics, patients with cholestasis or cholelithiasis present with intense itching and this condition has been linked to increase in stillbirth if untreated. Yes it is fine to treat with TCM but they must have blood tests to diagnose whether it is this condition or just itching! There is a medication which they can take. I teach in the TCM colleges about this so TCM students are aware of this in their clinics. Sometimes the woman may not see her midwife or GP about this and the acupuncturist may be the first she has told. Working with her midwife on this builds relationships, opens doors and shows the acupuncturist to be knowing and responsible. Perfect! I will be running workshops on recognising obstetric emergenices at the BAcC conference in the Autumn and hope practitioners who treat a lot of pregnant women will go away more confident. This is hopefully the way forward for us all to grow. In my private practice I have had to do a lot of learning on Western infertility terminology, treatments etc. As a previous poster said, the patients come along with this stuff. Being aware of OHSS for instance is very important. I learnt SO much from Jani White's infertility seminars with Diane Cridenda, Paul Magarelli etc. So I agree with Lorne. It need not be too daunting to learn more about these things and can be taken to whatever level people feel happy with.

Hi Sarah,

I heard great things about your practice and teaching form both Jani White and Debra Betts. We Debra in Canada and the States recently and she sang your praise. I was with Jani in Palm Springs for the PCRS conference in April and again your name came up.

I appreciate your post. Intense itching in pregnancy as a possible red flag is new to me. So again, I know this new western medical knowledge will eventually help me help another patient. And it si true, this creates incredible trust form the patient when you catch something like this. I too have noticed that referrals form these patients increase when you demonstrate knowledge not only in TCM, but western medicine as well.

I think you have a book out or at least published? Where have I read your material as I know I have seen your name on at least two texts related to TCM and pregnancy in the past.

Lorne
www.acubalance.ca
www.prodseminars.com

I see these discussions going on all the time between the west/ east. That there is some huge polar difference between them. Sure in many ways the approach to diagnosis and treatment can and does differ greatly but in many ways the two medicines cannot be seperated and work beautifully together. I really feel that the advances of western medicine has allowed practitioners of chinese medicine to get better and safer results.

Last January I attended a training workshop with Mazin Al Khafaji on the tx of autoimmune and allergy disorders. Mazin is so good at teaching topics that he knows he has had clinical success with and so the training is very useful and deep. One thing that Mazin insists on in his clinic is the regular testing of liver enzymes before and during the use of Chinese herbal medicine. This is to help avoid idiosyncratic reactions to the herbs and as well better his clinical outcome when using the more toxic herbs.

For example, in the treatment of Rhuematoid arthritis the very toxic herb Lei Gong Teng becomes primary. Lei Ging Teng is very effective in treating this condition, but its use has to be done with extreme care. The side effects can be similar to the western med Methatrexate, but usually offering better results. Lei Gong Teng reduces white blood cell counts and can elevate liver enzymes. Mazin makes sure that all his patients on this herb have regular blood tests for safety. He feels that it is an act of incompetence to NOT do blood tests if a practitioner is using this or other toxic herbs. Lei Gong teng is extremely effective and is worth using in practice as it can alleviate many peoples suffering, but if a patient is not properly monitored while using it, the risks can be very high and can out way the benefit. In this situation it becomes critical to have an understanding of western biomedicine to practice effective and safe Chinese medicine.

Sure there are other methods to treat RA but, from practicing Chinese medicine for so long, Mazin realized that for the severe recalcitrant cases there is nothing better than Lei Gong Teng. And instead of fearing such a potent herb, he decided to learn how to use it safely. Now he rarely ever sees a problem with its use, but on the contrary sees many people getting better.

The story above in regards to full body itching and pregnancy is another good example. It is interesting timing, but my wife who is training to be a midwife is now in the process of inducing a woman with cholestasis or cholelithiasis whose only complaint was severe body itch with no rash. I can just imagine some acupuncturist trying to convince this woman to come in 3 times a week for treatment without recommending any western test. While in the mean time her baby is literally dieing. I mean if one does not have some level of western knowledge in regards to the type of problems specific to the disorders that we treat, it literally can become life or death for these people.

In diagnosing and treating skin conditions it becomes important to have some understanding of biomedicine as the test will help guide the chinese medical treatment. For example some fungal conditions can look like a form of eczema or even psoriasis. In these situations a little scraping can be preformed and then analyzed under a microscope to see if there is any mycillium present. Since the primary treatment for fungal conditions is using external formulations (even with no internal remedy), a patients time and money can be wasted if the fungal condition is not properly diagnosed and the practitioner uses internal remedies without any external. In fact a fungal condition that is treated like eczema can in fact become worse.

I can think of many other examples of how western based knowledge only deepens our ability to practice Chinese medicine safely and with better results. The two mindsets are not really two, but one large system called medicine. They can and do co-exist together for a reason. If someone told me that I don't need to use my modern magnifying glass when looking at someones skin problem in order to practice pure Chinese medicine, I would say that "they were crazy!!"

Trevor

Thanks Trevor. I agree with your comments and feel that in this way lies growth .However, this is not the feeling of all acupuncturists in the UK, so hopefully these discussions may help.
With best wishes, Sarah

Thanks Trevor. I agree with your comments and feel that in this way lies growth .However, this is not the feeling of all acupuncturists in the UK, so hopefully these discussions may help.
With best wishes, Sarah