People who know me from this blog or via my other social media platforms probably already know this but…August and early September are the beginning of board exam season for me. I’ve been practicing traditional Chinese bodywork and providing mind-body health and wellness coaching for the past couple years but my program was designed to have me end up as a licensed acupuncturist. That involves a four and a half year program of study that includes quite a bit of clinical internship and board exams. Yesterday, I sat for and passed my Evil Western Biomedicine board exam and this is important–for you, and for anyone who goes to see a licensed acupuncturist.
Why is this?
People who know me in any capacity also know that I have a smart mouth and that I love making funny nicknames for things. Hence, the Chinese Iron Thumb of Doom (not to be confused with the Gentle Sicilian Thumb of Love and Kindness) that I wrote about in my essay following a volunteer project with Austin’s own Hill Country Ride for HIV/AIDS, here. The same goes for the Evil Western Biomedicine aspect of the board exams. (Next up? Foundations of Benevolent and Virtuous Chinese Medicine, of course). I do joke around a lot, but it’s a serious topic. For one thing, it matters that your licensed acupuncturist has a solid understanding of biomedicine. It also is important for you to know what their attitude towards allopathic practice is because this factor will make a difference in what kind of care you get. In this essay, consequently, I am going to talk about the preparation of acupuncturists and how their individual philosophies might affect your experience as a patient.
One thing that your licensed practitioner will want you to know is that yes, we do study Western biomedicine during our programs. There are a few musty stereotypes still swirling around, but the reality is that not all acupuncturists are granola-crunching tree-huggers. Some are, sure, but they had to take the same biomedicine classes everyone else does. In essence: we are not voodoo practitioners who move a magical fairy substance known as “Qi (pronounced chee)” as it is so often described in popular press. Qi is an umbrella term, and so is the notion of yin and yang. That balance that sounds so mystical? Eh. Western medicine has homeostasis and we have yin and yang balance. It means that you don’t have too much of one thing and too little of another. (The semantic value of that statement is subtle and nuanced and worth at least six essays, which will of course be forthcoming.)
In brief: one of the major barriers to Chinese medicine is, in part, due to syntax. Some things aren’t well translated. In the popular imagination, some things end up sounding a lot more groovy and akin to shamanism than they are in reality. And in reality, Chinese medicine is a system and, as a practice, it goes well beyond what language and cultural barriers have presented to the everyday imaginary regarding issues such as balance and the movement of Qi.
In actual reality, different practitioners will focus on different things and their treatment strategies may be based on different philosophical ideologies. Some tend to be more spiritual, others less. But we all have to study, we all undertake a considerable course load to gain a solid mastery, and we all have to pass a Western medicine board exam. When physical therapists who practice dry needling try to act as though we are witch doctors who “move qi (pronounced chee)” and they are actual science-based professionals who know real live actual science, that’s disingenuous to say the least.
(Side note: When it comes to needling? It’s really a lot safer to go to someone who has spent years practicing the art and science of correct and effective needling. We don’t work just from outside inward by jabbing at trigger points. We are trained to view the entire body as part of the dialogue and we treat accordingly. But that, too, is another essay for another day. This one is about why you should care that I (and others) are required to pass a biomed board.)
Acupuncture as a profession is undergoing some shifts right now. From a fringe element, it is now becoming more and more mainstream. What this means is that there is a large swath of practitioners who are actively integrative because they work in hospitals or as part of a medical team. Some people come to acupuncture school already a licensed nurse or therapist of some sort. There is no lack of practitioners who adhere to evidence based medicine and integrative care. On the other hand, there is an equally large portion of the population that really does not want to have anything to do with Western biomedicine. They still have to sit for the board exam but that’s about it for them. Their patients tend to not want to have anything to do with Western biomedicine either. Finally, there are those in the middle who make good use of what each branch of medicine has to offer. As we say in Spanish, for every pot there is a lid.
In my own case, I am not that unique in my inspiration to become a Chinese medicine practitioner. In essence, I came to Chinese medicine because Western allopathic care just doesn’t work for me. I always had things that were deemed idiopathic, mainly odd skin things but a few random others that were no kind of fun. I rarely got sick but it was always something quirky if I did. If I took any pharmaceutical drug, I always got the weird rare side effect. Always. In fact, when I took the required Pharmacology course we studied the same books that a future pharmacologist does and I felt like I’d have a stroke from rage on more than one occasion. How many times did I tell my MD that I had a reaction to a drug, only to be told that I was imagining things? And how many times did I have a reaction to a drug and not complain because I wondered if it was “just me”? Well, reading the textbook and seeing “A rare adverse effect can be [fill in the blank with EXACTLY what I experienced]” made me furious.
I had long since given up on Western medicine by the time I discovered Chinese medicine because in my experience allopathic medicine was useless at best and it made me sicker at worst. And when I found Dr. Fan, that was it for me. The ear ache that I had for fifteen years that one MD after the next said was maybe allergies and potentially because I had jaw tension? Dr. Fan fixed it in two treatments. My foot problem that no less than three different orthopedic surgeons in three different states over the course of a decade said would only get better via surgery? Oh, Dr. Fan fixed that easily too. And so forth.
But that’s just me. I am in the camp of folks for whom Western medicine doesn’t really work. There are just as many of us as there are those who need Western medicine and who probably wouldn’t care for Chinese healthcare.
Most people are in the middle of these two opposing ends of the spectrum. The majority of people are well-served by having resources in both camps. It depends on health, health concerns, and resources. Again, this is a whole other (and long) essay but what matters for the purposes of this essay is that I raise questions about your comfort level with your practitioners, both Chinese and Western. Think about it. Doesn’t it matter that your practitioner is on the same page as you are regarding your needs? If so, a couple more questions are in order. Essentially: Can you speak to your practitioner about this topic? Does your practitioner give you options?
The term before my final one, I was in clinic and had to borrow a stethoscope and blood pressure cuff from a fellow intern for an initial appointment. When I asked, her treatment partner asked, in scandalized tones, if I didn’t take blood pressure every time. I said that I do not. She was horrified and said so. My response? In Texas, the law is that we take blood pressure for the first visit or if the patient is there for anything related to heart health and blood pressure. Otherwise we are not required to take blood pressure. She looked at me like she wanted to say “Get thee behind me, SATAN” or some such and I shrugged. I told her that if I went to see Dr. Fan and he took my blood pressure every time I went, I would feel like I was at an Evil Western Physician’s office and if I wanted Evil Western Medicine I’d go to an MD. But I don’t. I want Benevolent and Virtuous Chinese Medicine, thank you very much. Oh, she looked at me like I had horns and a tail!
Interestingly enough, a couple days later one of my regular student clinic patients came for their weekly appointment. When I took their pulse (and pulse taking is an art in Chinese medicine, one that takes years to master), I felt that something wasn’t right so I did follow up with a blood pressure reading. The patient did in fact have a blood pressure issue that we addressed. But even without the BP reading, I knew that there was something that needed attention. The stethoscope and cuff (borrowed from the front desk, I confess) only confirmed what I already figured from a careful pulse reading. It also served to demonstrate to the patient, in a way that they could understand, what was going on with the blood pressure and to urge them to discuss the matter with their MD. In this situation, it was certainly appropriate for me to make use of Western biomedical tactics for this patient. To not have done so would have been remiss.
I don’t like Western medicine for myself but I firmly believe that it should be available to patients. Patients should be educated consumers and self-advocates for their own health and healthcare. If a person prefers Chinese medicine, that’s great. If they want integrative, that’s fine too. If they want Western-only, well, I think the person is missing out, but ok. My responsibility is to the patient, above all. And that being so, I do need to know Western medicine. If a patient has a brand-new, crushing headache like nothing they’ve ever had before, or maybe there’s suddenly some unilateral weakness and transient numbness, I do need to know that there is about a three hour window to minimize stroke complications. If someone has ankle swelling and difficulty breathing when lying down, it matters that I know what the signs of congestive heart failure are. I need to know what cancer signs look like and it is important that I know herb-drug interactions. And that’s just in the case of emergency.
In some cases, a full lifestyle change plus Chinese medicine would work for a patient much better than Western drugs. This is so for pre-diabetics and low-end high blood pressure cases. But if the person cannot change things (which happens–if it were all that easy, then nobody would have diabetes or high blood pressure) then they need to be realistic about the place of Chinese medicine in their routine. And, in response, they should be able to trust that their practitioner has an idea of what is going on for them in the allopathic setting. There are a lot of things that Chinese medicine can do that Western medicine cannot, but some of it requires adherence to herbal regimens, for instance, or regular treatment that may be slower than the outcome of a visit to an MD. If the patient is not willing or able to take the time and energy to go through all the steps then it may well be best for them to either go with Western allopathic care or, at the least, take a well-informed and integrative approach to health management.
After my four and a half year program and a board test to demonstrate my biomedical knowledge, I can say with confidence that I have a solid level of competency and professionalism. If and when I’m not certain, I have a network of senior practitioners in Chinese medicine who are generous with their knowledge. I also have a small and growing referral network of other providers that includes Western MDs, licensed psychotherapists, and naturopaths. Personally, Chinese medicine takes care of all my needs and it takes care of many of my patients’ needs too. But they deserve to feel safe and to to feel like they can trust me. My patients should feel like I pay attention and know when to refer in response to medical red flags. I have had some amazing patients who came to me because their MD felt that Western medicine didn’t have answers for them. It goes both ways. I send patients to MDs, too.
This is why it matters that I, and all licensed acupuncturists, take a board exam in biomedicine. It is a rite of passage that shows you, the patient, that even if you don’t want Western medicine, we still are looking out for your best interests. It is the culmination of a process that puts us at a level of professionalism equal to other healthcare providers that may seem more mainstream AND, on top of that, we do have all our training in correct needle technique. We’re not witch doctors. We’re knowledgable medical care providers. We have our own traditions but we’re able to converse with others. Some times, what we have to offer is much better for you; in other situations, the Western MD is far better. It really all depends.
Knowing about Western medicine does not somehow validate my training in Chinese medicine. Chinese medicine stands tall on its own, thank you very much. However, what it does signify is that I am ready and able to engage with biomedicine for the benefit of the patient. I have gotten referrals from an MD who has sent quirky cases to me–people like myself who don’t respond well to allopathic care–and I’ll refer the ones who aren’t responding well to my school of thought to the MD. This is how it should be, and this is how we can work together to provide the best care for you, the patient.
And that, dear reader, is why you should care that I just passed a board exam just as all licensed acupuncturists must do.
And on this note, it is time for me to get back to revising for my Foundations board. While undergoing boards, as many of you know, I am still taking appointments for traditional Chinese bodywork, of course, and health coaching. For these, check my services link. If you wonder whether bodywork is better for you, or if you’d be better served by acupuncture, take a look at my blog post on the subject, here.
Wish me luck!
(Update: If you had been wondering, dear reader….It’s summer of 2018 and yes, I am now a licensed acupuncturist!)
Paula Bruno, Ph.D., L.Ac., is a licensed acupuncturist and herbalist, an AOBTA-CP traditional Chinese bodywork therapist, and a wellness educator. She maintains an active and growing practice at her Austin, TX offices. Dr. Bruno is also available for distance appointments for wellness consultation or coaching.
In her first career, she was a Spanish professor.
Dr. Bruno’s specialties as a traditional Chinese medicine practitioner include: • Musculoskeletal health (acute or chronic pain relief; Ehlers Danlos syndrome & hypermobility support) • Digestive support, gut health, and weight loss • Aesthetic treatment, including scar revision • Men’s health • General preventative care and immune support for all persons.
When you are ready to discover what traditional medicine plus a vibrant and engaged approach to holistic health can do for you, either contact Dr. Bruno or book an appointment online.
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Note: Material on this web site site is not intended to diagnose, prevent, treat, or cure any disease, illness, or ailment. A TCM practitioner in Texas identifies syndrome patterns but does not diagnose illness. Material on this web site does not purport to identify syndrome patterns.