I Shadowed Dr Kuo, Dr Ho and Dr Liao in the past 2 days...
It was my 2nd day with Dr Ho yesterday and he managed to see 45+ patients in 1 afternoon. Dr Ho specializes in musculoskeletal pain and acupuncture treatments. I had the chance to see one of the main differences between clinic hours over here in a government hospital versus one in the States. Patient facetime with the physician is no longer than 5 minutes, but he managed to diagnose, and sometimes even treat their acute muscle pain in such short time. On top of that, he only had ONE assistant. Patients here though do systematically follow their number/order given by the front desk when they first check in, so they would just walk into the doctor's office once their number is called. In the States, however, most patients will have their own room and the physician will be the one walking into different rooms to see their patient instead (mostly due to privacy issues). Dr Ho showed me how to diagnose and treat musculoskeletal pain in 5-10 mins since many of his patients most commonly visited him for shoulder and LBP. He mentioned that he does not know the name of the technique and there aren't specific points that the physician presses on the patient, it's all based to palpatory skills and filling abnormal tissue texture and use limbs as a leverage, inducing motion front and back to release the tension of the muscle. Areas that he palpated for diagnosis include: cervical, side ribs, iliac crest, diaphragm, front 2nd rib and midline of thigh. These landmarks are very similar to those we use for OMM screening, except he is focusing on feeling the texture of the tendons and fascia instead. He also checks the level of medial malleolus, iliac crest and tibial tuberosity, which are also general landmarks that osteopathic physicians use for dx. There are definitely a lot of similarities between osteopathic physicians and TCM physicians in terms of diagnosing musculoskeletal syndromes. Dr Ho also used 皮内针 which is a type of short acupuncture needle (<0.3 inch) that is placed at the "knot" of the muscle/tendon w/ 3M tape on top of it, and can leave it on patient for 5-7 days. It gives immediate relieve and patient can remove the needle themselves by simply pulling the needle away. It was used to treat a patient who had thoracic/lumbosacral neuritis/radiallitis as a side effect from L4-L5 surgery. The basic concept of this technique is to "push" (推散) the knot.
Dr Kuo
Dr Kuo specializes in treating PND, nose bleed, migraine and dysmenorrhea. One interesting case that I have encountered was: 48 y/o 11 mo female PMH of sleep apnea CC constipation and symptoms of common cold. Western doctor normally would advice patient to eat more banana for constipation but Dr Kuo told the patient to avoid banana (and watermelon) as it will exacerbate the common cold even more and it will take longer for the patient to recover. He mentioned that there are no scientific evidence for the theory but there are a lot of clinical evidence to support it. We also went through the pathophysiology of migraine (Dr Kuo kindly prepared a ppt in English for international students) and discussed on the different viewpoints of TCM vs Western medicine on the disease. He said that in general if a patient presents w/ headache WITH photosensitivity, phonosensistivity AND nausea, the patient is defined to have migraine. Western doctors in Taiwan generally will prescribe acetaminophen as 1st line therapy, and if the patient does not improve they will then prescribe ponstan/NSAIDs/paracetamol, and lastly in the worst case Cafergot (ergotamine) + muscle relaxant and/or anxiolytics. Things that Dr Kuo suggested as triggers for migraine includes not drying the hair immediately after shower (he mentioned that it is MCC), women who did not stay home for a least a month after giving birth (chinese people refer it as zuo yue zi 坐月子). Chinese really stress about zuo yue zi after pregnancy while people in the States generally only have 2 weeks maternity leave.
Dr Liao
I asked Dr Liao in regards to how TCM physicians choose to use electroacupuncture. There is in fact no standard protocol for electroacupuncture, it all depends on the physician's preference and the body type/quality of the patient at that moment. To simplify, electricity is used more for acute cases, and also for patients with a "stronger" body. He simplified it as a concept of deficiency vs excess syndrome. We also saw a 39 y/o female who has PMH of premenstrural tension syndrome and uterus cysts of up to 5cm since last year. She has been seeing Dr Liao for the past 6 months for infertility. According to Dr. Liao, this condition is really common in Taiwan and its prevalence is up to 15%. She started her acupuncture treatment this week focusing on replenishing her "Qi" (補气) and increasing circulation (treatment consists of 6 sections to be performed all within 1 month).
Many patients will be taking both Chinese and Western medicine. For example, a diabetic patient w/ hyperlipidemia taking western Rx for controlling blood sugar and cholesterol while taking Chinese Rx w/ acupuncture for joint pain and swelling. I have also realized that all Chinese doctors always ask about the quality of the phlegm, including the color, consistency, shape, whether or not pt is able to cough it out, while doctors in the states don't usually emphasize too much about it. Tomorrow is going to be my last day at the TCM department. I wish I will have a chance to stay longer and at least get a good grasp on Dr Ho's technique on treating musculoskeletal pain...
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