Protocol Angst – Diamonds in the Rough

Yesterday I was in the TuiNa massage department doing what I usually do: watching patients get their backs’ rubbed down and their spines’ and necks’ cracked.  Around four o’clock, one of the orderlies asked me to work on a middle-aged guy with low back pain.  They weren’t expecting a whole treatment from me.  Typically, the students warm up the patient and practice some basic techniques and then the doctor comes in to do the fancy stuff, which includes some chiropractic adjustments and a few moves that aren’t in the textbooks.

So I started working on this patient and got to thinking, I’m going to do the whole thing – I’m going to give him the same thirty minute treatment I’d give in America.  Deep tissue.  Get in the muscle.  Stay in the muscle.

I worked on him for a bit and then I found that his piriformis muscle was super tight, super sensitive. I worked on him a bit longer.  Loosened him up.  Went for deeper techniques.  Still sensitive.  I got all sweaty.  I slowed down when the treatment started to feel finished.

Eventually, the doctor came over and started doing his thing.  Now I’m interested.  Now I want to see what he’d do that’s different from my style.  But no – he did the same low back treatment I’d seen him do on so many other patients.

I talked to his student and told him that in the US, this would be piriformis syndrome.  The IT band is tight.  The QL is tight.  The piriformis is crazy tight.  Guy probably has an office job or drives all day.  I told him that in America we’d give him stretches to do and talk about lifestyle changes.

The doctor looks up from treatment and tells me This isn’t piriformis syndrome – it’s low back pain from the third lumbar vertebrate.  I get that “lose face” kind of feeling and wonder if I spoke too loudly or spoke out of turn.

Don’t worry about it, says the student.  Different doctors have different understandings.   Actually, I’ve only seen 3 cases of piriformis syndrome at this hospital.

At the time, I didn’t think too much of it.  I was disappointed that the guy got up and left without any talk of stretches, but at the same time, it’s not a big deal right?  The doctor knows more than me.  After all, he’s the teacher and I’m the student.

And yet – slowly, slowly – this whole situation has been playing over and over in my head, and I’m questioning the whole thing.

You know, the acupuncture department had a lot of protocols for low back pain, insomnia, facial paralysis, etc, but at that time, all I could think of was Hey, maybe we’re wrong in the States. Maybe this acupuncture stuff isn’t too complicated after all.  But now, I’m seeing how this doctor works in the TuiNa department and I’m realizing that these are protocols too.  Wide nets to catch common problems.

Sure, we’ll hold the x-ray up to the light and point and nod about this disc and that disc, but the treatment is basically the same.  Massage the spine.  Pop the neck.  Crack the back.

I ask my Chinese classmate about all this and her response is Too many people. Not enough hospitals.  High pressure.  Bad bureaucracy.

Okay, I get that.   Still, I think the problem is – at the end of the day – mediocrity.  I can’t blame the textbooks.  I can’t blame the education system.  At this point, without any knowledge of how complicated insurance billing and record keeping is, I can only blame the practitioner for stopping short of a complete treatment.

I can say this because I’ve seen good doctors at this hospital.  There’s a TuiNa specialist that the other group of ACTCM students are following and he’s amazing.  He left the TuiNa department to have his own clinic within the hospital.  He’s busy and his diagnosis and treatment appear much more specific.

There’s also the head of the cardiology department, who is – day by day – more and more awesome.  His desire to do research, to use biomed concepts with Chinese formulas, and to talk at length about the modern struggles of Chinese Medicine – all of these elements make me know that he cares, that’s he’s not satisfied with half complete treatments and half complete results.

In fact, this cardiologist (did I mention he’s awesome?) says that Chinese Medicine’s biggest problem is Chinese people.  Not patients but practitioners.  At this point, Chinese either trust the medicine too much or don’t trust it at all.  They want to make good research but they often fail to show clear results.  The world is interested in what the medicine can do and yet no one can offer a clear picture.

He says that most hospitals have different departments with different doctors at different skill levels.  Patients come in to seek good treatment but rarely know who’s good and who’s bad, who’s effective and who’s scraping by.  As department head, this cardiologist says that he’s trying to build his own team of top notch physicians, so that everyone on his staff is at a high level.  He says that people don’t think it’s possible to have a hospital full of experts anymore.  Because people don’t expect it, it’s not there.

So yeah, I’m getting a little jaded with this hospital, but at the same time, like many of the patients, I’ve found some glimmers of light in this old place.  I’ve been lucky, and even when I’m not lucky, I still find something interesting, something I could use or at least talk about someday.

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