Patients....Who Are You?

Traditional Chinese Medical (TCM) practitioners look at the entire person when a patient arrives for treatment.  Our initial intake forms include questions that pertain to past medical history, familial medical history, current medical conditions, and lifestyle (drugs, alcohol, spiritual, emotional, sexual, exercise, etc) habits to understand who the patient is.  I was well trained to ask many questions of my patients and, quite often, some answers that initially do not seem of importance to them evolve into pertinent cluesfor treatment.  I recently read and recommend Dr. Benjamin Carson's book, Think Big.  Dr. Carson is chief of neurological surgery at Johns Hopkins, in Baltimore, MD.  Dr. Carson is an extremely intelligent, gifted and personable surgeon; but he is also a renaissance man - he has read more poetry, prose, philosophy, theology and sciences than most.  He is a humble man and proud of his accomplishments coming from a very underprivileged background.  Dr. Carson  speaks in his book about 'knowing who your patient is'.  I am a kindred spirit of this underlying philosophy.  A patient isn't a number, nor is the patient a statistic.  A patient is a human being who comes to my office seeking help for a health condition.  A patient places his or her well being and life in my hands with the trust that I will do everything possible to heal them.  This is a great responsibility and not to be taken lightly.   I believe that the more I know about my patients, the better I can serve them.  Acquainting myself with who they are, where they live, their relationships, professions, dietary habits - all these attributes contribute to a positive bilateral rapport with the individual and better trust in me, because they understand that the time I spend to know them better makes them special.  I become their 'family doctor' - old school style.  I will ask a patient the same set of questions I might have asked them two weeks prior during treatment.  Very often, they will remember something that is a valuable clue or insight into treating their condition. 

Case Study to Make a Point:  Patient X was referred to my office by her dental surgeon.  She arrived at my office with a chief complaint of chronic TMJ.  This patient was grinding her teeth and had bitten through two night guards within a month.  Her jaw was sore and offset from the constant nocturnal grinding.  During examination and inquiry, the patient presented with rapid and wiry pulses.  Her tongue was red and the tip was pointed (Heart heat in TCM).  I noted that the patient was inappropriately attired for a middle-aged woman.  She dressed more like a doll (frills, banana curls, bows) than a mature woman.  Excessive adornment on all extremities including the toes; she 'jingled' whenever she moved.   She laughed excessively for no reason (we note this in Traditional Chinese Medicine as a disturbance of the Shen or Spirit - a psycho/emotional disturbance).  Everything in her life was 'wonderful', according to this patient.  So, why the constant nocturnal grinding of the teeth?  She had no explanation.  She stated she had no stress at work, her home life was ideal, she was happily married and money was not an issue.  I treated the patient for her immediate complaint of jaw pain, but also addressed the psycho/emotional signs that were visible.  The patient was calmer and experienced great relief of her jaw pain immediately after treatment.  I suggested one treatment weekly for 4 weeks with a re-evaluation during week 4.  The following session (week 2), the patient presented with the same jaw pain.  She stated that the pain had subsided for 3 days and then returned Saturday morning when she woke up.  The evening prior, she had been grinding her teeth all night long.  Again, I asked the same questions:  Stress at work?  Anxiety? Rumination?  What could be causing this grinding?  I inquired about her schedule during the days between treatment and return of the pain.  Did she have dinner?  What did she eat?  Did she speak with someone who might have upset her?  Did she have nightmares?  All answers were negative.  Typically, this type of patient will speak of some stress or anxiety in their life that leads to nocturnal grinding.  This was a bit baffling.  So, again, I treated her for the pain and the psycho/emotional.  During this session, she laughed less and was less excessively giddy. This was a sign of the heart/mind calming down.  She made an appointment for a third session.  The third week, she arrived with the same story - she felt wonderful after treatment and, again...Saturday morning, she woke up with severe jaw pain.  I asked the patient what she did from Friday to Saturday morning.  She said she did the same routine every week - fish dinner home Friday night and working in her garden on Saturday morning...nothing more. She said they had no children, so weekends were 'nice and quiet'.   Date night with her fabulous husband was always Saturday evening.  Still perplexed by this return of the jaw pain, I decided to enlist a different point prescription for treatment.  To reach one of the points, I asked her to remove a charm bracelet she always wore around her left ankle.  When she removed the charm bracelet, I noticed a wide and deep scar near the acupuncture point I wished to needle.  I double-checked her medical history for any past surgeries to the ankle, as I did not recall her speaking of any surgeries.  There was nothing listed.  I asked the patient to please tell me how she received the scar.  Her smile faded, the giddiness fled.  Her response was that many years prior, she had one of the first legal abortions.  The father (her husband of over 30 years) and she were both young and could not afford to have the child.  They opted for abortion.  They were both from very traditional and religious backgrounds and this was a very emotional and traumatic experience for them.  During the procedure, the surgeon accidentally perforated her uterus.  She received over 6 pints of blood, given through the spot in her ankle where the scar is situated.  She had a hysterectomy as a result.  I asked the patient if Saturday evenings was the evening when she and her husband had sexual relations.  The answer was 'yes'.  I asked her if she had sexual anxiety and we spent some time speaking about how therapy could better serve her.  I recommended a good psychotherapist for her to speak about her past experience and sexual anxiety.  Approximately 6 months later, I received an email from the patient.  She no longer was grinding her teeth and, with proper therapy, she had come to terms with her experience.  She thanked me for helping her realize her pain, anxiety and for guiding her to the proper therapy for what ailed her.
The take home message here is this:  if you have a physician who really wants to know who you are, you are most likely in good hands.  If your physician spends all of 10 minutes with you and needs to look at your chart for your name or the reason for your visit - well, it's time to find a different physician.  You're not just a name or a number....you are a patient.  So, when I ask you 'who are you?', it's because I care.  Trust and rapport with your family doctor is a 'must' when it comes to healthcare!