Clinicians should measure and record treatment results of patient's primary complaint to validate the efficacy of acupuncture treatments. Preferably the measures should be objective. It is easier said than done to measure objectively in regards to acupuncture, but it can be done.
Some objective measures include testing range of motion and recording degree of motion, palpation of tissues to check if there was a change in tone, temperature, texture and tenderness, checking blood pressure and pulse (both Western and TCM pulses) before and after treatment. Posture could also be observed to see if there were changes relative to pre-treatment observations.
These are some of the ways of objectively measuring patient responses. There are also the less objective and more subjective ways to record results. As acupuncturists and Oriental Medical practitioners, there is an understanding that acupuncture works. The United Nations, World Health Organization has listed over 70 diseases, symptoms and conditions that acupuncture treats.
In Ontario, unlike many parts of the world, more work has to be done by practitioners, politicians, acupuncture regulatory boards and associations to continually strengthen the industry as to become fully accepted into the main stream.
In a fantasy world acupuncturists would be fully accepted as mainstream in today's world. Although the perception has improved substantially over decades, the reality is that most of the Western medical field and the public are still coming to terms with the efficacy of acupuncture.
As acupuncturists we must work to integrate ourselves with Western medicine. This is to say we keep our traditional medical philosophy and we work towards acceptance of our form of medicine.
This recognition must be done in a two-tiered fashion. One method is to influence doctors and the second is to affect the patient:
- The first tier is to have open communication with medical doctors via letters, phone calls or visits concerning particular patients. This method shows that the acupuncturist is willing to work with the doctor. It also reinforces to the patient that you are willing to work as a member of a team. Eventually what should happen is a building of trust between providers.
- The second avenue is to affect the patient. This is done via "as close to" objective recordings of primary treatment results and communicating these results to the patient.
A displeasing practice when it comes to post treatment behavior by the therapist; is when he or she ignores the primary complaint or "forgets" to ask about the primary complaint post-treatment. Often times what will be heard is, "How do you feel?" asked to the patient by the clinician. The patient usually says, "I feel great." Or "I feel fine!" The clinician then dismisses that patient without educating them about how to measure their own progress.
These forms of questioning are open ended and can be open to interpretation by the patient. This line of questioning is useful when the clinician requires more information or requires an opening of discussion such as at the post-treatment interview.
The clinician must go beyond this open ended form of questioning and ask the more solid closed ended questions. For example, you as the clinician may have asked the patient pre-treatment, "How would you currently rate your pain, from 1-10, 10 being the most excruciating and 1 being the least?" Post-treatment you would ask, "Mr. Jones, you rated your pain before treatment as a 7. How would you rate it now?"
Although potentially more subjective then objective, this type of questioning allows both patient and clinician to see if there was any perceived change in the patient's primary condition. This helps in reinforcing treatment plans that have been prescribed to that particular patient. For example, after five treatments out of 10 you may have prescribed to a given patient, the patient becomes irate that he or she perceives that her condition is stagnant. You could then go back to your notes and point out to the patient the changes that have occurred according to their own verbalizations recorded when asked to use a numerical value for their condition.
Recording of responses to treatment of primary complaint via numerical value is just one way of helping to record patient response. When you record responses, particularly positive ones, it will justify your treatment plan. In many patients' minds, they are justifying the expenditure for their treatment. They want to see that their money is being spent wisely.
Acupuncture indeed has a calming effect and indeed this calming effect can assist with the healing process; therefore patients will feel "great" or "fine" afterwards. Any half decent clinician can get this response after treatment. What separates the outstanding acupuncturist or any type of clinician for that matter, are the ones that can separate true positive results of primary complaint from just a "feeling good" type of treatment.
Admittedly, measuring the results of the primary complaint after treatment can be difficult depending on the condition or conditions. Many times a patient may have multiple complaints. A simple example is one of a patient who may be diagnosed with some sort of Kidney deficiency and may be suffering from lower back and knee pain. At the same time the same individual could also have urinary issues along with sexual dysfunction.
The other admission is that there are certain conditions that are difficult to measure post-treatment such as menstrual issues, night sweats and insomnia. These conditions or symptoms can still be measured via homework given to the patient by the therapist.
When a patient is directed towards measuring their own progress, it gives them more accountability and reinforcement of the benefits of the acupuncture treatment plan. Below is an example of a chart that can be given to a patient to record their changes. This chart can be expanded to include items such as frequency, intensity, duration, character of symptoms and if you wanted to even be more specific, time of day.
Experience-wise the simpler the exercise given to the patient for homework the more likely they will be compliant with the treatment plan. Give them multiple homework exercises and it could lead to frustration. Therefore it is advisable to keep homework to a minimum and add on every so often.
Below is a chart to be taken home by the patient. In this chart the patient is asked on an overall daily basis to number how their symptoms were on day 1, day 2, day 3 etc…You would instruct the patient to use a numerical value from 1-10 (10 being the most symptomatic or painful and 1 being the least).
|Symptom||Day 1||Day 2||Day 3||Day 4||Day 5||Day 6||Day 7|
This chart can be put on the fridge to help remind patients to record their symptoms. When the patient returns for their next appointment you and the patient can see the results of the treatment. This chart can also be used to assist the clinician in any progress letters sent to doctors. Doctors want to see that patients are progressing through their treatment; this chart allows observation of this.
Recording post-treatment results of the primary complaint is an excellent feedback tool. It is also a good tool from a patient retention stand point. Often times a patient may be unsure as to how they are progressing. They may decide to stop treatment because they become less confident in your work.
In your initial appointment you may have prescribed "x" amount of treatments. With patients, in particular the new ones, they may be reluctant to try acupuncture. In your first few sessions they perceive that there are "zero" changes. It may be a perception because there are some patients that are "pain or symptom" focused. For these individuals they are unsure how to gauge any changes in their condition. In their minds all they feel is the pain and/or symptoms regardless of the degree of frequency, intensity, duration or character. Due to their focus on their symptoms and their negative perception they may decide to cancel further appointments.
Your success as a business depends on your reputation for success. If you are able to extract information that gives positive feedback to your patient, it will build your reputation. A positive cascading effect will occur if acupuncturists consistently performed this common sense approach to feedback. This cascade will start from the patient then move to the patient's doctor and then start filtering towards other patients that may require acupuncture services. Eventually it will reach other doctors and the public.
If you want to strengthen your practice, actively pursue ways to get feedback from your patients about their primary complaint. It will validate your treatment plan and in a grander scale the efficacy of acupuncture as a medical system.
Resources for your interest:
- Orthopedic Physical Assessment, 5th edition by David J Magee
- Muscles Testing and Function with Posture and Pain by Kendall, Mcreary et al…
- Quick Reference-Evidence Based Physical Assessment, 3rd edition by Nikita Vizniak
- The 10 Steps of a Proper Assessment. Article in "Keeping in Touch", AMTA Vermont by Alfie Vente
Alfie Vente is a Registered Massage Therapist in Ontario, who graduated from Sutherland-Chan School and Teaching Clinic. He has been in practice for 11 years and has currently two practice locations. He also taught for 5 years at the Canadian College of Massage and Hydrotherapy as a Massage therapy instructor. He is a therapist at Physiomed's , Flagship clinic and also works at Spine and Sport in Downtown Toronto. He currently is studying in the 1900 hour Acupuncture program at the Shiatsu School of Canada, SSC Acupuncture Institute. With his background he has a unique perspective on industry, education and clinical issues and thus enjoys writing about these particular subjects. You can find more information about himself on his blog at http://alfievrmt.blogspot.com/. You could also email him at