When scheduling a new patient, I set aside an hour and a half for the initial consultation and acupuncture treatment. This may seem like an excessive amount of time to spend with a patient, as most patients are accustomed to seeing their physician for a grand total of six minutes. Additionally, the length of the consultation sometimes makes scheduling difficult, and often results in a new patient waiting a week or two to begin treatment. At times I am asked to curtail this time and squeeze them in. But it is something I cannot compromise on. Perhaps this article will explain why.
Taking a medical history in Chinese medicine is significantly different than taking the usual medical history that you may be accustomed to. Your stats–age, height, weight, and previous medical history including operations, illnesses, and family medical history–are all relevant. However, this is comparable to someone’s shidduch résumé. It is simply a chronology written on paper. It provides a lot of information, and I would probably have a good idea of what course of treatment to take at this point; however, I would only be treating a symptom.
For example, if someone came into my office with chronic migraines, I would learn this from the medications he lists, which may include Excedrin Migraine, Imitrex, or even Botox injections. I would immediately think of what I need to do to resolve his migraines. However, this would be a one-size-fits-all approach. Why is it that those same prescriptions work for one patient, and do nothing for another patient who also suffers from chronic migraine headaches? Things are usually not so simple. The solution may be buried deep within the patient, as opposed to the illness or symptoms visible on the surface. This can only be learned via in-depth discussion and review with the patient. It is often what is not found on the shidduch résumé, but can quickly be learned on the first date in minutes, that tells most about the individual.
My initial intake is thorough. In addition to your stats, we discuss other things that may seem irrelevant to you but provide important clues to me about your body’s overall function. It is here that I begin to connect the dots and put the entire picture together. For example, are the migraine headaches exacerbated by stress, or are they more severe at the end of the day, when fatigue has set in? Is the arthritic-like joint pain more severe with the damp weather, or is the stiffness worse in the first 20 minutes of waking up? Does the tinnitus or ringing in your ears sound like a high-pitch shrill sound or like water hissing? Do you have trouble falling asleep or is it staying asleep that is difficult? These are the types of questions that help me to ascertain what is going on.
The “proof” that I am looking for comes from questions that may involve digestion, bowel movements, and temperature, among many other factors. A simple question of whether you prefer to drink room-temperature water or cold water can tell me so much about you. It gives me clues that help reveal what the person may have difficulty doing. It is vastly different than an accounting of events that have happened to them, and is a better gauge of their overall health and constitution. In essence, it allows me to “connect the dots.” By gathering the medical information along with these clues, I get a complete picture–not only of the illness and symptoms the individual is suffering from, but the particulars of the root of the illness within the body. In this manner, I hope to not only alleviate the symptoms, but to treat the entire illness.
A young patient came to me a few weeks ago. She had been in a car accident a number of years ago. Until that time, her life had seemed pretty regular in terms of her health–meaning, she never thought about it. What a wonderful notion not to have to think about your ailments! Unfortunately, things changed drastically after that point. She had been in constant pain ever since. She had chronic joint pain affecting her neck, back, shoulders, knees, elbows, wrists, ankles . . . it pretty much took over her entire body. It was not a fibromyalgia presentation because the particular trigger points and other manifestations did not match. Her medical stats would show that she had extensive testing done. She had all the right blood work, MRIs, CT scans, etc. Everything was ruled out; there was nothing conclusively wrong. Thus the doctors and specialists she had previously seen were quick to assume that there was a psychological cause at play here. The patient was made to feel that much of her pain was in her head. Both she and her family were ready to accept the constant pain as a way of life for her.
When the patient came into my office, the thing that struck me most was the traveling aspect of the joint pain. When we talked about it in depth during her initial visit, it jumped out at me. The patient was eager to hear what I thought. I am usually cautious not to use many Chinese medicine terms when speaking to a patient. It may be confusing for someone who has little previous understanding, and makes acupuncture look like voodoo medicine, when it is a science-based medicine, proven over 4,000 years. However, in this scenario, I explained that the patient suffered from internal wind. The issue was less of joint pain, and more of the movement–the traveling that was causing the pain in the body to go from joint to joint. When I checked her tongue, I saw that it had a certain quiver which confirmed my diagnosis about the movement within the body. This is something that is not recognized in Western medicine. It is, however, recognized and treatable in Chinese medicine. We began needling acupuncture points to help expel the wind and calm the movement within the body. This was welcome because if I had to treat all of the joints involved, the treatment would have included many needles, more than the customary 20 or so tiny painless needles used within a given treatment.
The patient has had tremendous improvement. She is able to get through her day with minimal focus on pain, and we are only a few weeks in! She sends me regular updates which I thoroughly enjoy. I am grateful to be such an active participant in her healing journey. After years of suffering and being made to feel that it was all in her head, she is so appreciative and amazed at her progress. She wants to share it and bask in it. She is even considering a career in Chinese medicine.
An initial intake is not that different from a shidduch résumé. What is written can provide only so much information. We must take the time to read between the lines when we get to know someone. Connecting the dots and putting the entire picture together for an individual provides the proper insight and is essential for a successful course of treatment.