Make Room For Critical Thinking

I've had the privilege to be in practice for just over 15 years now. I love my profession, I enjoy what I do, and I look forward to caring for my patients every day. I find my practice to be challenging and exciting with new patients and new interesting cases to work with. Of course, there are days when the practice is frustrating, but I think that is just part of this life. I am very blessed to go to work every day.

Over the last few years, I have seen more and more ads for "miracle" health care tools. Whole catalogs come in the mail with all sorts of elixirs, poultices, tablets, wraps, braces, supports and jewelry that are guaranteed to bring happiness, health and prosperity. Now charlatans have been around long before P.T. Barnum, but they still have an appeal to the general public. As healthcare providers, it is our obligation to provide valid care and informed advice to our patients. When a patient comes in with a brochure about a special orthotic that is going to "erase" their bunions or a mysterious juice that is going to cure their diabetes – alarms should go off. Once they present this information to you, you are complicit in its use. You need to be aware of what your patients are doing and be very clear what your opinions are. It is wonderful to be motivated by a sincere desire to help your patients. Unfortunately, sincere desires are insufficient: one must have clarity throughout the process of investigating and adopting a new or different system of diagnosis and/or treatment.

It is almost scary what gets paraded out under the umbrella of "alternative medicine." Everyone should be careful about miraculous claims of success. Regardless of one's personal enthusiasm, claims, dedication or diligence – take a step back – listen, digest and critically analyze the information being presented so you can make an educated assessment. Be aware. Be skeptical. Be willing to look past the superficial.

Being open-minded means that a person is willing to look at new options – just make sure you do so with critical thinking. Critical thinking is important when you recognize or embrace a style of therapy or a protocol of treatment. We are all representatives of our profession – what we do reflects on each other. Everyone must work to keep the standards of their practice high.

A good example would be the use of a Neti pot. I have them in my office, I use one, and many of my patients do. But have you ever tried to explain one to a person who has never used one? You are telling them to pour salt water up their nose! Now, sinus irrigation is wonderful and in my part of the country, the air has a lot of particulate matter – lots of allergens. Neti pots are fantastic. It might sound like a weird treatment, but I can explain the rationale for using sinus irrigation to clear debris from the sinus cavities. At the same time, I have had patients ask me about the "Water Pik" attachment to do the same thing. Egads! I think this is a great example of "just because you can do something, doesn't mean you should." Aggressively forcing water up your nose is not going to clean the sinuses and can potentially cause more tissue damage.

Several years ago, Subhuti Dharmananda put out a great article through the Institute for Traditional Medicine. To paraphrase: "... there are many good, valid healing arts to be learned from. There are also many "trendy fads" in the realm of alternative medicine. The warning is that there are physicians who carefully study the medical tradition, observe the moral precepts, work hard and benefit their patient to the extent possible, especially by teaching the patients to help themselves. On the other hand, there are a growing number of "healers" who superficially study the literature, ignore the moral precepts, work only as hard as needed to gain the money they desire and take credit for any patients who improve while dismissing any suggestion of failure."

Of course, we can also extend this argument to any number of other companies, too. I recently received an email from a colleague with the header, "An Astonishing Find that Fails to Surprise." The article stated that researchers have found that 100 percent of industry-sponsored studies recently presented at the annual scientific meeting of a medical professional society reported findings that support product use. The question is then asked: With compelling evidence that the knowledge base produced by commercially sponsored research is biased, with evidence that physicians do not reliably detect bias in information presented to them, with no evidence that bias in individual studies is reliably detected and discounted, and with repeated examples of manufacturers using potentially biased evidence largely to promote sales ... what commercially supported research can be trusted? Comments like this should make all of us more aware.

We are judged by the company we keep. Be careful what you endorse and promote through your practice. Products that promise quick results and an "alternate revenue stream" should immediately be suspect. I greatly appreciated a recommendation by Dr. Murkowski in a recent seminar. He advised that if you provide a product to a patient – say a cervical collar – then you should include in your file with the day notes and the script a physical copy of a clinical reference for that treatment option. An extra step perhaps, but it gives credibility to your treatment plan and validates your course of action. We must learn to think outside our own practice bubble in terms of healthcare in general.

Ultimately, it is the patient that we take care of, not the insurance companies, attorneys or other doctors. Be very clear about the services you provide and why you chose them. Acupuncture deserves the same level of respect that any other health profession does, but that respect comes with a level of responsibility. Don't compromise good care for the sake of a sales gimmick or fast buck.