How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped. So how can we improve communication between acupuncture and oriental medicine (AOM) and biomedical practitioners?
AOM practitioners already have many of the tools they need to effectively communicate with biomedical practitioners. We are trained to be creative problem solvers, i.e. one disease many treatments, one treatment many diseases. We have a deep understanding of yin and yang and how to create balance. Additionally, we are tenacious, resourceful and trained in both AOM and biomedical languages.
AOM practitioners can use language and communication to create balance and bridges between the medicines. However, AOM and biomedicine speak very different languages. Languages that are not only a reflection of their respective cultural origins but also very different paradigms of thought. AOM and biomedicine are essentially different cultures and as such differ in their linguistic context.
When communicating it is always essential to know your audience, and in order to do that we need to understand culture. Culture is defined as "the shared values, beliefs, views, traditions, norms, customs, arts, folklore, history and institutions of a group of people. Culture includes ethnicity but is not limited to ethnicity".1
Culture influences communication, such as when to talk, be silent, give and receive compliments, listen, and joke. Culture also affects the cadence of speech, pausing, eye contact, formality of speech, directness, what is said versus what is implied, and how people formulate the structure of their speech. Culture affects intonation (pitch, loudness and rhythm) of words and can be used to express emotions or implied meanings. Culture greatly affects the way meaning is communicated through speech and linguistic patterns.2
All cultures can be categorized on a gradient from high to low-context within their communication styles. Phelan3 suggests context is "information that surrounds a communication and helps convey the message". Context also refers to the layers in communication. The Chinese have a high-context culture. Information is coded, contextual and highly relational with many unwritten rules and implicit messages. Misunderstandings of written and spoken language are common with foreigners, especially without an understanding of the rich, varied and highly complex culture and history of the Chinese people.
The United States and the majority of European countries are considered low-context cultures, where communication is uncoded, straight forward, and non-contextual. The speaker says precisely what he or she means, little is taken for granted, and fewer misunderstandings tend to occur. AOM as a subculture is considered high-context and uses high-context communication methods. The AOM paradigm seeks to explain the human body in highly contextual and relational terms with direct correlations to the Taoist roots of Chinese culture. Biomedicine as a subculture is considered low-context, and employs low-context communication methods. A greater valuation is put on research, data, numbers and images over words and implied meaning. The following are suggestions to enhance communication with biomedical providers.
First, establishing rapport is paramount. Rapport is based on understanding what that person values and delivering communication that engages those values.
Second, know your audience. AOM practitioners are fluent in both AOM and biomedical languages. When speaking with biomedical providers, AOM practitioners need to bridge the cultural gap and foster a sense of safety by speaking in low-context, biomedical language. For instance, never say qi, use the term "circulation." Stick to measurable data such as: improvement of symptoms, degree of ROM, "VAS for pain," neurological findings, specific muscular involvement, manual muscle testing results, abnormal blood pressure readings, and other physical exam findings.
Perhaps the most effective way to improve communication is to do what doctors do and send written reports. Medical dictation is the norm in the biomedical community and how doctors record and share information about their patients. Typed progress reports or dictated and transcribed notes using biomedical language will truly be "speaking their language" and also show doctors the results your patients are getting with AOM. Don't be surprised if you start getting referrals.
The future of integrative medicine is a synergy of the best parts of different types of medicines, not simply inserting AOM into the field of biomedicine. It is vital for AOM practitioners to value the knowledge they possess and their power as practitioners. We are custodians of an ancient, beautiful and effective medicine, and it is our duty to safe guard, teach and excel in execution of care. Doing so will allow AOM to grow and evolve into something more than the sum of its parts, for the whole and the reduction of the whole into pieces form a yin and yang in and of themselves. Truth and a uniting of the paradox can be found in the dance between the two perspectives, yin becomes yang and yang becomes yin.
With patience, education and open minds we can improve cultural competency to know our audience. By using our biomedical diagnostic skills and language, we can build rapport and improve communication with biomedical providers.
References:
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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