Exploring the ART in ChARTing

Do you ever wince at some of those bland intake forms (paper or tablet) you have to complete at various medical, therapy or dental offices? How about those martian-like figures where you have to shade in areas of pain for a physical therapist to try to figure out your problems? There’s a better way.

Body Outlines

During my decades of teaching zen shiatsu in North America and Europe, I encouraged my students to view patients’ creative use of body outlines as an unusual diagnostic tool that can be as revealing as our traditional hands-on or Q&A assessment methods.

Beyond computer graphics and tablet or online intake forms, I asked the artists in my classes to pen creative outlines of male, female and gender-fluid forms I would then copy on paper in colors to suit all skin tones and match the five elements. I asked the kids of my mixed ethnic students to draw outlines of a variety of boys and girls we could use for pediatric shiatsu.¹

Offering patients of all ages fun stickers and a pot of pencils in assorted colors adds insight, as we note which color or sticker they select to express which problem and surgical site. Outlines showing figures in meridian stretch positions encourage them to show areas of restricted movement.

Be Observant

“Justin G”* came to me because of chronic back pain. He shaded all his problem areas in black – but only on the female outlines.

“Any reason why?” I asked.

He hadn’t noticed. Justin pondered the outlines. Then he told me he grew up with a brutal father who doted on his sisters and made him feel worthless as a boy. He had no sense of male value. After working on his UB and ST meridians to strengthen his sense of’ “scaffolding,” I advised Justin to join a male cycling or hiking group as a healthy way of reinforcing a sense of maleness. He loved the idea.

A Fresh Outline Each Session?

Offer patients a fresh outline to fill in each new session. After a series of weeks, practitioner and patient can measure progress by studying a sequence of outlines to compare and track change in pain patterns. One of mine was stunned to compare the overload of “x” marks showing acute lower back pain in the first chart, compared with her happy-face stickers over those same areas some weeks later.

Pushpins on Wall Charts?

It’s equally useful to attach acupuncture charts to a cork board and offer patients a box of colorful pushpins to insert on meridians or acupoints to show areas of chronic or acute pain. How revealing it was to observe one of my patients, “Maddy J,”* jabbing the pins angrily on anterior and posterior close-ups of the wrists, to convey the rheumatoid arthritic pain she battled.

To ease some of that tension, it was helpful to do gentle qigong with her before each session, imagining a soft wind moving her wrists to and fro.

Maddy admitted the pain seemed to trap anger issues she experienced with her work colleagues. I encouraged her to practice qi movements every morning, before she prioritized ways of resolving toxic workplace issues.

I’ve written about Maddy J many times. She presents such a vivid case study of the effective combo of creative charting, qigong, discussion, and shiatsu sessions initially to transform congested qi in her GB meridian and joints.

Variations on Body Outlines

Some of my colleagues prefer to offer cut-out figures from magazines so patients can select a character that best reflects them in terms of body type, age, ethnic background, etc. Niklas Brochhagen, my FTM teaching assistant in Berlin, Germany, makes a further recommendation to give trans patients the freedom to express their preferred gender.

‘’Just leave a large, blank space, so clients can draw their own outlines,” he suggests, adding, ‘’It’s good to encourage clients to define their own bodies by drawing their own scars, breasts, chest outlines, and genitals – but only if they feel comfortable doing this.”²

Similarly, as trans terminology is ever-evolving, it’s wise to list “preferred suffix” and “preferred pronouns” vs. offering a series of boxes to check.

Honoring Diversity ... and More

How well I recall a fellow breast cancer survivor, an African American RN buddy of mine, who yearned for role models in the conventional handouts of postmastectomy exercises.

“All I see are drawings of white, middle-class women,” she said. “Do they think women of color don’t get breast cancer?”

I honored her observations and asked a young, Ethiopian MD friend of mine to model my exercises for postmastectomy and general breast health in my Self Shiatsu Handbook.

But we all know the disparity in health care goes way beyond optics. In a letter to The New York Times,³ Laura Crandon, founder / president of Touch4Life, a breast health equity nonprofit, writes, “Black women like me are more than 50% less likely to receive genetic and genomic tests to identify biomarkers for breast cancer that make us eligible for precision oncology clinical trials and lifesaving drugs ... many nonwhite women like me aren’t being tested.”

And More Concerns?

Some medical (especially OB/GYN) offices offer a line-up of boxes asking, “How many miscarriages and abortions have you experienced?” Seriously? As if any woman in a draconian anti-abortion state would risk admitting she has had an abortion?

Austin, Texas-based Suzanne Rittenbury, LAc, was stunned to encounter such questions. Logically, she asked, “Surely this is matter for a patient to discuss with her physician, and not on an intake form?”

Nini Melvin founder of shiatsu school Meridians – Pathways to the Heart in Northampton Mass., objects to traditional standard lines of questions that “ask about labels rather than creating openings,” “so practitioners can see the whole being sitting in front of them.” She focuses on philosophical questions such as, “How do you balance inward/outward self’” or “When and where do you feel safest to be your true selves? What obstacles are you facing?”

I would also encourage questions such as, “How has the discrimination you have experienced in life - and/or from medical professionals - affected your health? Racism? Homophobia? Transphobia? Ageism? Sexism? Emotional or physical abuse?” You’ll be blown away by the response!

Editor’s Note: Some names (identified with * in the text) have been changed from their originals to protect client privacy.

References

1. Ferguson PE. “Creating Child Friendly Clinics.” Acupuncture Today, April 2014.
2. Ferguson PE. “Creating Awareness for the Transgender Community.” Acupuncture Today, April 2018.
3. “Progress in Cancer Research” (letter). The New York Times, July 2, 2023.