Archive for tag: clinic

How a Clinic Internship Works

I get this question all of the time: "Do you acupuncture people yet?"

Yes, kind of, not really, I don't know what I'm supposed to say exactly. Do I put needles in people? Yes, of course. Should I? Well, that's where you've got me. Technically, I'm not a licensed acupuncturist yet, so I take that to mean that I can't charge people for acupuncture yet. Is it safe for me to needle people? Well, I do have my Clean Needle Technique certificate filed away somewhere....

2014-07-23_internDo I know what I'm doing? Can I help someone feel better? I don't want to be a pretentious jerk and assume the answers are "yes" here, but over the past year I've certainly had some good feedback. As a sometimes full-time and sometimes part-time student in the acupuncture program, I'm somewhere around Tri 5. I've completed a large chunk of the coursework, the whole observation phase in the clinic, and now I'm actively practicing on everyone who schedules an appointment with me in the AOM clinic on campus.

For the next year, I'll continue along in this internship, enjoying the opportunity to test out treatment strategies, hone my diagnosis skills, and figure out if "patient consents to treatment" actually belongs in the "A" or the "P" portion of the SOAP note. I'll do intakes; I'll form diagnostic impressions; I'll pow-wow with Dr. Cai, Dr. Stretch, and any other clinician I can find. I'll needle patients; I'll moxa their cold feet; and I'll do as much moving cupping as my forearm strength permits. If you're really special, I'll do tui na and I'll gua sha you afterward. Want some herbs? Sure, we have raw, granules, or patent pills. Right this way!

While the patient visits are the most important and most fun parts of the clinic internship experience, the clinic lottery is the part that causes the most anxiety among the interns. "Will I get my same shifts next tri?" "Which clinician will I work under?" "Which interns or observers will be on my shift?" All of these panic-stricken questions and many more can be heard all over campus right now -- the infamous Week 12 clinic sign-up and resulting lottery has arrived!

Photo of Stroger buildingSure, interns get to sign up for their preferred shifts and locations for clinic internships. We AOM students have the luxury of choosing the on-campus Lombard Whole Health Center clinic or driving to Stroger (Cook County Hospital) in Chicago for an off-site experience. My 45-minute commute is plenty, so I try to keep it simple and stick to the main campus. There we all are, fluttering around the sign-up sheet in the clinic lounge room, which is busting at the seams on a regular day, elbowing the interns who are actually trying to sit nicely and write SOAP notes that day.

If all goes well, there is a nice white empty slot shining and waiting just for you on the day and time that you've decided would be perfect for your upcoming trimester. In reality, someone else probably agreed and already signed up for that one. In the end, many interns are able to secure an acceptable shift and everyone survives the sign-up week. Some lucky individuals end up in the clinic lottery, where randomly drawn numbers allow devastated interns to play a sort of game-show rendition of "This will be your life next trimester."

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In my two years at NUHS, we haven't lost anyone yet! The sign-up process can be stressful for some, but by the time the next trimester rolls around, we're all just excited to start treating our patients and working with our clinicians to hone our skills. I have one more year of this endearing learning process, and then it's out into the real world for me (again). No more clinicians to ask questions of, no more easily accessible chiropractors down the hall to consult with on orthopedic issues (thanks, Dr. Anderson!), and no more half-days of work! Maybe this whole clinic deal is pretty great after all....

Choosing Your Intern

You've made the first move. You've called to schedule an appointment in the AOM clinic. Just as you think you're almost done with this first critical step, the receptionist throws a massively important, yet completely unexpected, wrench in your plan. "Which intern are you looking to schedule with?"

Oh. My. God. What do you do? Which name do you say off the top of your head? As you feel the pressure mount in those two seconds of silence on the phone, your brain quickly scans the names, personalities, general skill levels, and specific competencies of every student you know at NUHS.

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It might not seem like a big decision to some, but for many patients, your intern will make or break the entire appointment. I've heard it all in the halls of the clinic, "He got a D on that Point Location Exam, so I don't want to schedule with him!" "She's the only one who follows up needling with tui na every week--I want her!" "I only (or, I don't) want my best friends seeing me with my pants down." If you're bringing sensitive people--the elderly or young children--then even appearance might matter. If I scheduled my kids with a super-tall bearded man, they might run outside and hide by the swans!

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If you haven't thought about which intern you will choose for your first or next acupuncture appointment, here is a handy guide to help weigh your options. No, I'm not going to provide a rating list of each intern in clinic this trimester, complete with names, pictures, and assorted blasphemies or accolades. Instead, I'm going to walk you through the options that may or may not be important to you in your decision-making process.

  1. Do you want your friends to see you naked?
    Most of us don't mind in a medical setting, but if you get stage fright in this arena, consider it a factor. If you can't relax, then your acupuncture treatment can't be fully effective.
  2. Do you want to build a long-lasting relationship with just one intern?
    Don't select someone who's graduating at the end of the trimester. Many of us are part-time, which means that we will be a regular presence in the clinic for a year or more.
  3. Are you only concerned about having the most informed, top-of-the-class intern right now?
    Then go ahead and choose that fabulous intern who has the most experience with add-on extras--if you can get into her packed schedule!
  4. Should your treatment philosophy match your provider's?
    I think so, and I consider this when scheduling an appointment myself. Do I get a good feeling from this person? Do they ooze positive energy? I come to the clinic to build my qi, not to have it stolen.

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Image source: www.visualphotos.com

Now for the great part--there isn't one intern who fits every criteria! This is wonderful news, because it means that a variety of options exist for each patient who walks through the door. Each patient is different, and each intern is different. If you've tried acupuncture once, but just didn't get that great feeling, then try again with someone else! If you were lucky and hit it out of the park with your first intern, then stick with that person, or ask him or her for a referral for another intern who treats in a similar style.

Good luck, and happy hunting!

Want to Freak Out an MD?

2014-07-03_yurasekWhen they ask you why you came in for an appointment today, go ahead and let them know that your urine is coming out in long, clear streams, and that your dreams have been creepily vivid this week. Tell them that your bowel movements are light brown, formed, and coming with ease twice per day in forearm lengths that would make Dr. Yurasek proud. Mention that you've been feeling kind of cold and that you can't stand being out in the wind. That heaviness in your arms? Mention it.

Dive straight into the rest of Oriental Medicine's famed "Ten Questions," noting whether you've been extra hungry, not so thirsty, frigidly anti-sexual, exhausted from periods with quarter-sized black clots, or muzzy-headed in the afternoons. It all matters. If you're in an AOM clinic, these are the types of things you can expect to be asked by your acupuncturist or herbalist. No one here bats an eye when patients share the color and consistency of their bowel movements. In fact, if you withhold that information, we can't really help you very well.

Here they are, in detail but translated by me:

The Ten Questions

  1. 2014-07-03_outlineDo you feel hot or cold, or do you experience fever or chills?
  2. Are you sweating and is it during the day or at night?
  3. What's up with your head and face? (EENT)
  4. Do you have any pain anywhere?
  5. How's your urine and stool coming out?
  6. Are you thirsty? Hungry? Got cravings?
  7. How've you been sleeping?
  8. Anything noteworthy going on in your abdomen/thorax? Who says "thorax"?
  9. What's up with your gynecology? If male, you can put "N/A," thank goodness.
  10. 10. General/Past Medical History (in case we didn't cover it all yet)

Your acupuncturist or herbalist not only wants to know these things, but also actuallyneedsto know many of these things in order to properly diagnose your condition and begin a treatment plan. If you have long, clear streams of urine, loose stool, weak knees, a sore lower back, and feel cold all the time...well, we know what's going on. No, I'm not going to tell you here. Look it up. Better yet, visit an acupuncturist!

So, if you're in an AOM clinic, have your thoughts on these vital topics prepared beforehand. Otherwise, you might be so thrown off guard by some of the Ten Questions that you can't formulate sentences. That's actually fine, because none of the 10 questions directly correlate to grammar skill level. Thank goodness, right? However, if you find yourself in the office of an MD, keep in mind that you might not want to just jump right in with details about where you are in your menstrual cycle and how gassy you've been, if your chief complaint is seasonal allergies. Just a tip, from me to you.

How to Use Chinese Herbs

Think it's too difficult for you? I think you're wrong. File this post away under the "if I can do it, you can do it" series. Unfortunately, this practical how-to post is the result of someone actually needing to use raw Chinese herbs to feel better--and that someone is me.

Remember that whole "damp-heat in the gall bladder" thing from a couple of weeks ago? Yep, me too. Turns out, I still have that going on. Yes, I self-diagnosed and self-treated in near silence. Did I say I was good at this? I'm sorry. No. I'm a student. I know close to nothing. In my defense, upon an actual visit to the NUHS AOM clinic to exercise my student-access-to-free-care privilege, I learned that I nailed my diagnosis and was only one off in my acupoints selection plan.

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Ingredients for Treatment

I was indeed on my way towards getting back to normal, but not quite there yet. No. What I needed was a boost -- a big powerful boost in the health direction. I needed herbs from Dr. Cai. After showing my tongue and displaying my pulsating wrists to the masses of interns, I left the clinic with my trusty sack of Chinese herbs. At Dr. Cai's request, I also needed to add in a slice of fresh ginger and three red dates with each batch, which I happened to have on hand.

Many people would peer into this bag thinking, "What the heck do I do with this pile of roots, bark, mushrooms, berries, and other unidentifiables? Technically, there could be geckos and cicada shells in there...shudder. In fact I refuse to look up everything in the formula shown on my receipt just in case therearegeckos and cicada shells in there.... So, here it is--your pictorial step-by-step guide to using raw Chinese herbs in a decoction. This is the instruction sheet that goes home with the patient.

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Instructions for Cooking Chinese Herbal Formula

What this is trying to say is dump one batch of the herbs into a pot, soak it, bring it to a boil, then simmer to reduce the liquid to a drinkable amount. Now, you'll want to find the perfect balance between "disgusting taste" and "effective dose," and that isnoteasy. You know you want to concentrate the liquid for potency, but you also know that you're increasing the taste by the same stroke.

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Before Cooking and After Cooking

Most herbal decoctions do not taste good. Face it. Most of us are damp. We eat dairy and fried foods (mmmm...fried dairy), and we end up with damp-heat. Thus, we need bitter herbs much of the time. Who's the lucky fella who gets a simple Spleen Qi deficiency diagnosis that results in a sweet licorice and berries formula to take home? Not this guy!

So, I soak my bitter herbs, I boil my bitter herbs, I simmer my bitter herbs. I drink my powerful decoction, and I go to sleep to let my body do its thing. I wake up a little better, and I know I have five more nights of chugging down my "bedtime tea" before my tongue can register just how gross it really tastes.

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"Bedtime Tea"

I could avoid much of the "hard work" in this process by requesting my herbs in granule form (like a dusty powder that you stir in warm water to dissolve). But then I'd lose a little potency. I could avoid all the work and the taste by requesting a patent pill formula, but then I'd lose even more potency. No thanks, weak sauce. I need the most full-strength option known to man -- ancient Chinese man, specifically. I need to decoct my raw herbs!