Friday, January 27, 2012

Filming a Traditional Diagnosis (TD)

I decided that it was important for my Chinese students to observe me carrying out a TD at the start of a new patient’s treatment.  I have always said – and I repeat here again for emphasis – that a diagnosis only forms the first loop in a never-ending chain which unwinds a little bit more each time we see a patient.  One example of this is something which happened with a very longstanding patient of mine last week.  He told me something about himself that gave me a totally different insight into who he was, jolting me out of the kind of complacency an association of more than 20 years can lull us into.

This new patient of mine is a young man who was very happy to consent to being filmed, and enjoyed the thought that the video was to be played to an audience of Chinese acupuncturists in China.  On looking at it after the TD was completed, I thought that I had, overall, achieved what I had set out to do, which was to demonstrate the important components of a TD.   I felt I had already started to establish a close relationship with this patient, had heard about the most significant aspects of his life in some depth, learnt the reasons why he felt he needed help from me, and started to piece together the different areas of his life to create some kind of a pattern explaining why he was as he is now.

I realised how much the years of my practice and the hundreds of patients I had seen in that time had contributed to honing my diagnostic skills by helping me focus on what was significant rather than, as students tend to do, getting bogged down in a lot of detail which proves later to be of little significance.  This is where what I call a feel for the odd comes in, the sudden awareness of something the patient is saying or doing which jars.  I am better at recognizing the hidden signals patients send out, pointing to often submerged areas of their lives which we need to explore because of their importance. This means that I am able to home in more quickly on something which needs following up, as I noticed I did with this patient, persisting in returning to it again and again until I found an explanation.  I noted, too, those places where I had left some loose ends as something I needed to discuss with the patient next time.

The thing that I was constantly being told in China was people’s surprise at how much what they called “compassion” I showed the patients I treated there.  This was merely a reflection of the importance we attach to developing a close relationship with our patients.  This certainly always involves both compassion, and, just as importantly, and an essential ingredient of compassion, a sincere interest in every area of our patients’ lives.

I will be interested to see what my Chinese students make of this video. 

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