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Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
News in Brief
NBCE Launches Computer-Based Testing Era; California Chiropractors Get Expanded DOT Exam Privileges; New Jeff Hays Documentary.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
Improving Our Political Effectiveness
The November 2014 elections are right around the corner; members of Congress, governors and state legislators are all running. Now is a good time to talk frankly about our overall political involvement.
Let the Patient Tell Their Story
Often when a patient presents with an injury, they want to tell their story. People by nature like to talk about themselves, particularly when they're worried about their health.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
Medicalization and Mindfulness
The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
Rethinking GMO: Less Panic, More Context
Some of you may have noticed that after writing parts 1 and 2 of “Genetic Modification of Organisms for Human Consumption” a while back [Nov. 15, 2013 and Jan. 1, 2014 issues], part 3 never appeared.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Thoracolumbar Syndrome: The Great Mimic
The thoracolumbar junction is a common area of joint dysfunction. The most obvious cause is dysfunctional breathing or lack of diaphragmatic breathing. Treating this breathing problem will ultimately be the long-term cure for the syndrome.
Uncle Sam Needs You
Scrutiny into the Department of Veterans Affairs (DVA) continues to grow after efforts to reform the DVA by the former Secretary of Veterans Affairs, Eric Shinseki, were deemed "a stunning period of dysfunction" by Senate Minority Leader Mitch McConnell (R-Ky.).
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 1)
When we think of lower back pain, we tend to think in terms of the lower lumbar spine and the SI joint. These joints and their discs are obviously important. However, we tend to miss fixations that occur just above – in the upper lumbar spine. Three questions come to mind: 1) Why is the upper lumbar spine so important? 2) Why do we miss the fixations here? 3) How can we adjust them?
If You Get a Request for Records, Respond!
In our previous two articles, we discussed two of the main reasons for denial when chiropractic records are reviewed by Medicare contractors.
Help Secure Our Future by Sharing It
The National Board of Chiropractic Examiners (NBCE) conducts one of the most comprehensive surveys of the U.S. chiropractic profession every 4-5 years.
The Problem With Prolonged Sitting
We need to constantly talk to our patients about spending less time sitting and about what can go wrong with poor sitting postures. The fact is we sit too long in repetitive malpositions.
March, 2004, Vol. 04, Issue 03
Clinical Reasoning Skills
By Whitney Lowe, LMT
In the health care arena, assessment is commonly defined as the systematic process of gathering information in order to make informed decisions about treatment. We all do this any time we make a decision about how much pressure to use, which technique to employ, or how to address a particular problem presented by a client.What is different is the degree to which we use these assessment skills. As massage therapists become more involved in treating people, the process of assessment becomes increasingly important. You must be able to distinguish between conditions with similar symptoms and make vital decisions about how to approach a client's condition, or determine whether to treat the condition at all.
There are numerous systems of assessment for pain and injury conditions that share common elements, including the use of specialized orthopedic tests. These tests are used by different types of health care professionals to identify various pathological problems. Since different health professionals utilize the same tests, communication between multiple practitioners regarding the condition of a client/patient is easier. However, while these tests are a valuable part of the assessment process, a common trap can occur when using them. The trap occurs when too much emphasis is placed on using tests over other methods of assessment and evaluation. For example, if a client complains of shoulder pain, and you know about special orthopedic tests for shoulder disorders, it is a common fallacy to run through these tests to see if you can find the nature of the client's problem. This is still a shotgun approach. What is missing is an essential element of the assessment process: clinical reasoning.
When first learning about a subject, the information is often divided into separate facts or concepts. It is only after achieving a greater degree of mastery in the subject that people organize this information into usable patterns. Studies that have investigated the difference between the way experts and novices present information have found that experts put together more patterns of information, while novices tend to gather more separate details, many of which may be irrelevant to accomplishing the final task or skill they are learning. This aspect of learning and processing information is essential in assessment and clinical reasoning processes, and can be well-illustrated in the following example.
When a client complains of shoulder pain and describes the common symptoms, the practitioner must determine what information is relevant and how to proceed in the evaluation process. If the statements are considered separately, they may not lead to essential clues about the nature of the condition. This is often where the practitioner jumps to the use of several tests to see if he or she can hit on the "right condition"; however, the more skillful practitioner will pick up on statements during the initial intake and begin to form patterns. This practitioner will see connections between various signs and symptoms, and the further line of inquiry will almost lead itself in many cases. The art of reasoning is the ability to see these patterns of connection; therefore, the challenge is learning how to perfect those skills and see the patterns.
Consider the job of a detective. When investigating a crime, the detective must pick up on clues and determine which ones are important (and which ones are not). The ability to discriminate between the two can be difficult. The best way to make this choice is through a combination of subject-matter knowledge and experience.
For clinical practitioners, the more we know about various pathological problems, the wider the base of information we can draw from when searching for relevant clues. At the beginning, it will be difficult to know which clues are relevant - this is where experience comes into play. After seeing similar conditions a number of times, we develop an experiential background against which we can see similar patterns and recognize which cases are similar to others we have worked with before. As we combine our knowledge and experience, we are able to more accurately and quickly find the nature of a client's complaint.
The more skilled you become in clinical reasoning, the easier and faster the assessment process will be. Therefore, as you learn about assessment and range of motion evaluations, muscle tests, or specialized orthopedic tests, always think about why you are using a particular procedure, instead of just going through the motions. The more you understand why you are doing what you are doing, the more you will contribute to your ability to see these patterns within the clinical evaluation process, and significantly improve your skills.
Click here for more information about Whitney Lowe, LMT.
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