Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
The Year to Make Things Happen
It is hard to believe that the Year of the Ram – 2015 is half over. Time seems to be moving especially fast. This is the year for things to happen for the acupuncture profession.
The Nectar of Plants: Essential Oils and Chinese Medicine
Essential oils are a very hot topic these days, especially with the likes of the Ebola virus and the resurgence of measles lurking in our awareness, but when I first became interested in Chinese medicine, essential oils weren't on the radar screen for acupuncturists.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients, in May 2014, researchers showed that drinking the equivalent of 2 to 4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
What Does Success Mean to You?
Recently, I was asked to speak to young, budding businesswomen about running a successful business — and at first I thought, "Me? You want me to speak to others about success?!"
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
Acupuncture in the U.K. Today: A Personal View
When asked to write a short piece on the current state of the U.K. acupuncture profession, my first response was to say it has all been relatively quiet.
TMF 2015 Scholarships
The Trudy McAlister Foundation (TMF), a nonprofit organization established to support students who are on track to make contributions either to clinical practice and/or to the understanding of the role of Traditional Oriental Medicine, has announced the 2015 scholarship recipients.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
Marijuana, Apathy and Chinese Medicine, Part 2
A talented young woman presented herself with emotional mood swings, which included being nervous, anxious and jittery.
How One Little Symbol (#) Gets You More Patients
Are you struggling to get more fans or followers for your acupuncture practice? Or are looking for ways to simply connect with your patients? Or do you just want to know how to keep them engaged (comments, retweeting, liking and sharing)?
Use Technology to Gain New Patients and Improve Efficiency
From the smartphone in your pocket to your microwave oven, advancements in technology have made almost every aspect of our lives easier.
The Modern Acupuncturist
You studied ancient Chinese medicine, but I'll bet you don't practice it! Contrary to popular belief, our medicine has evolved A LOT over the years. Let's take a brief walk through history and discover the differences between ancient and modern acupuncturists.
A Poor Choice for Pain Relief
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
Acupuncture and the Pulse
In 1991, I attended a martial arts workshop hosted coincidentally by Sung Baek, a martial artist and the head of his lineage as a Korean trained acupuncturist. I was enamored by the details Sung could attain from the pulse, as told to me by some of his apprentices.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
Breath: The Movement of Oxygen and Energy
I remember with surprising clarity the first time a patient started crying during an acupuncture treatment I was giving. This is now quite a long time ago, back in 1999, when I was a student.
The Source-Luo Point Combination
The luo collaterals are part of the acupuncture channel system presented in the Su Wen and the Ling Shu (The Nei Jing). The function and clinical application of the luo mai are primarily presented in chapter 10 of the Ling Shu, however, they are also found in others chapters in the Su Wen and the Ling Shu.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
Calculating Billable Units
I recently learned of an office that was audited based on the number of acupuncture sessions performed in one day. Is there a maximum number of sessions that can be performed in one day?
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
July, 2005, Vol. 05, Issue 07
Medical Conditions in Massage Practice, Part II: The Client in a Physician's Care
By Tracy Walton, LMT, MS
Thanks to better training and texts in the field, massage therapists tell me their knowledge of contraindications is growing. But many report gaps in knowing how to interview for contraindications and how to apply the answers in the session.In part one of this series, I wrote about my early attempts at interviewing and how that changed over time. I also offered an interview question - about client activity level and types of activities - with examples of the kinds of important information it can bring to light for the massage session (June 2005, www.massagetoday.com/archives/2005/06/04.html).
These articles offer all-purpose questions for the massage interview and examples of using the client's answers in massage design.
The task of interviewing clients for contraindications feels easy for some therapists, harder for others. Some tell me they rush through it to get to the hands-on session; others like to take their time. The massage setting can also influence the interview. In private practice, we have as long as we are comfortable scheduling with the each client. Many therapists allow an extra 15 to 30 minutes for a first-time session. In contrast, most spa and other high-volume settings (on-site, sports events, fundraising walks, etc.) allow for very little information gathering. Years ago I worked in a spa where we were taught to limit our intake to one question on the way from the greeting area to the treatment room: "Is there anything I should know about your health?" Many spa practitioners tell me this is still the limit of their questioning.
The problem with this question is that clients don't usually know what we're looking for or which health conditions are important to massage therapists. Indeed, some frustrated massage therapists tell me that they don't always know what they're looking for either. Our pathology and clinic training doesn't always prepare us for gathering information quickly, easily and thoroughly in a range of massage settings. From massage therapists I meet around the country, I am learning that given lists of contraindications, massage therapists don't always know how to interview for them. Given lists of interview questions, we are not necessarily taught how to use the answers.
As the profession develops, we will grow to understand our interviewing tasks more fully and be able to adapt them to the special challenges of different massage settings. I am confident that we will standardize brief, efficient interviews and protocols for higher-volume settings and more extensive intake practices for other settings. For now, here are some "umbrella" questions to ask every client, which should be added to any interview regardless of the setting in order to get a good health picture and design an appropriate massage for each person.
Are you currently (or have you recently been) in a physician's care?
For those in high-volume settings without forms or record keeping, this is a question to ask on the way to the table. Even if your setting allows forms and ample interviewing time, ask this of everyone. If your intake form includes a list of specific conditions, this is a good all-purpose question to catch any that are not listed. It might prompt a client to remember something he/she forgot to mention elsewhere on the form. Then you can apply appropriate massage contraindications.
This question leads to the first, most obvious follow-up question: "For what condition or complaint have you been seeing them?" Here you are looking for the diagnosed condition to determine massage contraindications and for the complaint that may have brought the client to the physician in the first place. For example, suppose a client has chronic acid reflux or constipation for which she is seeing a physician. If there are no specific questions on your form about digestion and elimination, the physician question may capture this. Reflux might dictate a change in the massage position - a surface slightly inclined toward the head - or bolstering in the side-lying position. Constipation, depending on the cause, may indicate reflexology or acupressure techniques, or even gentle abdominal strokes or contact.
Another, broader follow-up question might be, "Are you seeing any health practitioner regularly?" to spot conditions the client may be bringing to a chiropractor, acupuncturist or movement practitioner, for example. Here you might find out about his/her acupuncture treatment for headaches, dental treatment for TMJ, or chiropractic treatment for a chronic low-back injury. Answers can lead to collegial conversations with these professionals and to proper timing and coordination of treatments.
I know acupuncturists who ask their clients to let acupuncture "sit" for a day or two before following with other treatments such as massage. Massage therapy can be a useful adjunctive therapy for TMJ. The chiropractor would benefit from knowing the massage therapist's approach to the client's low-back issue. And in each of these cases, there might be contraindications or indications to massage therapy depending on the cause of each condition. If a number of diagnoses are possible, massage should be tailored to the most conservative of these: If doctors are looking at either arthritic changes or bone metastasis as a cause of pain in the low back, treat the area as though bone metastasis were the cause and avoid pressure and joint movement in the area until proven otherwise.
"What kind of diagnostic procedures are you undergoing (have you recently undergone)?" is another direction to go. The diagnostics question is useful for several reasons. It tells us what the client's other health care providers are concerned about: tumor as a cause of headache; fibroids as a cause of low back pain; stress aggravating stomach ache. This information is useful without memorizing lists of diagnostic tests. Instead, ask the client what is being investigated, and why. While some clients are more knowledgeable about their care than others, this question may yield clear contraindications or indications to massage. Massage therapists don't necessarily need to go to nursing school or medical school to understand their clients' medical status - they just need to figure out what other care providers are concerned about, then investigate their own field for any adaptations for massage.
Finally, a compelling reason to ask about a client's diagnostic procedures is simple interest in the client's life. Put simply, diagnostics are stressful. Sometimes painful, often requiring awkward positioning or holding still, some procedures aggravate muscle tension that we may be well equipped to relieve once we've followed suitable precautions. The long wait between test and result can be difficult, depending on the nature of the test and possible diagnosis. Our clients' experiences of their medical care can tell us not only where to avoid massage but also where to focus it and how to listen. I once worked with someone who had an MRI for a knee injury the day before. She was awaiting word on whether to have surgery. The MRI was hurried and the technician neglected to tell her when the test was starting. It began before she was comfortably positioned, and she had to hold perfectly still for 20 minutes. Already frazzled, this experience left her more worn out with tension in her hips and low back. The wait for the doctor's call was an anxious time. Careful massage of tense muscles and a listening ear helped her cope as she waited for word on her immediate future.
We handle the human body with care and attention, but we also interview with care and attention, which is as therapeutic as our hands-on services. We ask about another's experience of their body. Questions about their health care tell us something about the texture of our clients' days. These small questions ask, "What is it like to be you?" which can, in and of itself, be healing. A client's answers are as useful to our massage design as our own palpatory cues. At the same time, they can deepen our understanding and the compassion we bring to our work.
Editor's note: Look for part three of Tracy's series in the August 2005 issue.
Click here for more information about Tracy Walton, LMT, MS.
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