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The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
June, 2007, Vol. 07, Issue 06
Show Me Your Outcome Competencies
By Keith Eric Grant, PhD, NCTMB
In early 1984, I spent a month at the Esalen Institute practicing core shamanic methods in a small group led by Michael Harner, author of The Way of the Shaman2 and founder of The Foundation for Shamanic Studies. During sessions, Michael always was the model of focus and professionalism. Outside of the sessions, however, he was animated and social. And at dinner, we never had a problem figuring out where our group's table was, with Michael's laughter that could be heard across any crowded dinner hall. Often, the laughter came in recounting some scene from his favorite movie, "The Treasure of the Sierra Madre." Thus, we came to know the opening quote quite well. I also was given a model of being flexible and learned to shift my personal presentation to fit the needs of the context. That flexibility has been a "competency" of some of the best teachers I've had the privilege to learn from, which leads me to the real theme of this column. With apologies to Dobbs and Gold Hat, if you are the bearers of "high standards," where are your outcome competencies?
My fellow columnist, Ralph Stephens, and I both like to shine light on where we feel massage training and entry requirements fall short. In the inimitable words of baseball player and manager Yogi Berra, however, "Our similarities are different."3 For me, another Berra quote succinctly captures the root of the problem: "You've got to be very careful if you don't know where you're going, because you might not get there." The licensing and certification of massage practitioners likely has been lowering their competence.
It's not so much the licensing itself as it is how licensing has interacted with mainstreaming and training. At one time, teaching massage resembled teaching martial arts, a system of tacit knowledge conveyed from expert to student. The expert may not have said a lot, but they knew how to look at you while you practiced and would keep you at it as long as they felt there was "something missing." Consider that system to be history, now that we have explicitly defined entry requirements. Explicit requirements don't add to a tacit system; they replace it. You get what you explicitly value. The catch is that we haven't defined the outcomes we value; only the total hours and some blocks of hours in vaguely defined subject areas. Career colleges and community colleges teach to what we defined. Students self-select for their ability to match our explicit requirements. We are getting what we asked for, as long as graduates meet the entry requirements. You expected something else, perhaps?
Don't complain about getting what you asked for; do the work of defining the outcomes comprising what you want. Here's the recipe: Insist on differentiating between "high requirements" and "high standards." Standards lead to observable outcomes while requirements don't have to. Define a job specification for an "entry-level practitioner." Define all of the contexts in which you believe the job is done. For each context, break the performance into tasks. Get feedback from the stakeholders in each context. For each task, create a list of required observable competencies or, if covert, competency indicators. Define the needed proficiency levels. Get more feedback. Merge the individual lists of competencies into a master list of competencies, taking the highest proficiency level at which each occurs. Implement a plan to identify applicant learning gaps and teach them what they aren't doing. Assess the results, and modify definitions and teaching methods to obtain the outcomes you want. Reward yourself for creating something that meets specific goals for stakeholders and is a clear guide to schools and students in reaching them. Then go back and assess the results again. The beauty of this method is that all levels are explicit. If you compare your competency standards with someone else's, you can track down the exact source of differences.
The best resource I've come across for going through all of this is a set of books authored by Robert F. Mager called The New Mager Six-Pack.4 I'm of the opinion that no one should be allowed to talk about standards without first being required to demonstrate an understanding of what's in those books. Consider it an entry-level requirement for a "standard discusser" position. The books are clear, readable and filled with examples.
Your efforts, should you accept this mission, won't be alone. New resources to do information handling are coming from the venues of technology and distance learning. (I recently blogged about this: "Guidelines, Learning Objects, & Competency Definitions."5) The Massage Therapy Foundation's Best Practices Committee is actively working on an open and transparent creation process for evidence-based guidelines. At a March meeting of the committee, I co-located with Whitney Lowe in the physical world. Whitney has embodied a lot of the outcome-based concepts in an online clinical reasoning course.6 The course uses an open-source educational framework that supports working through case studies, first as small groups and then as individuals. I particularly like that the environment provides built-in discussion forums to teach students the ability to solve problems by interacting with mentors and peers; a refreshing walk away from the idea of pre-canned answers for everything. Finally, I've been following my own project to create a library of massage competency definitions.7 I'm grateful to a number of people on different massage e-mail lists for their contributions. You'll find their names next to the competencies they suggested.
While I've been discussing massage training, the same process works for personal and business goals as well. Define where you want to be. Define what being there looks like and what skills you are using. Set up a plan to close the learning and experience gaps. Implement that plan and you'll be heading where you want to go. Remember to enjoy the journey and the people you meet along the path.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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