resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
June, 2008, Vol. 08, Issue 06
The Essence of Palpation: How Do You Feel?
By Leon Chaitow, ND, DO
Palpation lies at the heart of much that we do in manual medicine and bodywork in general, and massage in particular. But how accurate and reliable is it?
What we do therapeutically commonly is determined by prior palpation and the meaning we give to what has been palpated.In other words, we assess and decide what treatment is needed and then apply techniques in order to achieve those ends. If, however, our palpation skills are limited or our interpretation of what it is we are feeling is inaccurate, then the treatment we choose to apply based on such misinformation is likely to fail.
Famous osteopathic physician Viola Fryman said: "Palpation cannot be learned by reading or listening; it can only be learned by palpation."1 Palpation represents a two-way communication between the examiner and the patient. Decisions as to what to do therapeutically often will be based on a variety of palpation and assessment methods, together with the symptoms and the patient's responses to these manual (and sometimes observational) evaluation procedures.
In other instances - I am thinking of methods such as neuromuscular technique or many massage techniques - palpation and treatment are synchronous with decisions over how we should respond by varying the degree, duration and directions of forces. These decisions are determined by what is being assessed/felt by the contact hand(s), and how this is interpreted in real time, moment by moment. What is being done therapeutically in such a setting is directly related to what is being palpated and assessed at that moment, rather than having been planned ahead.
For experienced practitioners and therapists, much of the instant decision-making that results in modifications of application of forces (compression/stretch, etc.) happens without due deliberation. The hands do the thinking - intuitively, so to speak. - in much the same way a tightrope walker makes instant, non-cognitive decisions based on the processing of multiple pieces of information.
In other circumstances, active deliberation and thought are required as to what to do next. How accurate such decision-making is will be based on a combination of experience and learned information, as well as being present in the moment and truly in touch with tissues that offer information requiring interpretation.
So, at the heart of palpation is what I termed palpatory literacy many years ago. Do we know how to read the signs and signals the body and its tissues offer us? Nowadays, with the clamour for "evidence-based" methods, a great deal of effort goes into evaluating how reliable and valid (accurate) palpation and assessment-methods are. These can be looked at in several ways. The most common are studies that try to see how reliable an examiner's findings (and therefore the methods used) are. This is measurement of intra-examiner reliability. The other major focus is on how repeatable findings are when different examiners are involved. This is measuring inter-examiner reliability.
The difference between these is that one (intra-) looks at how competent you are in making judgements about what you palpate, and whether the same findings are repeatable when you apply them to other people or other tissues that display similar characteristics. Do your current findings commonly agree with your previous findings? In this case, there is good intra-examiner reliability.
Inter-examiner evaluation looks at how much agreement there is when others palpate the same tissues. Do they come to the same conclusions you did? In that case, there is good inter-examiner reliability.
It's worth reminding ourselves that such reliability does not necessarily mean accuracy has been achieved. The interpretation of methods of palpation that can reliably be duplicated and which agree with the palpation findings of someone else, does not in and of itself mean the conclusions deriving from the palpation exercise are accurate. You may both be wrong, depending on the basis for your interpretation of similar palpation findings. For example, you could reliably aim and hit a dartboard every time you threw a dart, and this would reflect your throwing reliability. However, only if you consistently or frequently hit the bull's-eye would the dart-throwing be categorised as accurate.
So, how can we ensure better intra- and inter-examiner reliability and accuracy? I've explored ways to do this in my book Palpation and Assessment Skills, which attempts to lead the reader through multiple graduated exercises that should result in enhanced skills. Assessment and palpation methods need to be standardized, well-taught and regularly assessed for both reliability and validity (accuracy). The acronym STAR is used in osteopathic medicine to describe characteristics that commonly are present and assessable when dysfunction exists:
Some of these elements are measurable and some not. In other words, some are subjective (tissue texture, for example) and some are objective (range of motion, for example). One thing is certain: The more you practice palpation methods, the more sensitive and reliable your methods should become. What your palpation and assessment means depends on the degree of knowledge you have acquired and your particular belief system. For example, when palpating the radial pulse, your belief system might cause you to interpret findings as relating to heart rate, whereas someone else who appears to be performing precisely the same palpation might be evaluating qi levels in different meridian systems. I will return to the vast topic of palpation in a future issue.
Click here for more information about Leon Chaitow, ND, DO.
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