AOMA Blog

At a recent gathering, a friend mentioned having knee pain. I quickly assessed it using neoclassical pulse diagnosis techniques and by palpating the location of the pain. Afterward, I found and applied four acupressure points with press-on seeds. As a result his knee felt much better throughout the party and the following days.

By using neoclassical pulse diagnosis in a clinical setting (meaning with further investigation and time), I am able to confidently provide my patients with efficient care for myriad health concerns, including pain, pyscho-social issues, insomnia, energy loss, hormonal imbalances, and digestive issues.

Having success in the clinic is a result of applying the techniques taught in Dr. William Morris’ neoclassical pulse series and training with him as an intern in his clinical rotations.

In Will Morris’ neoclassical pulse courses I learned how to assess a patient’s radial pulses as a diagnostic tool and immediate feedback loop. This feedback loop is invaluable in creating confidence in the practitioner, treating quickly and effectively while obtaining great clinical outcomes, and in maintaining my own health. Successfully using neoclassical-style pulse diagnostics created confidence in me as a practitioner.

During my treatments on patients I am able to monitor my patient’s pulse as it changes. As my patient’s pulse becomes more balanced and level, I know I have chosen a good course of treatment.

Neoclassical pulse diagnosis is also a great tool for assessing and treating on the go, because you can quickly evaluate the pulse, apply a few acupressure seeds, and still get great results. Learning to use the pulse as a feedback loop in clinical settings creates high-quality, efficient patient care.

Yet it isn’t just for patients. In fact, I find myself evaluating my pulse and applying indicated acupressure points.  This daily self-care ritual takes seconds and is a great way to stay healthy, emotionally balanced, and pain free.  

I am honored to have trained with Dr. Morris, and will continue to attend his classes and online teachings, as he provides invaluable insight into the world of patient-centered care. I highly recommend his neoclassical pulse series to all students interested in expanding their acupuncture and diagnostic repertoire.

Anne Cusick LAc, MAcOM graduated from AOMA in 2008 and is in current practice with Dr. Clark-Brown at a family care integrated clinic, specializing in pain management. www.cusickacupuncture.com

 

 

 

As a teacher and practitioner of Chinese medicine well into my second professional decade, I have felt for a long time that some of the most important areas of study in our medicine have received the least attention. This discrepancy is probably most relevant in the area of pulse diagnosis—and with good reason. Pulse reading can be an extremely subtle art, and there seem to be multiple ways of interpreting the same pulse. Add to that the fact that teaching the pulse is, at least in part, a transcription of our concrete sense of touch into an abstract verbal interpretation. The resulting confusion is nearly always daunting for the student and professional alike, and we wind up falling back on the not-so-subtle aspects of the pulse, limiting our data-gathering to a narrow number of simple distinctions like excess vs. deficiency. And though these distinctions are useful, if they were the only data we had to form our diagnoses, our treatments would be lacking.

When it comes to pulses, theory alone can never suffice. If you go to apply what you’ve learned and your finger position is a little off or if your finger pressure is too heavy or too light, you are not going to pick up the right information from the pulse. Having taught his system for many years, Dr. Will Morris understands that when teaching the art of diagnostic, lecture cannot be the only mode of teaching. There is a great deal of hands-on practice in these classes: from basic calibration of pressure, to correction of finger positions, to insights for practitioner comfort, and, of course, comparing pulses around the room. Dr. Morris and trained assistants are right there with you while you are feeling pulses in the class, available for checking your findings against theirs and offering further explanation relevant to the pulse you are feeling at the moment.

I bet most of us have a sense that if we could only improve our pulse diagnosis technique, clinical effectiveness would improve accordingly. Well, of course we are absolutely right in thinking so. But how do we improve our pulse diagnostic skills? One of the keys, I learned from Dr. Morris, is that we need to approach each pulse with the right framing tools. The pulse diagnostic we use to create an herbal prescription might be a different system than what we use for an acupuncture strategy. Furthermore, the pulse system we use to determine which channels are most affected by a soft-tissue injury may be different from the way we approach the pulse if someone comes to us with insomnia or shen disturbance. If Dr. Morris had contributed nothing else, his tools for filtering through the multilayers of informational “noise”in the pulse to help us home in on what is relevant in this context for this patient in this visit would have been a valuable contribution to our field. As it is, he has actually contributed a great deal more than that.

In this series of pulse classes taught by Dr. Morris, the participant learns many distinctions in the pulse that can be applied immediately in clinic; others need more time to master. One of the “extras” in the class is that Dr. Morris is liberal with sharing a multitude of clinical insights. Not only does he cover a variety of pulse techniques in depth, but he shares treatment strategies and ways to think about treatment strategies that correspond to the pulse diagnostic technique being taught at the time. Because you walk away from these classes with new, clear, diagnostic skills, new treatment strategies, and clarity for how and when to apply the new material, your practice benefits immediately. As you study and use the material from Dr. Morris’ pulse classes over time, your connection with the medicine deepens while your confidence and effectiveness as a practitioner solidify.

John Heuertz, DOM has been practicing Chinese medicine since 2001. He is nationally certified as both an acupuncturist and a Chinese herbalist practicing in New Mexico. Dr. Heuertz publishes and lectures extensively to colleagues in the Chinese medical field.

 

By William Morris, DAOM, PhD, LAc, AOMA president

I would like to explore the title of doctor, its historical use and impact upon programs and policy. It is time that people entering the AOM field, putting in four years of effort and often times the better part of $100,000 earn the title of doctor.

So, let's take a closer look at what exactly that title means and whether doctorates fit into the world of AOM.

A Doctor defined

The term Doctor (Dr.) attracts confusion regularly. Learned people consider the doctoral education in U.S. AOM to be PhDs. They are not, at least for now. Then there is the OMD that ended in 1998 as the field sought accreditation for master level education. Now, we have a post-graduates specialty in the DAOM and a looming first professional doctorate: title to be determined.

The first doctorates were PhDs. According to The Oxford English Dictionary, the earliest written use of the English word doctor was in 1303, referring to doctors of the church, meaning "learned men in the scriptures." In 1377, medical doctor as title for those who treat illnesses or diseases gained presence. Somewhere in the late 14th century, a church father enjoyed the title doctor as a religious teacher, adviser and scholar. In Latin, it was docere: to teach, in French, doctour. M.D. doesn't arrive until 1755 in the abbreviation of L. Medicinae Doctor "doctor of medicine."¹ In Chinese, language Dr. is designated yshng, this is a professional medical practitioner in the tradition of Chinese medicine.

In contemporary western practice, there are several forms of doctoral designation with respective roles. Research doctorates have the title PhD. There are first professional doctorates that are achieved within the disciplines: educational doctorate (EdD), dentistry (DD), medicine (MD), physical therapy (DPT), chiropractic (DC) and law (JD). The AOM field is unique in that it has a post-graduate Doctorate in Acupuncture and Oriental Medicine (DAOM) with competencies in a clinical specialty plus a smattering of research and education.

The DAOM

Let's review the requirements for the DAOM. All current DAOM programs require graduation from an accredited master degree program. After two years of undergraduate level education and 3.5-4 years of education at the master degree level, the DAOM can be earned with two years and at least 1,200 hours of education. This makes for 7.5-8 years minimum for doctoral level education in the AOM field, consistent with first professional degree education throughout the disciplines.

The DAOM program must provide a curriculum covering the competencies in the following core areas (2):

1. Advanced patient assessment and diagnosis;

2. Advanced clinical intervention and treatment;

3. Consultation and collaboration;

4. Clinical supervision and practice management;

5. Clinical evaluation and research.

DAOMs require teaching skills (4. Clinical supervision). As an educator, this is an interesting area. In one DAOM program, the new cohort was surveyed about their willingness to precept (supervise learners in their clinics). Of some 15 learners, only one was interested in precepting. After the program, all but one was willing to serve as a preceptor. Seemed successful. This is an important area of contribution and it is not a competency that is likely to be pursued in first professional doctorate.

Should the Current Master Degree in Oriental Medicine be a Doctorate?

The average time to complete a PhD is 10 years with four years at the PhD level; two years master level education and four years of undergraduate education. First professional doctorates are different. The state of New York defines a first professional doctorate as two years of undergraduate study with four years of graduate education in the profession. While the PhD is typically 10 years, and it is possible to complete a first professional doctorate in six years, it is more likely that the undergraduate education is more substantial at four years. Thus, the first professional degree involves typically 7-8 years of education after high school.

Maybe we shouldn't! Some school leaders argue against first professional doctorates because of the costs involved and concern that it could put a school out of business.

There are two primary reasons a school may fear failure should doctoral programs arise. First, the state in which the school operates may not allow for doctoral education. Second, many schools do not have the resources for developing doctoral level education. Thus, the uneven competition created by state laws and institutional capacity could cause schools to fail if students were to flock to available first professional doctoral programs. Ah! There is a third. Those schools that have put resources into developing DAOM programs at great expense may be concerned that a first professional doctorate would somehow cause interest to be lost in the DAOM program.

"But, there is increased med-legal risk for the acupuncturist to gain a doctoral title," was a common refrain of AOM doctoral opponents of yore.² That tune evaporated as the DAOM programs places graduates onto the streets and the insurance rates remained the same for that group as the master degree prepared practitioner. In my opinion, an improved educational standard lowers risk rather than increases it. A study that could highlight this view might be to explore the number of malpractice suits sustained by doctorally vs. masters prepared practitioners.

Who Cares?

I stand for doctorates in the field of AOM because I believe it is the right thing to do. It is a position that I have maintained since the early 80s'.

In Texas, where I live and work, there is no assurance that permission to grant first professional doctorates can be obtained. There is a risk. I continue to support first professional doctorates, because I believe it is right for the field, even if there is risk. As president of a school of AOM, my approach to leadership has been that what is good for the profession will be good for the school. This is the view when first professional doctorates are discussed within the Council of Colleges of Acupuncture and Oriental Medicine.

Power dynamics are leveled there is a common title among participants. Practitioners of Chinese medicine are often outside the mainstream currents in policy development, higher education and in the practice arena. Thus, AOM providers sustaining doctoral titles can serve a common social good, because the ability to influence access to care by the public is enhanced.

It is important for senior learners to teach junior learners, because it is through the act of transmission that senior learner learn! And, as John's Hopkins medical educator said in the early 1900s, "There is no way we can teach them everything they need to know to enter practice. The best we can hope for is to inspire them towards lifelong learning." Today's master degree in AOM is more rigorous than the MD of 1900.

While it is the internal and not the external qualifications that make a practitioner, in the eyes of the other, rank can be a leveling tool. The doctoral title may help those who are dedicated to erecting this profession and what it has to offer both society and the patient. The doctoral title often enhances relations with community partners, patients and policy makers. For these reason, which are tied to creating just and equitable access to healthcare that is often times safer and more cost effective than post industrial medicine, it is important for the acupuncturist to gain doctoral recognition.

Comments on the first professional doctorate would be speculative since the standards are still subject to process including public hearings and input. The AAAOM operates a forum where voices can be heard. Go here: http://groups.google.com/group/aomcommunity?pli=1 to participate in dialogs about the development of a first professional degree. The dialog is open and uncensored.

References:

1. Etymonline. Doctor 2011: Available from: www.etymonline.com/index.php?term=doctor.

2. ACAOM Accreditation Manual: Structure, Scope, Process, Eligibility Requirements and Standards. Greenbelt, Maryland: Accreditation Commission for Acupuncture & Oriental Medicine; 2009.

3. ACGME. ACGE Outcome Project. Minimum Program Requirements Language [serial on the Internet]. 1999: Available from: www.acgme.org.

This article was originally published in Acupuncture Today January, 2012, Vol. 13, Issue 01.