Tuesday, February 12, 2013

The State of Chinese Medicine in America and the fine art of healing

As we prepare to hear how our president views the state of the Union, I would like to share my own detailed  view on the state of the profession of Chinese medicine in America, as well as healing in general.   I  warn you though, some of what you read (if you are a student or practitioner of TCM or acupuncture)  you might not  be comfortable with.

 I see Chinese Medicine in America as analogous to a  fairly young tree whose roots are not all that deep or strong and which has been growing crooked (xie). Nonetheless, the soil in which it finds itself  is rich, nutritious, deep,  fertile, and healthy, although it is being contaminated even as we speak with pollutants.
That tree needs to be replanted and tended so that it can grow straight and tall. The soil is good and the tree is quite healthy, but we must make the nutrients more accessible and  we must not allow the toxification to continue.  

Before I translate what all this means, I want to look back for a moment:  There is a  wonderful historical novel  called "The Physician" by Noah Gordon, in which the great Persian physician, Ibn Sina (or the anglicized Avicenna), is introduced as the "prince of physicians," who establishes the first formal medical school, The Madrassas,  in Isfahan.  To become a  physician in the madrassas, one needed to be an expert in surgery, herbalogy, theology, jurisprudence, languages and philosophy, among other subjects.  Ibn Sina insisted upon a very high level and breadth of scholarship, skill, and experience in order to qualify as a physician, and the finest doctors in the world were his students and graduates. I  believe that this same model of excellence needs to be applied to our doctors and doctors to be.

Translation and transition to a new model:  
1. Current licensees: those who have graduated and are licensed should maintain their status quo but should also be required to take an increased amount of  Continuing Education Units (CEU's).  
2.  Schools: must raise their standards of grades and admissions.  It is much to easy to get into Oriental Medical School Master's programs, and  grades of C or D should not be acceptable and passing.  Students that have difficulty but who are really motivated need to retake courses until they master the material.  Forget attrition--start with quality, require a Bachelor's degree, carefully evaluating undergraduate grades, more thoroughly interviewing candidates and considering more carefully their written and oral communication skills. 
 3. Master's programs: The course of study must be more rigorous and students should not be allowed to graduate without demonstrating their practical and technical skills-- again, they need to do well in order to be allowed to graduate.  If this means that the course of study is extended, then so be it,  but the key must be proficiency not hours of time spent. 
 4. Mentorships: are a sorely needed priority for our students.  I would love to take a student under my wing, be available for him, teach him, answer questions that he has from his studies and  have him challenge me.  In my view this should not be just a nice option, but rather the sunlight without which the tree cannot flourish. 
5.  Autonomy:  We need to make a massive effort to prove our efficacy as a profession and enforce ourselves just like the MDs and Chiropractors do.  It is absurd that individuals and agencies that know next to nothing about what we do have been placed in governing and enforcing positions.  Our profession has been poisoned by mediocrity. Our governance and enforcement should not be directly linked together with the FDA and DEA, because we use and treat food and medicinal substances differently than MDs.  Though there does need to be enforcement, instead there needs to be  subdivisions of these agencies in which standards are high, and  officers are knowledgeable in what we do and what we use, and therefore wise as to what real abuses are.  Yes, there are problematic substances in our prarmacopeia, but it is absurd that so many important substances and useful substances are not available to us because of ignorance as to how we have been educated to use them. Having our own divisions would resolve this problem.  

Again, we are young, vibrant and find ourselves in  flourishing terrain.  Our tree has grown crooked and yes, wild, because it was not attended to properly, (and no, wildcrafted is not always better!).
I really believe that by raising the bar, we can affect an enormous change in the success of our profession.  I would suggest that as with Ibn Sina, students need to get much more practical tutelage and experience.  They need to get a much stronger foundation both relative to the past and to the present, by being taught a much broader survey of classics.  They also need to take more than just one course in Chinese medical language in order to be able to open Chinese medical journals to continue learning cutting edge developments in our profession internationally,  and they need to  learn to be much more competent in Western medical diagnosis and how to use WELL the tools that Western physicians use.  Ultimately, I think that if didactic course studies were more rigorous and if clinical training was more interactive and challenging we would produce graduates who had greater confidence in their knowledge and greater competence in their abilities.   I am absolutely certain that with this greater proficiency, as well as going into the world guided by mentor: a successful and experienced senior colleague, there is just no way that someone couldn't make a good living doing what we do, as long as they have drive and desire to make it.   

We have so many brilliant colleagues.  Just as the process is thorough and detailed in writing and developing good educational programs, why can't a "constitutional congress" of sorts convene in order for us to reclaim our profession?  And to where should we look to for our model?  Perhaps we can get  an idea by looking backward.


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