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Archive for June, 2008

Dengfeng Wrap-Up

In Dengfeng, we’ve experienced frustration, disappointment, major embarassments and not an insignificant amount of awe, which sounds about normal for a pilot trip to a new place. In truth, from a very superficial viewpoint of what I had understood of Dengfeng, by the end of the week, I was ready to leave. To cite an example: our primary sources of entertainment were visiting the local sketchy internet bar and watching bad Chinese tv singing competitions.

Now the big question: could we have done better? Yes and no. Yes, in that I think we could have had a better attitude and pushed harder to meet the Shaolin Temple monks or delved deeper into some other aspects of the Shaolin Temple. We had five days in Dengfeng; even if denied access to the Abbot, we should have asked to talk to local people or the local monks.

Would this request have been met with success? Not necessarily — hence the ‘no’ part. In general, what generally makes or breaks an experience is the people involved, and Dr. X is no exception. I am hugely grateful to Dr. X for showing and taking us around. Still one problem that remained was the fact that he voluntarily gave us very little information, even in little cases such as where it was that we were heading at the very moment. Hence, it made access to any type of really difficult and very frustrating at times; for example, over the many meals we had with him, he consistently declined to answer what type of medicine he practiced (I think it may have been a paranoia of revealing secrets in public) but it was initially hard for us to understand this as first and he provided no explanations. When he did explain to us late at night in our hotel rooms, we didn’t understand why such information couldn’t be revealed over dinner (where nearby guests were most likely tourists) . Furthermore, his certain mannerisms such as consistently only introducing one of us and not the other made friendly overtures towards him not as easy as it could have been.

All in all, at the end of the five days in Dengfeng, we were looking forwards to Zhengzhou. Just a preview of Zhengzhou – romance! danger! and a near fatal accident!

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Miracle Stories

Whenever we asked patients how they chose to see a certain TCM doctor or how good that doctor was, we were invariably met with a series of miracle stories that went somewhere along the lines of: “I knew this person who had this horrible disease X that all Western doctors said was untreatable, and he/she only had Y months left to live. Then he/she sought out this TCM doctor who prescribed Z treatment, and after N weeks the patient has completely recovered! It’s been years since and the person is still fine. All the Western doctors he/she went back to for checkups said it was a miracle.”

After one too many of these stories, Nan and I got incredibly sick of them and started counting sheep in our heads every time someone launched into one of these stories. Being the students educated in Western science that we were, we dismissed the ability of these stories to say anything about the abilities of a doctor. Now, I think it is entirely possible that the said TCM doctor may be incredibly effective, or he may be an ordinary doctor who got lucky, but short of a double blind study, I wasn’t willing to use these stories to draw any conclusions about the effectiveness of a doctor*. It’s a matter of probability, I told myself. Of the hundreds of patients the doctor has seen, the 5% of the time when a patient recovered beyond expectations (whatever the reasons) would be attributed to the doctor’s abilities, and the story would propagate like rabbits. The rest 95% of the time when the patient’s results were absolutely ordinary or even worse than expected, well, the disease was incurable anyways, so no one can blame the doctor for not being able to nurse the patient back to life.**

After hearing so many stories, I couldn’t help but wonder, what about these stories were so appealing to patients? I think the mere possibility that a disease considered incurable by WM may possibly be cured by TCM is incredibly alluring, especially for those who have received the death sentence by WM. It doesn’t have to work 100% of the time, but if there is that possibility, the patient is willing to try it. There’s not much to lose anyways. It gives them something to hang on to, some little slimmer of hope. And for a terminally ill patient, hope, or at least some kind of positive attitude, can be incredibly helpful.***

Add to this slimmer of hope a doctor’s self-confidence, and you get an even more convincing combination. Towards the end of our stay in Dengfeng, we saw Dr. X in action as he saw a patient in his hotel room. The patient was a 49-year-old peasant woman who had persistent pain in the left leg. Her left leg is thinner, shorter, and weaker than her right leg. Having seen many WM and TCM doctors to no avail, this woman was slightly skeptical and very apprehensive about the pain of acupuncture. Throughout the treatment period, Dr. X oozed self-confidence and took many opportunities to show off his skills. For example, he believes adamantly that a “good” doctor is able to tell a patient what’s wrong with them without being told (see previous entry The Enigmatic Dr. X). Thus, he prohibited the patient from describing her symptoms and proceeded to list them after a quick examination and pulse-taking. In cases where the patient disagreed, Dr. X still hung tight to his diagnosis, even if he had to convince the patient otherwise. Here’s a sample:

Dr. X, after taking a pulse: “You have had this leg problem for more than 10 years.”

The husband, a friend of Dr. X, nodded: “Yea it’s been about 10 years.”

The wife, looking a little resistant: “I remember it’s about 8…”

The husband: “No no it’s been longer than that.”

Dr. X: “It’s been more than 10, because the problem was already festering internally before it manifested physically.”

Before he administered some acupuncture to the woman’s legs, the woman was visibly scared and resistant because her memories of acupuncture involve a lot of pain, but Dr. X kept reassuring her strongly.

“My acupuncture is different from other doctors. Real, effective acupuncture will not hurt. Trust me, this is not going to hurt much at all. You’ll see.”

As he tapped needles about 1.5 inches into her left and right calf, the woman cringed a little. Dr. X looked up and said, “See, it doesn’t really hurt right?”

The husband also looked at her expectantly. The wife replied, “Yea, it’s not too bad…”

After he pulled out the needles, Dr. X exclaimed, “Look! The left needle has a little bit of dark blood on it, which shows it has problems. The right one doesn’t. With real acupuncture you’re able to see these results.”

Now, I have no idea really how long the woman had her leg pains or whether it really didn’t hurt, but I do know that Dr. X was incredibly self-confident, and the patient seemed more and more convinced throughout the session. And I realized that for unconventional forms of medicine that cannot be evaluated systematically, two things are important for how a patient can evaluate a doctor. 1) Anecdotal evidence from trusted sources, aka miracle stories, that prompt you to seek out a doctor in the first place. 2) How competent a doctor seems at your clinical encounter, influenced by his confidence and his ability to convince you of his skills. Dr. X certainly fulfilled both criteria.

Now, my favorite miracle/anecdotal story that I heard is this: One day there was a peasant who ran into a lion in the woods. Absolutely terrified, he raised both arms and stabbed the spear he was holding into the lion and escaped frantically. Thereafter he found that he was unable to move his arms from their raised position, and he walked around all day with his two arms above his head. No doctors could heal him. One day he met this old folk doctor who told him he could cure him. As treatment, the folk doctor gathered all the villagers around and stood the man in the center of the crowd. The folk doctor then took out a knife and slowly started cutting away the band holding the man’s trousers up. The man shouted for him to stop, the crowd jeered, but the doctor persisted. As his trousers were about to fall, the man’s arms shot down and grabbed his trousers. He yelled angrily at the doctor, but the doctor grinned at him and said, “Now you’re cured.”

*Interestingly, I learned from my health policy class that the way Americans choose what physicians to see is very similar. Most people give reasons along the lines of “My close friend/relative recommended this doctor because they had good results.” In fact, the patients’ least trusted source of information is health insurance companies. Ironically, insurance companies are actually the sources with the largest sample size and therefore most statistically reliable evaluation of a doctor’s effectiveness.

**I have no hard evidence, but from my small sample size of people I’ve talked to, popular evaluations of Western medicine (WM) seem to follow the opposite trend. The 5% of the time when a doctor messes up, the story spreads like wildfire. The times when Western medicine helped a patient, well, that what it’s supposed to do anyways.

***On a related note, WM doctors tend to give prognoses to patients that are more optimistic than what the doctor knows to be true. Why they do so and the consequences or this are another story. Yay Sociology 180 and Christakis’ Death Foretold.

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