Feeds:
Posts
Comments

Archive for the ‘Medicine’ Category

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.

Advertisements

Read Full Post »

The Enigmatic Dr. X

For the first few days after we met Dr. X, he evaded the question when we asked him to tell us about his medical practice. Towards the end of our stay in Dengfeng, after Nan and I have bugged him enough with questions about his practice, he finally sat down for long hours at night to tell us about his practice. I thought these conversations were the jewel of our experiences in Dengfeng since they showed us the folk medicine side of health care in China, a side that is usually unacknowledged by academia but widely utilized by the populace. It turns out Dr. X is a folk healer who treats diseases that conventionally don’t have a cure (yi2 nan2 za2 zheng4). The top ten of these disease include rheumatoid arthritis, high blood pressure, stroke, diabetes, lupus, and psoriasis. Depending on how serious it is, he can cure some of these diseases, and improve the quality of life for patients with other diseases.

~Learning his trade~

He started learning TCM from his father at age 7, who also learned from his father. At age 15, he had already started practicing at the bedside. The medicine that he knows, however, has been learned from various sources, not just his father because what his father knew was limited. He constantly improves his trade by seeking out other doctors who are known to be good at treating certain illnesses and requesting lessons either by trading skills of his own or paying money. This type of learning results in some pretty unique forms of treatment, such as the use of electricity. He was very proud of his skills and said that his medicine can compete with that of any expert in any area. However, he admitted that he is only good at bedside practice and would not be able to teach theory in the classroom for the life of him. (When Nan and I later saw him try to add 7 to 16 with his fingers, we believed him.)

~The transmission of knowledge~

The transmission of knowledge in TCM is a tricky issue since “the Chinese are jealous” (his words) and traditionally believe only in passing on skills and knowledge to sons (since daughters are married into other families and technically become part of other families, thus divulging family secrets). As a result of this extremely selective transmission system, a lot of trade secrets (mi4 fang1) have been lost throughout the years, which is a great shame. When I asked if he has a remedy for this, or if he would himself put down his knowledge in writing, Dr. X quickly laughed off the idea. He said that he would never put down his trade in writing because that makes his trade worthless. He does, however, take students if he deems them to be “good people.” Out of the 20 something students he’s taken, however, not all turned out to be good students. Some left after they have learned some skills and claimed to be better than their teacher, defaming him. The good students, he said, are the ones who call on New Year’s to see how he’s doing.

~What defines a “good doctor”-the ability to diagnose by looking~

Dr. X doesn’t officially open a clinic since he doesn’t hang up a sign. He has a house in Guangzhou where patients come to him by word of mouth. He lives in the house with a western doctor who seems to function in a supporting role. According to Dr. X, whenever he diagnoses a disease, he will refer his patients to get a western imaging test to confirm his diagnosis, more to convince the patient whatever he says is true than to double-check his own diagnosis. He emphasized that his skill lies in “kan bing” (looking at disease), or basically diagnosis. He quoted the saying that if you can diagnose a disease correctly, then it’s already half cured. He claimed that just by looking and taking a pulse, he can tell a great deal about what illness a person has. The way you decide if someone is a good doctor is by not telling the doctor what illness you have, and letting him describe it for you. For example, he claimed that just by looking at one of our common acquaintances, he knows that he has diabetes, and Dr. X excitedly prompted us to ask said person if he indeed does. (Nan commented later that diabetes is one of the easier diseases to diagnose.)

~Selecting patients~

Without advertising or even having an official office, Dr. X already has a ready stream of patients who have heard about him by word of mouth. He said he doesn’t work at a hospital because there are too many patients, and he would feel guilty since he couldn’t possibly treat all of them. Instead, he goes by “yuan2 fen4” (a Chinese concept that has no equivalent in English). If you are able to hear about and find him, he will treat you, with the caveat that you must be a “good person.” He claims he only sees patients who are “good” and told the story of how once a rich man came in a wheelchair pushed by his Indonesian servant, and the old man treated the servant really crudely. When the man talked to Dr. X and begged him to treat him, Dr. X refused, saying he doesn’t know how to treat his disease, and he stuck to his decision no matter how much the man begged. Dr. X claimed that the payment he takes depends on how much money the patient is willing to pay. He could charge a rich man tens of thousands of dollars and a poor man next to nothing. (Previously he had also said that about 90% of his patients were business owners, CEOs, politicians, and other rich people who surely paid him a lot of money. The cynic in me thought it was strange that he doesn’t have as many poor patients who surely would come flocking to him if he does indeed treat them for next to nothing.) At the end of our encounter, he also offered his aid to us when we need it because we are “good people.”

~External qigong~
At the end of the conversation, he offered to demonstrate external qigong on Nan. Asking her to sit with her back towards him, he pulled up her shirt to demonstrate that there was nothing on her back along her spine. He then stood about 4 feet behind her and got into a leg-parted stance. Swinging his arms around firmly left and right, he went through a series of motions that seemed to take a lot of effort, since he started sweating and his face was flushed. Then he shot out his right arm with two fingers extended in a claw-like fashion about a feet away from the nape of Nan’s neck, and slowly and shakily dragged his fingers down through the air. When he finished, he lifted up the back of Nan’s shirt to reveal 2 stripes of red flushed skin about 2 to 3 inches long alongside her upper spine, right under the base of her neck. He explained that this would clear up her meridians (da3 tong1 jing1 mai4) and is good for her health. However, doing this kind of qigong is taxing on the body of the performer, since it takes away from the Original Qi (yuan qi, or zheng qi). He says he only taps into his Original Qi for treating patients about 5 times a year, or otherwise it would be bad for his own health.

Read Full Post »