by Christian Nix

I haven’t heard anything official, but I suspect the Hospitalito in Santiago, Atitlan may have to change its name. The inauguration of the new building – more than five years in the making – was Friday, November 19, 2010 and the size and quality of this new facility immediately makes this one of the premier hospitals in all of Guatemala. It is no longer a hospitalito (-ito is a suffix which connotes something diminutive); but rather a full-blown Western medical hospital with rooms for in-patient care, emergency services, surgery and delivery, as well as a full lab, x-ray room, dental clinic, and . . .

Since I split my time between traveling/teaching and relaxing (and teaching) at my house on Lake Atitlan, my clinical practice these last several years has been primarily here at the hospital in Santiago.  No setting so benefits from a community acupuncture practice like a Western hospital.

The single greatest ‘fringe’ benefit for me and for patients is the air of professionalism, which pervades the hospital environment. I cannot rely overmuch on placebo or nice feng shui, nor even a silent and discreet setting; yet still my ‘barefoot’ practice brings noteworthy value to many of the patients whose conditions are not adequately relieved after their foray through Western medicine. The inherent complementarity of community-style acupuncture in a Western medical setting is obvious.  Yet certain skills are required by practitioners who would thrive in such an opportunity: 1) above average communication skills; and 2) rigorous professionalism in appearance and methodology.

Actually the Hospitalito has been a relaxed and friendly atmosphere, utterly open and accommodating to what I offer and eager to collaborate. Yet it was communication skills that landed me the position; and what has stood me in good stead during my tenure here is logical methodology.  I never, ever use the word qi when speaking to a Western physician but have instead ‘translated’ this concept, relating it to functional medicine. When a physician asks about what I do, I relate a logical methodology, pointing out that holistic CM has a different logic – i.e., a different way of mapping disease and diagnosing it; but never do I attempt to teach this logic in casual conversation except in the most general terms. This helps me avoid both the potential pitfall of seeming pretentious or pedantic, and also any territoriality and hostility that might accompany such interaction. If I were to outline the three most important areas required for obtaining confidence in speaking with Western medical physicians, I would be forced to emphasize the following fundamentals; (not exciting, but quite effective).

1. Learn the statements of fact that describe the linguistic reality of holistic Chinese Medicine. It may seem odd to memorize statements of fact of Chinese medicine in order to bridge the communication chasm with Western physicians. However, in reality it is clarity about and a thoroughgoing understanding of your own practice paradigm that are the prerequisite for any attempt at paradigm equivalency. It is a medical anthropological fact that language does not merely describe reality; in medicine language actually creates reality. ^{1, 2, 3} In addition, the 2007 study by the National Education Dialogue to Advance Integrated Health Care Academic Consortium for Complementary and Alternative Health Care, for the Integrated Healthcare Policy Consortium, declare conclusively that the singular skill required for inclusion in a Western medical setting is communication (See chart below). ⁴

The statements of fact in holistic Chinese medicine are linguistic building blocks, leading to clarity and deep understanding of the clinical reality of Chinese medicine.  They are also the foundation of clear communication skills when speaking with Western medical professionals.

2. Learn the disease causes/disease mechanisms of Chinese medical patho-physiology. Here again is a basic cognitive skill by which any Chinese medical professional clarifies for him or herself just what is causing a given clinical condition. In my situation at least, understanding Chinese medical patho-physiology helps me avoid the omnipresent temptation to lapse into Western medical explanations of diseases, in other words, using biology and chemistry instead of Chinese medical thinking. The biomedical model is so easy for us to default to in communicating with Western medical professionals; it’s what we think they want to hear. However, I think it leads to a loss of our professional position as opposed to enhancing it. In my experience, a clear understanding and appreciation of Chinese medical disease causes and mechanisms, communicated in the language of holistic metaphor and the technically correct statements of fact shows that we have learned our own model thoroughly and well. To actually do our job well in the integrative environment, we may need to understand the Western medical logic and process, but we don’t need to compete on the verbal “turf” of the Western practitioners with whom we interact.

3. Practice presenting to physicians (or anyone for that matter). Like any skill, good communication comes from practice. The number of questions Western physicians ask can fairly well be counted on one hand. Once you are familiar with their suspicions, motivations, objections, and legitimate misgivings, you can craft your answers using the best possible vocabulary, emphasizing the exact point they seek to understand without sounding either condescending or defensive.

While nothing replaces the ability to ‘think on your feet’ in the clinical environment, a good way to hone your interactions with MDs is presenting a talk at a hospital or to any group you can (lots of talks are better than one). That said, my personal preference is simply to dialogue with other providers. I ask MDs whose patients I am treating what they wish to understand and speak directly to a specific question or issue. Obviously this requires a certain modicum of confidence in one’s skills and the ability to describe what I am thinking and doing without apology or any hint of smoke and mirrors. Still, this has worked well for me and Western physicians genuinely appreciate it.

Summary:

The Hospitalito Atitlan has been a tremendous laboratory of learning for me in these past three years. Several students from various parts of the world have likewise enjoyed the experience and I continue to admit students and practitioners to this unique program in which I detail the essential elements of working in a Western hospital setting.  At present the administration is interested in a full-time collaboration that would allow Chinese medical services year-round. Though not a paid position, the experience and level of exposure to high-level medical professionalism is – for many TCM/AOM folks – an unprecedented and rare opportunity for cultural immersion and deep and meaningful interaction with Western medical professional.

Works Cited:

1. Flaws, Bob and Douglas Frank. Curing Arthritis Naturally with Chinese Medicine. Blue Poppy Press. Boulder, Colorado, 2006.
2. Flaws, Bob.  Arguments for the Adoption of a Standard Translational Terminology in the Study and Practice of Chinese Medicine in the English-speaking World. The American Acupuncturist. Vol. 37. Fall 2006a.
3. McKenna, Terrance. Food of the Gods. Bantam Book, 1992.
4. *Survey of MDs/Administrators of Integrative Clinics to Gather Information on Competencies of Licensed Acupuncturists for Practice in Hospitals, Integrated Centers and Other Conventional Healthcare Settings

Produced by the: National Education Dialogue to Advance Integrated Health Care Academic Consortium for Complementary and Alternative Health Care. For the: Integrated Healthcare Policy Consortium.  Project Director: John Weeks.  Key Collaborators: Pamela Snider, ND, Elizabeth Goldblatt, PhD, MPA/HA, Catherine Niemiec, JD, LAc, Kory Ward-Cook, PhD, Bryn Clark, LAc. Sponsor: National Certification Commission for Acupuncture and Oriental Medicine. December 2007

Christian Nix, MA; L.Ac.

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