How To Choose a Practitioner or Doctor of Chinese Medicine

Standards for practitioners of acupuncture and other Oriental techniques are constantly evolving. The treatment of complex disorders and pain syndromes often requires an ongoing relationship with a physician. Therefore, to make the best decision, you have to inform yourself as to the options available. In this discussion, I will use the term "acupuncturist" to refer to a licensed or certified acupuncturist and "physician" to refer to a D.O. or M.D. who has at least had 500 hours of specialized acupuncture training in addition to the normal 8 years of medical education.

Practitioner Training

Generally, more is better. Physician graduates of M.D. and D.O. schools have much more exposure to patients with a wide variety of conditions during their training, and they spend thousands of hours in the study of physiology, pharmacology and anatomy. They generally spend many hours in continuing education and study to maintain current knowledge and incorporate new information.

You may wonder why I emphasize the need for Western training. Even though some studies have shown that up to 40 per cent of patients who are seeing Western physicians are also seeking alternative treatment, it is often overlooked that almost 100 per cent of those getting alternative treatment are also being seen by a Western physician.

Therefore, it is imperative to coordinate care. Unfortunately, many Western doctors do not know to ask about a patient's intake of herbs or supplements, and many more have so little education in this area that they cannot provide useful guidance. Many physicians are not aware of the many conditions for which acupuncture can be a first choice of treatment, or where it can be used as an adjunct.

Similarly, most alternative practitioners have limited education in surgery, pharmacology, and other aspects of Western medicine, and so cannot help the patient explore these options or coordinate care effectively with a Western plan of care. Because of the technical language used by physicians, alternative practitioners have difficulty understanding and communicating with Western physicians, and the reverse is true, also.

For these reasons it is optimal to find someone trained in both traditions. Another very important issue arises when a patient is taking pharmaceutical and plant based drugs at the same time. Because potentially dangerous interactions are possible, the best precaution is to have your care monitored by someone familiar with both systems.

Doctor Experience

Experience requires a presence of the student in both location and attention; Not only does a physician have to be physically present in a place where a lesson is being taught, but he or she also must be attentive.

A physician distracted by fatigue, hunger, pain, mental impairment, or lack of focus might have years of "experience", but is still unable to form an effective plan of care due to impairment of the mental focus and clarity that is necessary to separate the essential issues from the distractions.

A single needle placed with perfect intention has greater value than a hundred placed casually. Nonetheless, it takes great determination to develop this level of focus. Providing a minimum number of treatments also allows the physician to learn variations in anatomy and location of treatment points.

Beyond that, a physician has to learn how people of different constitutions suffering from different disorders react to treatment of various acupuncture points. Finally, it takes time to practice any skill at a high level.

Therefore, it is useful to ask about the experience of your practitioner. A practitioner who sees only a few patients a week, or sees only a few limited conditions, is going to require many years of practice before they will possess the wide range of skills necessary to address complex modern conditions.

For acupuncture, it is my opinion that you will be assured of an acceptable level of competence if the practitioner has placed at least one million needles. I want you to use some flexibility in applying this rule, but I recommend that you consider it as a guideline. Why one million? Well, I generally use about 250,000 needles a year, and I try to use the minimum for each patient.

So, someone working at a comparable rate will have placed a million needles after only about four or five years of full time practice. After this amount of effort, a conscientious person should be aware of their clinical strengths and weaknesses, and should be able to provide capable basic acupuncture.

Remember that the road to mastery of Oriental medicine takes decades and is just as arduous as the mastery of any aspect of modern Western medicine, and requires the same level of commitment.

Someone in practice 10 years should be moderately skilled; after 20 years, highly skilled; and from 30 to 50 years of practice you will find the true masters. Of course, there are some who can attain a high level of expertise more quickly, and there are some who never quite "get it" even after many years of practice. Let your intuition guide you if you are not sure, and it always helps if a person who has already had treatment from that practitioner refers you.

Herbal Medicine

Most of the time, a plant derived formula is helpful in addition to acupuncture. Herbalists' training is less standardized than that of acupuncturists, and as I indicated earlier, interactions between drugs and herbs must be monitored by someone familiar with both.

Plants are drugs, and though they are in general much less dangerous than prescribed medications and have fewer side effects, "natural" does not mean safe. An experienced herbalist should be prescribing formulas for about 80% of their patients, and almost everyone should be receiving some dietary advice also. Most good herbalists are also good cooks, by the way.

Character and Truthfulness

An additional issue which should be considered is the character of the physician or practitioner. This is sometimes difficult to determine, but you should soon have the feeling that the practitioner you choose is worthy of your trust and confidence.

If you have doubts about their professionalism, sincerity, or honesty, it will be difficult to establish the sort of relationship which leads to the best care.

Be wary of those who self style themselves "masters" after only a few hours of training. (or even a few years!) In fact, it is not traditional to refer to oneself as a master at all. Such a display of arrogance would be unseemly or in bad taste for true Oriental masters. Better to find someone whose students refer to them as "master", and who is less self-aggrandizing themselves.

Beware also of exaggerated claims. Most conditions can be addressed to some degree by acupuncture and Oriental medicine, but some may take considerable time and effort to treat.

Very few diseases of modern times are curable with minimal effort, and a majority of problems are chronic by the time the average patient seeks out alternative treatments. If the cause for the condition cannot be eliminated or completely opposed, treatment will have to continue indefinitely.

This, of course is true for many Western treatments also: stopping medication for high blood pressure or chronic arthritis will result in the symptoms returning.

Seek Out Someone Who Speaks Your Language

In medical school, I was taught that 80 per cent of the diagnosis is derived from the history that the patient gives. This is true in the Oriental systems, also. The nuances of a physicians' questioning can be very subtle, and understanding exactly what the patient is complaining of is essential.

This is why dealing with a native speaker of your language is so important. For example, when a patient says, "I feel dizzy"; the doctor has to know to determine if the problem is vertigo or lightheadedness.

The physician may also have to know the patients cultural background to determine the best way to phrase a question, or to understand how a patient interprets symptoms of disease.

It is true that some few doctors can diagnose just from the pulse, or the urine, or palpation, but after more than 30 years of study and experience, I can say that these doctors are very rare, and even they will glean important information from the patient's story.

I have treated patients successfully in many countries, often when communications were not the best, but I am sure the best care comes when the patient and physician can communicate most clearly.

Where Do I Start?

The first place to begin is to ask your present physician if they know someone to recommend. Word of mouth referral from physicians, family members, or other patients whom you know is actually one of the best resources.

There are two large organizations that maintain web sites to help locate practitioners in your area. The American Association for Medical Acupuncture lists graduates of their program, which is based at the University of California at Los Angeles.

This program is only open to M.D. and D.O. graduate physicians. The system taught is based on the Energetic School of Chinese acupuncture as it is presently practiced in France. There is also training in the five phase models of disease and the treatment of the curious meridians. I use energetic treatments all the time and find them very helpful.

Physicians can generally communicate well with other physicians, so coordination of care is somewhat easier. Nonetheless, there are significant numbers of Western physicians who find the concepts and practices of Oriental medicine to be so foreign to their training as to be unacceptable. Naturally, many of their patients never tell these physicians that they are taking plant based medicines or acupuncture, and this lack of communication significantly compromises care.

The second large group certifying practitioners is the National Commission for the Certification of Acupuncture and Oriental Medicine. This is the oldest national group, and since their first exams in 1985 they have developed certification standards for acupuncture, Chinese herbology, and Oriental bodywork. Graduates of non-medical programs as well as physicians may sit for their exams and certifications.

You should be aware that despite certification, the depth of training for any individual may vary, and those who have minimal training in Western medicine, or who cannot keep up with the constantly changing landscape of Western practice, may not be able to coordinate care with your physician.

I am sorry to also report that I have found physicians themselves have difficulty coordinating care with each other, and the antiquated specialty system by which most modern physicians compartmentalize their thinking has impeded many a patient's treatment for multisystem disease.

One factor of interest regarding non-medical practitioners is that they aren't inherently conflicted about using techniques from many ages ago. Some are extremely skilled in their areas of expertise. Not having as much formal training in modern laboratory science, they are more focused on the clinical realities than on theory, a plus. There has also been an increasing emphasis on learning about pharmaceutical and standard Western approaches in recent training programs for non physician acupuncturists.

On the other hand, acceptance of bizarre or incorrect theories of disease and physiology are more common than among physicians. Diagnosis and understanding of the complexity of a disease may be limited by a lack of medical education.

Depending on the applicable practice regulations in different states, non medical practitioners are often unable to order or interpret laboratory results which might help to clarify the progress of treatment, and they may not be knowledgable regarding medical options for diagnosis and management.

I have also placed links to other practitioner databases at the Acupuncture Information and Practitioner Databases section of the "recommended website" page at this site.

So, these are places to begin to find a practitioner. In addition, it is likely that you will need to schedule an evaluation to see if you can both work together to solve your particular problem. Be also aware that a good therapeutic relationship may include some conflicts. A charming bedside manner is not always the best sole criterion for choosing a physician, although we are all more comfortable with those who have better social skills.