Cultivating expertise (and apropos pulse-Dx machines)

[Guest guest]

August 2006 issue of Scientific American magazine features cover

story on " Secrets of the Expert Mind " . It deals largely with chess

mastery, as this area has a long history of scientific study, but

also mentions issues of expertise in areas including medicine. " Just

as a master can recall all the moves in a game he has played, so can

an accomplished musician often reconstruct the score to a sonata

heard just once. And just as the chess master often finds the best

move in a flash, an expert physician can sometimes make an accurate

diagnosis within moments of laying eyes on a patient. "

 

The gist of the scientific findings is that motivation and intensity

of study, especially challenging oneself, over a period of about 10

years, results in expertise or mastery, as opposed to natural talent

or attaining formal credentials. The learning process involves a long

process of meticulously working out pathways of relationships and

their logic, which become built into an ability to recognize salient

features more quickly and accurately only eventually being able to

make a correct choice without an explicit detailed analysis. I am

reminded of the analytical rigor of the Shen-Hammer pulse diagnosis

training, and then the speed and accuracy with which Dr. John Shen

could diagnose a patient.

 

This relates, I suspect, to the use of pulse diagnostic

instrumentation. As was the thrust of the McCullough-Bronfman system

(at least as published in the late 1990's), the intent was to help

with the education of clinicians, rather than to automate diagnosis.

 

One area where this approach might help is that of arriving at

unambiguous terminology for describing pulse qualities. As in the

Shen-Hammer training, there's an important distinction between

accurate, communicable description of pulse characteristics, on the

one hand, and the interpretation of their clinical meaning, on the

other hand. Having struggled in TCM school with a sketchy, at best,

training in pulse-description and -reading, and having later studied

the Shen-Hammer system, I am naturally suspicious of commonly

encountered pulse descriptions. I think the common terms are used to

describe widely varying sensations. In many cases, I believe the

individual practitioner may have a cultivated system which is, to

them, clinical accurate and useful. But, without sitting down with

them and comparing terminology to empirical sensations, I have little

confidence that we communicate information of pulse-reading that well.

 

An in-depth look at this kind of problem can be found in an article

by Dr. Leon Hammer,

<http://www.yaviah.addr.com/articles/3tradition.pdf>Tradition and

Revision; Clinical Acupuncture and Oriental Medicine; Vol. 3 No. 1,

2002. (can be found through the website dragonrises.org, on the page

" Dr Hammer's Articles " .