patient load

[Guest guest]

" Jill A. Likkel " wrote:

>In our town each practitioner has their own pharmacy.

What do you and others think about having pharmacies(like

chinatowns

in larger cities) instead of each practitioner having their

own?

 

Jill,

I really like this idea--there just needs to be enough

volume for the pharmacy to stay in business. Someone tried

it in my area just before I was licensed and it went under

within a year. I like taking the 'profit motive' out of herb

prescribing. I sometimes feel compelled to reassure my

patients that I don't make much on the products I sell but I

would feel much better about just writing the prescript like

MD's do. Marian.

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[Guest guest]

I found alot of the problems went away when I used powder companies like

Qualiherb and

now Al Stone who has a powder pharmacy nearby. I can focus on the acupuncture,

after

the treatment ponder the formula and then fax it to the company later that night

or the

next day. I have a standard price that gives me a modest profit, the client gets

his or her

herbs in a few days and I don't have to invest anything. I also keep some

patents on hand

for those who need something right away.

doug

 

 

, " Marian Blum " <marianb@r...> wrote:

>

> Laura wrote:

> > am definitely struggling with this issue. . . The amount

> of money that I get in exchange for the herbs just doesn't

> seem worth all the work involved. Therefore I am only

> prescribing herbs for people if I've tried acupuncture and

> its not getting the results that I want and it seems really

> important that they get herbs---or in obvious situations

> like infertility.

>

> Thanks for your comments, Laura, I'm pretty much doing the

> same thing. Marian

> ---

[Guest guest]

, " Marian Blum " <marianb@r...> wrote:

>

> " Jill A. Likkel " wrote:

> >In our town each practitioner has their own pharmacy.

> What do you and others think about having pharmacies(like

> chinatowns

> in larger cities) instead of each practitioner having their

> own?

 

 

good idea, but everyone wants a piece of the pie. so most folks would rather

make a

profit on patents than write raw herb scrips and give someone else the money.

 

>

> Jill,

> I really like this idea--there just needs to be enough

> volume for the pharmacy to stay in business. Someone tried

> it in my area just before I was licensed and it went under

> within a year.

 

 

I tried it, too. didn't work and I even offered a piece of the profits.

 

I like taking the 'profit motive' out of herb

> prescribing. I sometimes feel compelled to reassure my

> patients that I don't make much on the products I sell but I

> would feel much better about just writing the prescript like

> MD's do.

 

I agree. MD's are not allowed to own pharmacies and ND's are advised by their

professional association to not profit on supplements as it is unethical (ha-ha,

they follow

that advice well). I still find myself telling patients at PCOM that I don't

make a dime on

the herbs so they can trust me.

 

[Guest guest]

, " Marian Blum " <marianb@r...> wrote:

>

> Laura wrote:

> > am definitely struggling with this issue. . . The amount

> of money that I get in exchange for the herbs just doesn't

> seem worth all the work involved. Therefore I am only

> prescribing herbs for people if I've tried acupuncture and

> its not getting the results that I want

 

That's so unfortunate, but I truly understand. That's why I am so enthusiastic

about the

potential for software to facilitate the study and clinical application of

herbs. There are

already programs out there that can speed up individual prescribing many times

by giving

you more rapid access to possible solutions to any case. Proper use of these

programs

can enable rapid multipattern prescribing. I have recently been approved for a

CEU class

on the use of computers in this process. It will be given at PCOM in the fall.

I am also

developing my own software to aid the formulation process. Keep you posted.

 

[Guest guest]

, " "

wrote:

> , " Marian Blum "

<marianb@r...> wrote:

> I like taking the 'profit motive' out of herb

> > prescribing. I sometimes feel compelled to reassure my

> > patients that I don't make much on the products I sell but I

> > would feel much better about just writing the prescript like

> > MD's do.

>

> I agree. MD's are not allowed to own pharmacies and ND's are

advised by their

> professional association to not profit on supplements as it is

unethical (ha-ha, they follow

> that advice well).

 

TOO RIGHT you should see Bastyrs Dispensary!

 

I still find myself telling patients at PCOM that I don't make a

dime on

> the herbs so they can trust me.

>

 

 

I don't feel I make much on herbs compared to the time I put into

the process. So I have no guilt about the markup on herbs, granules

or prepared medicines (formerly known as patents!).

But it would be quicker to just write a script and have someone else

fill it. I suppose I could hire someone else to do it if I really

felt motivated. I'll probably just muddle along like I am for a

while but I am going to bring it up with the group of practitioners

here.

 

Jill

[Guest guest]

> MD's do.

 

I agree. MD's are not allowed to own pharmacies and ND's are advised by

their

professional association to not profit on supplements as it is unethical

(ha-ha, they follow

that advice well). I still find myself telling patients at PCOM that I

don't make a dime on

the herbs so they can trust me.

 

 

 

I think this is a good point, and here at our pharmacy we do the same thing.

We basically take any profit that would be made and put that money into

hiring students (at a good wage) to fill formulas. Telling the patient that

you are not making any $$ off of the herbs builds confidence and not to

mention is ethically sound - only helping the profession.

 

Also I think this discussion gives some weight to the idea of having to

memorize formulas and herbs (in school) instead of completely going to a

case based model. For example, one should be able to whip out a Rx in a few

minutes (depending on the case of course). I do think when in school if one

follows the mentality that they do not need to memorize the formulas etc

because they can always look up things in the clinic only leads to such a

scenario as mentioned - Not having time to make the RX. The physical making

of the formula does not take long at all, I imagine what people are

referring to is coming up with the formula. One should easily have time to

do intake, needles and rx in 1 hour. (and make it yourself if necessary) -

{Note: there are days where we don't have P-support and I do not find it

that difficult.} Unless of course you are spending your whole Tx doing

Japanese acu .. :-) Comments?

 

 

 

-

 

 

 

 

 

 

 

 

[Guest guest]

, " " <@c...>

wrote:

 

>

> Also I think this discussion gives some weight to the idea of having to

> memorize formulas and herbs (in school) instead of completely going to a

> case based model.

 

I think I have not been clear about what is meant by a case based, problem

solving model.

Retention of data is still the goal. And it has been shown in countless studies

in western

medicine, which is far more data laden than TCM, that while less data may be

introduced

in the problem based learning environment (PBL), the long term retention is far

greater.

Some studies show triple retention rates for average students (the emphasis on

average is

important here. see below). Students still need to spend time memorizing the

data on

their own. However class time is not used for rote presentation of material.

In addition,

homework involves using problems and cases to elicit recall. This is more

similar to real

life than just memorizing lists out of context. It is also more traditional in

that it is more

like an apprenticeship where one learns by doing. In ancient times, people

didn't sit in c;

lassrooms. They studied the texts on their own, discussed them with their

teachers and

learned by doing in the clinic. That is how my teacher Wei Li learned from her

father.

 

Keep in mind this does not apply to top students. Top students who are either

geniuses,

virtuosos, possessed of photographic memory or unusual powers of discipline and

concentration cannot be the guidepost for all others. There are othermethods

that are just

more reliable.

 

For example, in lower level classes, I believe all the zang fu pathomechanisms

could be

taught with a series of carefully chosen cases. The solutions to the cases

would gradually

reveal or force the study of all the pathomechanisms. The concern with applying

this type

of approach to lower levels of training is always that the pure memorization

value of the

rote component with its linear hierarchical organization will be lost. but not

really, if you

think about it. In the process of working on a case, one will intuitively

compare and

contrast many similar possible solutions.

 

Consider working on a case where the pathology is obviously one primarily of the

liver.

the novice student will not know what liver pattern, but if they have learned

their OM1

basics, they will see the clear signs of the liver (lets say wiry/stringlike

pulse, anger/

irascibility, hypochondriac/ribside pain). But they are not sure which liver

pattern is most

likely to present with dizziness or nausea or PMS, pick one. So they must

compare and

contrast all the liver patterns in order to solve the case. While the teacher

would not stand

up in front of the class and say liver qi depression is this and liver yang

rising is that, the

students still would have to consider those things in determining their

solution. In

discussing the proposed solutions, the finer nuances of these issues could be

discussed

(such as how liver yang rising is distinguished from liver wind and liver fire

or the matter

of liver depression transforming into heat). Students would still have to

memorize rote

lists of data on their own so they could identify patterns on exams and should

be quizzed

regularly on this.

 

I believe the same thing could be done in herbs classes. Cases could be used to

prod

students to compare and contrast entire categories. For purposes such as the

above, the

use of databases greatly facilitates the process. For example, in Roger Wicke's

Herbal

tutor program, one can sort and search tables along a variety of parameters.

All herbs

that treat cough or all that in a single category or have a particular function.

The

advantage of Herbal Tutor over Acuvision is that you can display much more

relevant data

in a single window. For example, one could look at the functions of ten herbs

at once all

on the same screen. So in herbs 1, if the case called for herbs to release the

exterior, one

would have to compare and contrast all those herbs to solve the case. This

process

actually results in students really remembering the important details of the

herbs, much

moreso than they would just by memorizing lists. They also use this method at

SIOM,

where it apparently works quite well. This method will lead to the goal you

desire, but

more effectively than the old german drill and kill em method that the

nationalist chinese

adopted for their university system in the 20s and which the maoists inherited.

 

 

For example, one should be able to whip out a Rx in a few

> minutes (depending on the case of course). I do think when in school if one

> follows the mentality that they do not need to memorize the formulas etc

> because they can always look up things in the clinic only leads to such a

> scenario as mentioned - Not having time to make the RX.

 

I think you have mistaken styles of learning and teaching for a deemphasis on

memorizing data. I would argue that it is not really the rote memorization of

data that

give Chinese doctors the ability to prescribe more rapidly, but rather their

huge amount of

experience observing experienced prescribers in grand rounds. We must teach

process

and data in 4 years with minimal internship. Of course, you want to look up as

little as

possible, yet you also argue of the importance to study classical cases to

understand

modern ones. So what is it? That one should do it all instantly off the top of

the head or

spend time in the books. At various levels of study, one will have to spend more

or less

time in books. Once upon a time, I had to use my books a lot in order to apply

basic TCM.

My memorization of data occurred in this context, not through reading lists. It

would

never have happened that way because my brain does not work that way and if that

was

my only option, I would have done something else with my life.

 

Luckily several of my early teachers used this PBL approach, including Tim

Timmons, who

learned it from Dr. Cheung at ACTCM. Now I am often commended now on my ability

to

recall minute details of materia medica or theory and rarely need to access my

books for

my normal patient load. However I do need to study the shang han lun and wen

bing to

better understand pathomechanisms for those difficult cases. So I need to read

some

more and sometimes even in clinic. But it is a mistake to say if one can't

memorize it all

by the time one is an intern, then one is not fit to use the herbs. I guarantee

I could

produce far more competent (not necessarily great) herbalists by this method

than you

could by your suggestion. And the great ones will be great, regardless and the

average

folks will just give up, as they currently do. My interest is in all interested

students being

to achieve a level of competency. The idea that merely by insisting that

everyone spend

15 hours a week memorizing lists will not make it happen. Why has even western

medicne

abandoned this style of teaching when their students are arguably the best

memorizers

and test takers we have in the USA. Because it has been proven over and over

again, the

old method does not work. And be clear the so-called old method is really a

modern

aberration from millennia of more organic learning environments which have

merely been

revived in PBL.