Senate Bill 233

[Guest guest]

Alon,

We weren't talking about integration. As I mentioned, I'd

personally rather have others handle the blood tests, WM testing,

etc, and concentrate on Chinese medicine. It is fine to work in

integrative environments, and one does have to be trained to read and

interpret WM testing. However, we need to master our own tools of

the trade as primary, WM tools as secondary.

 

 

On May 10, 2005, at 10:52 AM, Alon Marcus wrote:

 

> Zev, these days its both, there are many single

> practitioner environments that integrate. Also, if we

> are to become part of the system, ie collaborative

> environments, then we need to be prepared. The road we

> are taking if for further isolation

 

 

 

 

[Guest guest]

Greg,

This was a general reply on the issues at hand, not specifically

to you. But lets look at the first issue. It is true we need a

diagnosis to make a superbill. However, because our profession never

pushed for codes for pattern differentiation, we are stuck with

biomedical diagnoses codes. And, lets be honest, most of the codes

filed for acupuncturists are 'second-hand' diagnoses, in other words,

already diagnosed by doctors and other WM health professionals. Even

with expanded tools, we will still be limited as to what we can

diagnose. If we move into such areas as diagnosis of diabetes, heart

disease, cancer and other internal medicine conditions (as opposed to

musculoskeletal conditions), this will require greater advances in

training, increased liability insurances, and many other cross-

discipline issues with the medical profession.

 

I agree with you that we need to watch the legislative drama

carefully, and respond proactively, not reactively as we seem to

always do.

 

I'd like to see a more effective method of engaging the

political arena, and applaud your own efforts to do so.

 

 

On May 9, 2005, at 9:10 AM, sperb1 wrote:

 

> Hi Z'ev

>

> I don't know where this is coming from. At no point in my message

> did I advocate anything about biomedicine. In this discussion, I

> don't care how, who, where, or why the diagnosis comes from, but to

> bill insurance, to create a superbill, to even chart, we need a

> diagnosis. Whether that is as simple as low back pain or whether

> that is a narrowing of the spinal canal due to an anterior

> protruding disk after an MRI is immaterial. We must have the ability

> to diagnose or we will cease as an independent medicine.

>

> Please do not put words in my mouth about biomedical diagnosis.

>

> And just to make it clear here, I am not saying that reduction of

> our ability to diagnose is in the amendments to SB 233. It seems

> that that may be the case, but I am still waiting to hear a legal

> opinion.

>

> Dr. Greg Sperber

>

> , " "

> <zrosenbe@s...> wrote:

>

>> I have to disagree here, Greg.

>>

>> We are hardly united as a profession on the core issue. What is

>> Chinese or Asian medicine?

>>

> is correct. There is barely enough time in an hourly session

>>

> to

>

>> diagnose by pulse, tongue, questioning, etc., not to say

>>

> prescribe

>

>> both herbal medicine and acupuncture treatment. Add on to that

>>

> the

>

>> various Western diagnostic tests, and it becomes prohibitive to

>> practice what we are supposed to be doing.

>>

>> There are many of us in this field who don't want to be mini-

>>

> docs.

>

>> If I want my patients to have biomedical testing, diagnosis or

>> treatment, I refer them to who I think is best in that realm. I

>> want to excel at Chinese medicine. Yes, there is a certain amount

>>

> of

>

>> Western medicine that we must know, but we have to be careful not

>>

> to

>

>> spread ourselves too thin in our practices.

>>

>> This field seems to be pushing for more biomedical classes, more

>> training, more practice of biomedical specialties. However, I do

>>

> not

>

>> see a corresponding trend towards deeper study in Chinese or

>>

> Asian

>

>> medicine itself, including learning an Asian language, more in-

>>

> depth

>

>> knowledge of acupuncture and herbal techniques, theory,

>>

> diagnosis,

>

>> Shang Han Lun, Wen Bing, and a host of other related subjects.

>>

>> I am not in any way for reducing our scope of practice, however,

>>

> the

>

>> LHC is right about one thing. We need to keep separate what

>>

> Chinese

>

>> and biomedical treatment and diagnosis are in our own minds, and

>> avoid confusing the public.

>>

>> I'd like to see us define our own profession more, instead of

>>

> trying

>

>> to absorb more biomedicine into what we do. As Todd says, get

>> additional training if you want to practice biomedicine.

>>

> Otherwise,

>

>> we may gain scope of practice, but pay dearly in malpractice

>> insurance to cover it. We may not be legislated out of the

>>

> medical

>

>> marketplace, but we may be priced out.

>>

>> Having said this, I agree with you that we need to carefully

>>

> watch

>

>> what legislators do and the legislative process. The political

>>

> realm

>

>> is filled with twists and turns.

>>

>>

>> On May 7, 2005, at 12:04 PM, sperb1 wrote:

>>

>>

>>> Finally, this is not about diagnosis, it is about the

>>>

> status

>

>>> and stature of our profession. Please do not rehash the old

>>> diagnosis argument.

>>>

>>

>>

>>

>>

[Guest guest]

On May 10, 2005, at 10:44 AM, mike Bowser wrote:

 

> Zev,

> We should not forget that decisions to refer rely upon the

> practitioners and

> their knowing when to refer and is part of participation in a

> healthcare

> system. That, in turn, relies upon us having the WM knowledge to

> do so.

> This is something that we need to have in order to properly perform

> our job

> in our society and be a part of the healthcare system of America.

> If we

> cannot continue in this respect it could jeopardize our profession

> and have

> the impact of reducing us to PT or even to MT level. Few people

> will pay

> this amount of money to be in that type of situation. Some people and

> practitioners want us to crawl back under a rock. The progressive vs.

> conservative mentality is alive and well in our profession,

> especailly over

> this issue yet we cannot afford to lose this one.

 

Mike,

No one is saying that one shouldn't have WM knowledge. The issue

is whether one becomes required and liable to do specific western

testing at the expense of Chinese medical diagnosis. This also

effects education. As I mentioned earlier, few if any professional

organizations seem to be rallying for more in-depth study of Chinese

medicine, medical Chinese language, or study of the classics. All

the efforts seem to be towards increased biomedical training.

>

> In addition, there are many current instances that I have

> encountered where

> modern practitioners use western lab tests as a marker in herbal

> prescribing. Jake Fratkin makes frequent mention of it in his patent

> textbook as does Misha Cohen in her hepatitis certification.

> Western lab

> tests are not the property of only the MD and do not mean that we

> conduct

> surgery, prescribe drugs, etc. This is another tool or way to

> evaluate the

> correctness of care. We should fight for this otherwise it will

> only take

> one bad herbal formula with a negative herbal outcome to show that

> we should

> not be allowed to use herbs.

 

I agree with you about lab testing. This doesn't require time out of

the patient interaction setting.

>

> We hear a lot about education on this forum, mostly areas that need

> to be

> improved. I can think of no greater way to better our profession

> than a

> western understanding of care and also knowledge of lab testing.

> Practitioners can always refer a patient to their GP and most do

> for some

> concerns but we should still be able to read and understand the

> results.

> Our educational knowledge is justified by retaining this ability.

> This is

> similar to chiropractic in that they can also order routine lab

> tests. We

> should take a page out of their playbook.

 

In my opinion, schools such as PCOM give ample time to these concerns.

>

> In the end, in oder for the profession to grow and prosper we need

> to have

> better integration in the healthcare system. We are seeing various

> collaberative efforts with schools and hospitals as well as

> employment ops.

> We do not want to lose these I would hope. Later

 

I will stand on my contention that we need to develop our own

institutions so that we are not always taking second place in

biomedical circles. Both developments need to happen. The focus is

clearly on integration into the present-day health care system. I

think we need to develop alternatives as well.

 

 

>

[Guest guest]

Or, to put it metaphorically,

 

I'd rather ride 'first class' in a small private airplane,

 

Than 'stand-by' on a 747 jet.

 

 

On May 10, 2005, at 10:44 AM, mike Bowser wrote:

 

> In the end, in oder for the profession to grow and prosper we need

> to have

> better integration in the healthcare system. We are seeing various

> collaberative efforts with schools and hospitals as well as

> employment ops.

> We do not want to lose these I would hope.

 

 

 

 

[Guest guest]

We brought this on ourselves. I

see a wave of self-destructiveness in the field that needs to be

rectified.

>>>>Agreed

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

But lets look at the first issue. It is true we need a

diagnosis to make a superbill. However, because our profession never

pushed for codes for pattern differentiation

 

>>>>You got to be joking. Just look at the ABC codes, they are not going

anywhere. We need to live in the real world, at this point that means using CPT.

If you want to work on getting CM codes, best luck to you.

Why are we not talking about having a real 4 year medical school level education

here? The chinese and Koreans have shown a fuller education is possible and

doable.Students will have to actually study and read and not be spoon fed.

Getting a better general education does not need to be at the expense of any CM

studies.Having a round education makes one a better practitioner period. It will

also be the only way we can assure to keep an independent profession.

 

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

On May 10, 2005, at 2:52 PM, wrote:

 

>>>>> You got to be joking. Just look at the ABC codes, they are not

>>>>> going anywhere. We need to live in the real world, at this

>>>>> point that means using CPT. If you want to work on getting CM

>>>>> codes, best luck to you.

>>>>>

 

Why would I be joking? It is the 'me-too'ism " that has plagued our

profession. We have not offered any alternatives to the codes and

the system, or developed our own structures for in-patient care,

insurances, or anything else. If your 'real world' is limited to the

biomedical world only, gezinte heit to you.

 

> Why are we not talking about having a real 4 year medical school

> level education here? The chinese and Koreans have shown a fuller

> education is possible and doable.Students will have to actually

> study and read and not be spoon fed. Getting a better general

> education does not need to be at the expense of any CM

> studies.Having a round education makes one a better practitioner

> period. It will also be the only way we can assure to keep an

> independent profession.

 

I agree that education needs to be improved, but I don't see anyone

in the ongoing debates dealing with increasing the depth of Chinese

medical studies. This has to remain the core of what we do.

 

 

 

 

 

 

[Guest guest]

And just to make it clear here, I am not saying that reduction of

our ability to diagnose is in the amendments to SB 233. It seems

that that may be the case, but I am still waiting to hear a legal

opinion

>>>Greg, it is important look at trends when thinking of these issues. Its not

what is in or out of any single bill.Intents usually only revel themselves when

trends are looked at. The slippery slope is what we need to fear and again for

those of us that have seen this coming it is very alarming.

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

Why would I be joking? It is the 'me-too'ism " that has plagued our

profession. We have not offered any alternatives to the codes and

the system, or developed our own structures for in-patient care,

insurances, or anything else. If your 'real world' is limited to the

biomedical world only, gezinte heit to you

>>>Again, look at the ABC codes

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

I agree that education needs to be improved, but I don't see anyone

in the ongoing debates dealing with increasing the depth of Chinese

medical studies. This has to remain the core of what we do.

>>>>I have always evocated increasing both and have always said that there is no

conflict between the two. Because true qualitative increases in biomedical

training mean most schools should close, this is were the resistance comes up

and therefore most of the conversation revolves around.

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

It is fine to work in

integrative environments, and one does have to be trained to read and

interpret WM testing. However, we need to master our own tools of

the trade as primary, WM tools as secondary.

>>>>Zev, again where is the conflict? i do not see it. Information is

information that is all. integration for me is not having mall, go to one store

then the next. Integration is a thinking process.. if one does fully understand

the pieces on can never integrate. Integration is about synergy.

 

 

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

I have no problem with anyone practicing in integrative environments

or billing insurances with the appropriate codes. I have done both

in my career. However, IN ADDITION I would also like to see those

who practice independently, have cash practices, favor herbal

medicine and use more 'traditional' approaches considered and

protected as well. I think we need more than one model for the

future practice of Chinese medicine in the West. I intend to spell

this out in an article soon, time permitting.

 

 

On May 10, 2005, at 3:24 PM, wrote:

 

> It is fine to work in

> integrative environments, and one does have to be trained to read and

> interpret WM testing. However, we need to master our own tools of

> the trade as primary, WM tools as secondary.

>

>>>>> Zev, again where is the conflict? i do not see it. Information

>>>>> is information that is all. integration for me is not having

>>>>> mall, go to one store then the next. Integration is a thinking

>>>>> process.. if one does fully understand the pieces on can never

>>>>> integrate. Integration is about synergy.

>>>>>

>

>

>

>

>

>

> Oakland, CA 94609

>

>

>