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Providing Quality Patient Care in TCM: The Four Cs

by Jason Bazilian, L.Ac.

At the hospital and in my private practice, I am constantly asked, “What makes Chinese Medicine so different?” This question can be answered in many different ways. Yet, along with some of the more conventional differences, I choose to add the same (or at lease a similar) response every time…the caring, holistic physician is what makes Chinese Medicine so different. The quality of care provided to the patient from the moment he or she walks through the door is the difference. Provision of quality patient care and bedside manner help to create a treatment environment that can facilitate positive changes toward improved total health. Combining Chinese Medicine and its rich 3,000-year history with superior patient care, bedside manner, and a smile enable the physician to effectively make a difference in his or her patient’s path toward greater well being. The above-mentioned health care approach, which focuses on a broader and deeper understanding of patient care and bedside manner, will be discussed and detailed in the article to follow. As an introduction, this article can serve fellow physicians as a daily guide and reminder of the integral components in providing optimal patient care.

The first question to address is how to define patient care. In its most simple form, patient care should be, in fact, caring for our patients. Providing care for another individual is as essential to the physician of Chinese Medicine as any other singular aspect of medicine as a whole. For the purpose of this article, I will utilize the terms patient care and bedside manner as two closely related concepts. Rather than differentiating between these two concepts, I will focus on and highlight the four key components underlying patient care and bedside manner. Providing quality patient care entails employing with every patient what I call the 4Cs: Communication, Connection, Concentration, and Compassion.

Communication
In order to truly communicate with our patients, we must first be willing to listen to their concerns, complaints and comments without passing judgment. Clarity of communication, which includes effective decoding the message from communicator to receiver, clear word choice and receptive body language, plays a major role in connecting on a meaningful level with a patient. Actually understanding what is both said and demonstrated by the patient requires an open mind and an open ear. Our patients are individuals, like all of us, who possess a need to be heard and understood. Being mindful of conducting thorough questioning and practicing active and attentive listening will also serve to heighten our self-awareness as connected communicators.

Connection
Connection, the second “C,” is the act of relating with a patient, with his or her problems, position in life, priorities or experience with pain and illness. It is our job and our responsibility as physicians of Chinese Medicine to find a common thread with the patient which can then become the avenue from which to improve communication and begin the process of connecting. This process engenders trust. Increased trust between physician and patient is an invaluable foundational building block that will inevitably strengthen the course of healing. Following is an example from the hospital that demonstrates the first two “Cs” of quality patient care in practice.

I have been treating an 80-year old man in the hospital for three weeks. He has suffered from debilitating one-sided migraines since the age of eleven, when he was struck by a car during a neighborhood snowball fight. Based on Traditional Chinese Medical pulse and tongue diagnosis, his underlying pattern was determined to be Kidney Yin vacuity, Liver Qi depression, and an accumulation of dampness and phlegm in the lower Jiao due to weakness of spleen and stomach function. These had been terribly exacerbated by nineteen years of poor nutritional habits, limited amounts of sleep, and an addiction to fifteen to twenty extra-strength Vicodin pills taken throughout the course of each and every day.

Further, this was an individual who might easily be misunderstood as angry, annoyed, and outright distrusting of the notion that acupuncture and Chinese herbal medicine may be of some help. He associated needles with the flu shot and said he does not understand how Chinese Medicine “works.” This patient was initially unwilling to cooperate and not interested in communicating about any topic, let alone his health concerns. One of the first comments uttered from this patient to me was, “What a load of hogwash! Nobody’s been able to help me for 19 years. What makes you so special?”

On our initial visit, we spent the better part of an hour discussing the last 79 years of his life, his five children, his nine grandchildren, his record collection including over 15,000 old 78s and 45s, his favorite author, and of course, what made him smile. I noticed that his smile seemed fullest when discussing the topic of music. So, on that day, during the first hour and treatment, music became our initial point of connection. A glimmer of trust entered into our communication, and as I inserted the first needle at Kidney 3, he took a deep breath and closed his eyes.

One important point in this case, like so many chronic, difficult-to-treat, multi-layered conditions, was to initially allow for open communication and connection. By continuously paying close attention to the details of his life, we were successful in improving not only his daily migraines with regular acupuncture treatments but his quality of life and general outlook, as well. These are both important components of overall wellness brought about by specialized patient care, above and beyond a detached – yet all-to-common – treatment in many healthcare settings. By “specialized,” I simply mean that by applying the first two “Cs” of Communication and Connection, the physician is granted the special opportunity to encourage positive change. Taking the time necessary to concentrate on bringing about this positive change is the next challenge.

Concentration
Paying close attention or concentrating on the details is the third “C” in striving to provide quality patient care. Concentration on the patient’s entire medical history, as well as his or her mannerisms and idiosyncrasies, is paramount for making a thorough and accurate diagnosis. We, as physicians, must not be distracted too easily by the phone ringing, a door opening and closing, or by getting ahead of ourselves and deciding point selections or medicinal prescriptions for the patient without fully concentrating and hearing out the full details from him or her. Physician/patient interaction must always be 100% inclusive of the patient. In your practice or healthcare setting you can concentrate and practice “being” there together with the patient. Physical and mental presence underlies concentration. There is an old Chinese saying that says, “With a settled mind, he can sit with anyone at anytime.” With the aforementioned 80-year old patient, concentrating on the subtle details of his life led to the best diagnosis and most appropriate and holistic treatment plan for him.

Compassion
In being present with our patients, we must also be compassionate – the fourth “C” of quality patient care and bedside manner. Compassion can be shown in many ways. Sharing a smile, giving positive input or feedback, and human touch such as a simple massage can all be considered acts of compassion. Maintaining a relaxed and settled physical presence can also be compassionate. I find that simply maintaining eye contact markedly helps to establish a greater sense of comfort and trust in the treatment environment. It is important to remember that our kindness and truthfulness as human beings are integral in approaching the human needs of our patients. Compassion for the 80-year-old patient was shown in the hospital each morning by encouraging him to share a story that made him smile and appreciating him as a person with wisdom and experience. Through the meaningful and compassionate daily interactions between physician and patient, two human beings, I was able to witness and experience his increasing trust in my treatment approach with TCM, effectively allowing me to help him in his healing process.

Providing quality patient care and bedside manner through special attention to each of the four “Cs” may be the most powerful approach a physician can employ to maximize his or her effectiveness in applying the practical skills in which we have been trained. Caring for our patients is our number one job. The spectrum of patient care is incredibly broad, the methods diverse, and the boundaries, at times, can seem gray. TCM physicians can begin by practicing a simple approach to improve our overall bedside manner. The four “Cs” of Communication, Connection, Concentration and Compassion provide a framework for daily practice of providing quality patient care and truly “being” with our patients. Ultimately, the consistent application of these four concepts can function to bridge the gap between physician and patient, bringing us closer as human beings – both responsible and active in the healing process.

Jason Bazilian is both a state and nationally licensed acupuncturist and Chinese medical herbalist. He received his Master of Traditional Oriental Medicine degree from the Pacific College of Oriental Medicine in San Diego. Jason is a certified specialist in Chinese gynecology and women’s health and has spent time training in an integrated Chinese/Western hospital in Hunnan Province, China. He currently practices as part of an integrated medical team treating chemical dependency and chronic pain at Knollwood Hospital in Riverside, California, where he is the Director of the Acupuncture and Pain Management Department. Jason also maintains a private practice in Poway and Redlands, California where he specializes in pain management, women’s health and other internal medical issues.