Acupuncturists who treat adult outpatients generally rely on a set of assumptions about our patients that make us equal partners in a business transaction, exchanging our expertise for their money. We assume they are hiring us on their own initiative because they want to, can stop if they change their minds, can recognize and articulate their own likes and dislikes, and can evaluate and reject anything we tell them that doesn’t fit with their values or preferences. A number of these assumptions are simply not valid for some patients with infertility, chronic pain or terminal illness, as well as inpatients, children, and the elderly or cognitively impaired, all of whom may be emotionally, cognitively or socially limited in their ability to choose what they accept from us.

 

This class clarifies legal and ethical definitions of autonomy and consent, using case studies from practice to illustrate gray areas that may arise, along with how to recognize and manage them. Transference, countertransference and the ‘bodhisattva complex’ are discussed. Advice is given for drawing the important but elusive line between hope and magical thinking, in the context of current research which shows that acupuncture has measureable and meaningful ‘non-specific’ effects of context and patient interaction, (aka ‘just placebo’). Straightforward practices for are presented for consciously monitoring the patient’s emotional engagement with the diagnosis and treatment process. As a form of mindfulness these approaches can enhance any patient relationship. They are particularly useful for practicing with vulnerable patients, and charting to minimize malpractice exposure in emotionally difficult cases.

Objectives 

Students taking this class will learn to:

  • Understand which patients should be considered physically, cognitively or socially vulnerable, and what measures are appropriate to take in response.
  • Recognize and manage emotional vulnerabilities such as transference, countertransference and magical thinking.
  • Efficiently solicit and monitor verbal and nonverbal ‘assent’ at each step of treatment planning and execution
  • Manage discussions with patients and doctors regarding ‘placebo effect’ in a positive manner that builds respect and collegial relations

Outline

  • Physical and cognitive vulnerability
  • Emotional vulnerability
  • Talking about ‘placebo'
  • Soliciting, monitoring and charting assent or ‘endorsement’ for each step

Claudia Citkovitz

Presenter: 

Claudia Citkovitz, PhD, LAc., has led the Acupuncture Service at NYU Lutheran since 2004, supervising 8 acupuncturists who provide inpatient care and clinical instruction in the areas of neurological and orthopedic management, rehabilitation, labor and delivery, pain management. Dr. Citkovitz studied Chinese language in Beijing and acupuncture at the Pacific and Tri-State colleges in New York. An internationally known lecturer on acupuncture practice and research methodology, she lectures regularly for the American College of Traditional Chinese Medicine, the Oregon College of Oriental Medicine and the Pacific College of Oriental Medicine, the University of Westminster in London and the British Acupuncture Council. Her PhD study on acupuncture during acute stroke rehabilitation was the first conducted in the United States, as was her 2006 study of acupuncture during labor and delivery. Dr. Citkovitz is a frequent peer reviewer and Editorial Board member on journals including Acupuncture in Medicine, BMC Pregnancy and Childbirth, the Journal of Alternative and Complementary Medicine, Explore, and Meridians. She is a past member of the NCCAOM’s Task Force on Hospital-Based Acupuncture, the Tri-State College Advisory Board and the Touro College Institutional Review Board, and is currently a Commissioner of the Accreditation Commission for Acupuncture and Oriental Medicine.

Claudia Citkovitz