diagnosis, treatment, and assessment are continuously being carried ou

There is a patient in the acumoxa/tuina dept who has been coming in for lower back and shoulder pain. Her back pain (related to a fall that fractured a lumbar spinous process) has been resolved, but her right shoulder pain (related to a radical mastectomy that involved removing her entire pectoral major muscle) is still giving her trouble.

I often give patients massages while they are waiting for Dr Ye. This particular patient will always ask me if I'm free to give her a 'warm up'. Today she was especially communicative about her shoulder - showing me which positions were painful, asking me to stretch her arm to the back and so on. At one point she pointed out 'the exact' painful point in her shoulder joint (at the area where the long head of the bicep crosses the joint). She asked me to press there. More! There! Then she asked me to provide traction on her arm - pulling it above her head. She knew what direction and how much force to use.

Reflecting on this later, I realized I want to be a tool for the patient to use. Not so much for the 'patient', but rather for their awareness of what is needed. Getting to a postion where the patient can express this awareness (and I can respond accurately to it) is going to be a great challenge.

This style of practicing contrasts highly with the "diagnose the problem, perform the treatment, assess the response" style. In the aforementioned style, diagnosis, treatment, and assessment are continuously being carried out, with great emphasis on eliciting feedback from the patient (whether verbal or through subtle physical indications).