Acupuncture students at the American College of Traditional Chinese Medicine (ACTCM) at CIIS fulfill clinical residency requirements alongside Western medical students.
It’s 8am at Highland Hospital in Oakland, CA, and Dr. Kara Romanko is making her morning rounds: a differential diagnosis for a teen complaining of lethargy and weakness; treatment planning and evaluation for a man recovering from back surgery; a morbidity conference led by senior staff on complications associated with stroke. At noon she is called for a consult; a woman with late stage cancer is struggling with pain and nausea. In years past, prescription opioids would have been the first, and in many cases only, line of defense, but with the Joint Commission’s 2018 mandate that all U.S. hospitals provide at least one non-drug alternative to managing pain, there are now other options.
The mandate comes on the heels of a nation-wide opioid epidemic. According to the Center for Disease Control and Prevention (CDC), upwards of 40,000 deaths occurred from opioid overdose in 2016. That’s comparable to the estimated number of deaths from car accidents and gun violence. What’s more, it is costing the United States roughly $78 million per year, including the costs of healthcare, addiction treatment, lost productivity, and criminal justice involvement.
“The TCM [Traditional Chinese Medicine] community has long advocated non-pharmacological treatments for pain, among other conditions,” says Romanko, herself a Doctor of Acupuncture & Oriental Medicine and an ACTCM graduate. “Acupuncture, acupressure, herbal and nutritional therapies, as well as other modalities like meditation and yoga, can be used in concert with Western medicine in order to make patients more comfortable.”
Integrating Western and Eastern practices is something Highland Hospital has been doing for more than a decade, specifically, acupuncture for pain and substance addictions. With treatment viability and demand came the need for qualified professionals who could operate in a hospital setting. In 2014, Dr. Amy Matecki, chief of the Division of Integrated Medicine at Highland, began recruiting licensed acupuncturists with TCM doctorates to provide inpatient and outpatient care. Her vision was to make acupuncture a mainstream, non-addictive treatment option for pain and its practitioners co-equal members of the clinical team. Initially, the program was voluntary. Four years later, under Matecki’s leadership, Highland introduced a formal TCM Residency Program, the first of its kind in the United States.
Intent on adhering to its rigorous standards (in 2014, Highland’s Emergency Department residency training program was recognized by U.S. News and World Report as No. 1 in California and No. 6 in the country), the hospital replicated its training model used for Western medical students and physicians as a way to integrate Chinese medicine. TCM residents join their cohorts side by side for inpatient rounds and to provide consults in departments from the ER to the intensive care unit. TCM residents also have the opportunity to interact with the medical doctors (MDs) through presentations, morning reports, morbidity and mortality conferences, and research in Integrative Medicine.
“The Highland TCM residency program has been a profound experience,” says Romanko. Ramanko has recently been named Highland’s TCM Chief Resident, only the second person to hold the position. “In addition to expanding many of my skills, I’m happy to see that residents of both orientations have not only developed mutual respect for one another’s approach, but also discovered shared value in the integration of Eastern and Western treatments.”
There are, of course, still hurdles to overcome in making the integration seamless. For instance, the use of language. According to Matecki, acupuncturists need to know Western medical terms and understand the hospital environment in order to be taken seriously. “We try to avoid the word Qi,” says Romanko, smiling. While the TCM residents do talk about energy when appropriate, they translate TCM concepts into Western medical lingo as much as possible so that MDs can more accurately determine when to call in an integrative consult. “Shared communication is essential, which is why I think we’ll see greater emphasis on Western medical education in the TCM curriculum…not as a way to dilute existing TCM education. Rather, as a necessary skill set for Chinese medicine practitioners to thrive in clinical settings.”
The Future of Integrative Education and Care
The TCM residency program at Highland Hospital is currently only open to students of select Chinese medicine schools in the Bay Area, including ACTCM at CIIS. But Romanko and other leaders in the field believe this model is both sustainable and reproducible. “Already, representatives from other institutions have come here to observe, as far away as China where TCM is currently integrated with conventional medicine,” says Romanko. Moreover, they are optimistic that the program will prove its value through research. A 2017 feasibility study conducted by Highland and published in the Journal of Alternative and Complementary Medicine indicated that ICU patients treated with acupuncture reported a statistically significant decrease in pain, anxiety, and morphine usage. TCM residents are also contributing to an ongoing retrospective study on the efficacy of acupuncture in the Emergency Department.
Eastern and Western medicine both offer valuable perspectives to and effective treatments for health care today. In light of the opioid crisis, the medical community is increasingly embracing practices that are non-addictive and non-invasive as a meaningful alternative to pain. “Integrative medicine is the future of health care today,” says Romanko. And with residency programs such as the one at Highland Hospital, today’s practitioners have a bright horizon.
Research & Writing by Dr. Stephanie Albert
Dr. Stephanie Albert holds a Doctorate of Acupuncture and Chinese Medicine from the American College of Traditional Chinese Medicine in San Francisco, CA. She runs a private practice out of the Lotus Center in the Mission district of San Francisco, where she works with patients to address stress, insomnia, pain, women’s health issues, and other health complaints through acupuncture, herbal medicine and lifestyle modification. www.stephalbert.com
References
- “Opioid Overdose Crisis.” National Institute on Drug Abuse. (March, 2018). Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
- “Economic Toll Of Opioid Crisis In U.S. Exceeded $1 Trillion Since 2001.” (February, 2018). Retrieved from https://altarum.org/about/news-and-events/economic-toll-of-opioid-crisis-in-u-s-exceeded-1-trillion-since-2001
- Wills, C.P., and Duong, D. “Letter from the Residency Director”. Retrieved from http://www.highlandemergency.org/letter-from-the-residency-director
- “Opioid Overdose: Understanding the Epidemic”. Centers for Disease Control and Prevention (August, 2017). Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
- Feeney, C., Bruns, E., LeCompte, G., Forati, A., Chen, T., and Matecki, A. (2017). Acupuncture for Pain and Nausea in the Intensive Care Unit: A Feasibility Study in a Public Safety Net Hospital. Journal of Alternative and Complementary Medicine. 23(12): 996-1004
- “FDA Drug Shortages: Current and Resolved Drug Shortages and Discontinuations Reported to FDA.” (n.d.). Retrieved from https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm#tabs-1
- “Old Practices Now New — Traditional Chinese Medicine Residency Program at Highland Hospital.” Alameda Health Systems. (June, 2018). Retrieved from http://www.alamedahealthsystem.org/old-practices-now-new-traditional-chinese-medicine-residency-program-highland-hospital/
- “Alameda Health System’s Emergency Department Residency Program Ranked No. 1 in California and No. 6 in Country by U.S. News and World Report.” (September, 2014). Retrieved from https://globenewswire.com/news-release/2014/09/23/667903/10099543/en/Alameda-Health-System-s-Emergency-Department-Residency-Program-Ranked-No-1-in-California-and-No-6-in-Country-by-U-S-News-and-World-Report.html
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About American College of Traditional Chinese Medicine
American College of Traditional Chinese Medicine (ACTCM) has provided affordable, quality health care to the public and trained professionals in acupuncture, massage and Chinese medicine since 1980. In addition to its graduate curriculum, ACTCM offers continuing education, public education, community outreach and clinical services in acupuncture and herbal medicine. ACTCM has been the recipient of many awards for its curriculum, faculty and clinic, and has been voted “Best of the Bay” by both the San Francisco Weekly and the San Francisco Bay Guardian. ACTCM is accredited by the Accreditation Commission for Acupuncture and Oriental Medicine and is a private, nonprofit, 501(c)(3) tax-exempt organization