Objective measures of progress

Hi Matt,

I like your examples in your book of how to track progress for pain conditions – intensity, frequency, medication etc.  What do you do to more objectively measure a patient’s progress for  concerns that are harder to track?  For example, with anxiety and depression – what kinds of things do you use as a marker?  It can be hard to tease out of them more specifics.  I sometimes get the reply of “I don’t know, I’m just anxious” when I ask more detailed questions. I’ve tried having them chart mood/energy/sleep with comparing the next to the day before, but compliance in daily charting has been pretty low. 

Also with fertility patients, especially when I’m asking them to come in twice a week in the beginning…  I can use their menstrual symptoms or BBT charting – but their next period might still be three weeks away and some fertility patients are resistant to tracking their BBT for various reasons. Would love to hear your thoughts on this.  Thanks!

As you know from reading my book, I stress that measuring progress is really important for two reasons: One – so you can know if you are on the right track with your treatment approach and Two – so your patient appreciates that they are making progress and will keep coming for more treatment. Of course, with the wide variety of patients we treat, there will be some types of conditions where measuring progress is much more straight forward than with others as you pointed out with things like anxiety and depression.

 In those types of cases, I make sure I stress this with the patient from the time of their initial consultation. I let them know I am very focused on measuring progress but with their type of problem measuring progress is not so easy so I need them to help me do this as best we can. I ask them to try to think of just what types of issues they will be able to point to as a marker of success.  Doing this actually helps the patient to think about just what their issues are instead of just being trouble by a sea of “woe, is me”.  It also takes some pressure off you if the patient does not seem to be progressing right away.

You can even ask the patient during their initial consultation – “ If the treatments were to start helping you do 10-15-20% better, how would you be able to tell? What would you focus on to see if you were 10-20% better? “  Let them know that you think there is a good chance the treatments will help but it often starts with just 10-20% improvement before building from there so you both have to put your heads together and try to find a way to measure initial progress.

As for fertility patients, I tell my female patients that have some irregularity to their cycles that it often takes two cycles before we can see how much the treatments are helping both because if takes time to sift hormone patterns and also because the ovaries are on a 2 month cycle – one is more active and releasing and egg while the other is less active and not releasing an egg and then that switches the next month. It takes two cycles then before you are back where you started and can contrast how things are going. While it is best to start with twice a week treatments; unless there is a lot of discomfort to their cycles this is a type of case that is OK to start at once weekly and then go to every two weeks. I try to make these near their mid-cycles and near their periods.

  Fertility is something that should not be rushed even for those women worried about their bio-clocks ticking because you should be helping them get healthier and improving their fertility health with each passing month. I actually don’t want my fertility patients to conceive within less than 2 months of treatment time. I find improving cycles – the days between them, the quality and quantity of flow, issue of cramping, etc., to more significant than BBT charting anyway so I don’t focus much on that unless the patient is already enthusiastic about measuring that and/or in those cases where the cycles are already quite normal and you have little to monitor there.  Hope this helps! 

Matthew Bauer

For patients that you think really don’t know why they are anxious (or depressed), I really love this question that Jack Daniel uses. When the patient says, “I don’t know”, he asks, “If you did know, what would it look like?” By suspending the need for the patient to give you a precise or concrete answer, it keeps that questioning doorway open a little longer and gives the patient the opportunity to answer with a “maybe because” response that might just have a little gem in it for you.

Practitioners may also want to consider watching the TED talks with Brene Brown on vulnerability. Lovely and insightful, and could be very salient with patients who are guarding their real issues, concerns, etc.

I hope this is helpful and welcome any questions about the above thoughts.
Jennifer

www.jwyattacupuncture.wordpress.com