Wednesday, March 11, 2020

Winter's Research Roundup

keywords:  research literacy, metrics, research writing resources, and more resources shared since last "research roundup" blog article

Review of the "Research and Metrics Thursdays" theme from the public Facebook Page and newsletter

At the Hospital Practice Handbook Project, we encourage practitioners to cultivate mentor-relationships and practice research literacy.

SAR 2019 Conference Notes, Published Articles, and Highlights
For a compilation of the community's notes on SAR and the articles (or their citations) written about the SAR 2019 conference since June 2019, go to our Conference Notes module.

Interested in Measuring Your Work?
New Acupuncture Research shares since last blog article

Massage Therapy Evidence Map 

Research Literacy Basics: Practical Applications for the Hospital-based Practitioner
The following citations were added to the blog article, "Research Literacy Notes for the Hospital-based Practitioner".

Research Thursdays: Oncology article
The following was updated in the "Research Thursdays: Oncology" blog resource article.
  • Journal of the American Society of Acupuncturists (JASA), formerly Meridians: JAOMfall 2019 issue articles on oncology
    • Clinical Pearls section query is "How Do You Treat Chemotherapy-Induced Peripheral Neuropathy in Your Clinic?" p. 30 - 36
    • "Exceptional Results in Traditional Chinese Medicine and Oncology: A Focus Dryness and Heat Part One, Radiation: External Dryness" by Dr. Yair Maimon, p. 36
    • The 2019 Society for Integrative Oncology conference report by Dr. Jason Bussell, p. 40

New or Updated Resources on Research from NCCIH
  • Pragmatic Clinical Trials resource.
    • For those of you interested in clinical research in real-world settings, see NCCIH's online resource, "Rethinking Clinical Trials, A Living Textbook of Pragmatic Clinical Trials". This resource is published by the NIH Health Care Systems Research Collaboratory. It contains information about the design, conduct, and dissemination of pragmatic clinical research. And it has examples from the Collaboratory's demonstration projects.
  • NCCIH on the NIH HEAL initiatives to stem the opioid crisis with non-drug pain management approaches

"Join NCCIH and our director, Dr. Helene Langevin, as we launch NCCIH’s strategic planning process for the next 5-year plan (2021–2026). We will kick off this year-long process with a webinar for the complementary and integrative health community on the topic of 'Whole Person Health.' Dr. Langevin will share her thoughts on this topic, which considers the whole person and the relationships among numerous factors, including biologic, environmental, behavioral, mental, and social factors, in determining health. She will also focus on how this concept fits into and expands upon NCCIH’s current strategic plan and may serve as a way to inform our strategic planning and future research directions.
"Input gathered as a result of this event will feed into the NCCIH strategic planning process being led by Ms. Mary Beth Kester, Director of the NCCIH Office of Policy, Planning, and Evaluation.
"Dr. Langevin presented initial thoughts on this topic at the afternoon session of the September 20, 2019, NCCIH Advisory Council meeting." 

Podcasts's "Working Scientist" podcast

Reviewing Some Research Basics

Metrics: Clinician Employee Burnout & Employee Well-Being
Are you interested in measuring burnout or well-being?
Learn more about the NAM Clinician Well-Being Series at our concise blog post here

For more on the topic of research

Other monthly research summary blogposts
Research Review posts
Research Resource Websites & Journals

Did you find this information useful or interesting?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

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You can support this community-wisdom-sharing work by buying me a coffee or sponsoring a newsletter via our website.  Thank you.

Tuesday, March 3, 2020

Vision Statement

Our Vision for the HH Project
last revised 3.3.2020
In 2016 I created this wisdom-sharing resource, the Hospital-Based Practice Handbook Project for Acupuncturists and their Hospital Sponsors (Administrators). The Project supports this challenging new avenue of employment for acupuncturists. The Project enables hospital program managers to learn and share the latest evidence-based practices and research in the integrative medicine field and include the acupuncturists in each step.

The Project is a resource for licensed acupuncturistsMore acupuncturists are being hired in hospitals, FQHCs, hospice, county clinics, and other mid to large healthcare systems. The Project is designed to streamline these hiring procedures and promote the integration of acupuncturists into any hospital's biopsychosocial patient-centered care model. Specifically, the Project facilitates a clear understanding of how acupuncturists' procedures and approaches can complement ongoing patient care in each service line. This can reduce miscommunication about the hiring of licensed acupuncturists as well as illustrate the value of LAcs as health care professionals working as advanced practice clinicians.
The Project helps hospitals streamline the hiring of licensed acupuncturists by providing the hiring staff and credentialing team with published standards on hiring and credentialing of them. The Project connects users to resources that include basic program frameworks--from standard operating procedures (SOPs) to clinical outcome metrics.

The Project is a resource for program managers. Whether the goal is to address increased patient demand for integrative health services or to meet Joint Commission, CDC, and HHS/CMS recommendations for non-pharm options for pain management, this resource is an important asset for the champions and change-makers in the healthcare field. It provides documentation standards and templates as well as practical program standards and outcome metrics. 
The Project is a knowledge-sharing network designed to quickly and successfully implement a cross-section of programs, from new program setup to selection of relevant metrics that track cost savings and patient-centered outcomes. Whether it's program success in these patient-centered outcomes or improved access to non-pharm pain care, the Project provides versatile applications for all hospital programs. It also presents effective models for revenue generation as well as service reimbursement.
The Project supports individual program managers as well as their hospital by facilitating connections
between other managers who work with integrative health (IH) professionals or run IH programs. This is important because it helps in-house acupuncturists understand the pressures and standards the facility is working toward; for example, it's handy for developing (or improving) a clinic's outcome measures to align its metrics with the facility's larger mission and vision.
The Project connects standards of practice in documentation (coding, use of relevant research-validated metrics), compliance, billing, and reimbursement models, and research. It also connects the user to resources in health policy, thus directly affecting an acupuncturist's hospital-based practice.

A Resource for All.
The Project is designed for use by all healthcare professionals, not just licensed acupuncturists. It can help both program managers and LAcs streamline a set of new programs before they are implemented or assist with the move into new areas by connecting colleagues such that everyone can learn from each other's successes and failures.
The Project connects users to relevant published research and program frameworks (from feasibility studies to pragmatic trials.) This offers great potential for collaboration in multi-site research projects. The Project hosts discussions of relevant research in the field as well as vetted recommendations for continuing education resources, whether it's through courses or conferences. Included are both closed group resources for discussion and social support through connections to mentors and existing resources and the beta-testing of new resources.

Project resources include

Welcome to the Project!

Megan Kingsley Gale, MSAOM, Dipl OM (NCCAOM)
Founder & Facilitator of The Hospital Practice Handbook Project, a community resource project (volunteer)

Excerpts of this were published in a "Dear Editor" letter in the summer 2019 edition of The

Want to learn more about the Project? 
Start with our "why" at Why This Project?

Support This Work Today 

"Transformation doesn't just happen. It requires intentionality."

Saturday, January 11, 2020

2019 at the HH Project: Review and Accomplishments

keywords and topics: year-in-review, progress in goals and projects, review of current resources

"Start by doing what's necessary; then do what's possible..." Saint Francis of Assisi
Home and family
Review of the HH Project work in 2019
Goal setting & re-evaluating
    2018 goals that led to 2019 goal restructuring
    2019 goals
Resources that grew significantly in 2019
this also went out as an email newsletter 01.13.2020. Go here for the newsletter version.

Home and Family
First trip to collect sap from the maple trees
Now that we live in the Mid-South and my husband is on shore duty, I am taking the opportunity to travel with my kids to visit my family (just a two-day drive in the car each direction now) in Minnesota as much as we are able. As you may remember, we moved from the Pacific Northwest to western TN in the Mid-South of the U.S.A. in July 2018. One of my kids had a flare in a chronic health condition so we didn't travel until late March 2019, during spring break.

For our first "maple syrup March" we headed to the multi-generational family farm to assist (mostly watch and learn from) my uncle gather sap from the sugar bush (grove of maple trees). In summer we escaped the southern heat for a few weeks visiting family and then attended a family funeral.

Mayo Clinic books on Integrative Medicine
In fall we again were able to escape the autumn heat of the Mid-South during fall break where we squished in time with extended family in Rochester and the North Shore, including a wedding, and a quick visit with our integrative health colleagues at the Mayo Clinic. I received a copy of their latest (2017) Guide to Integrative Medicine: Conventional remedies meet alternative therapies to transform health by Brent A. Bauer, MD. I recently rediscovered one of the older copies that survived all the household moves (2007).

In early September my oldest was officially in remission (no more flare). Hooray! In late September my mom was hospitalized for anemia and later diagnosed with cancer. So this fall has been a rollercoaster of health issues with my family.

Review of the HH Project Work in 2019


May 2019 submission to The 2020 International Congress on Integrative Medicine and Health (ICIMH). At the encouragement of my hospital-based colleagues, I submitted a multi-day pre-conference idea for “Basics of Hospital-based Practice for Acupuncturists and their Hospital Admin.”

Late June 2019, I attended the 2019 Society of Acupuncture Research Conference in Burlington, Vermont
This conference experience was wonderful. I was able to cheer on my colleague, Lisa Taylor-Swanson, PhD, in presenting our work related to WA State Workers' Comp Pilot. I met up with many of my hospital-based practice colleagues and introduced more people to the Project community.
You can read more about the conference in the article I wrote for JASA and see notes, photos, citations of work from the conference, and how to join SAR in the Notes from the 2019 SAR Conference online module.
Gale, M. Report on the Society of Acupuncture Research International Conference. JASA: The Journal of the American Society of Acupuncturists: 2019 6(3): 32-34.
Screenshot. Go download the article!

July 2019—published two articles in the peer-reviewed journal, Journal of the American Society of Acupuncturists (JASA), formerly Meridians: Journal of Acupuncture and Oriental Medicine (JAOM)

"There are two objects of medical education: to heal the sick, and to advance the science...Medicine is both an art and a science, and both make appeal to the true physician." C.H. Mayo
October MN trip—visited the Mayo Clinic's integrative medicine team. See our Facebook Page for an album of photos from this trip, especially if you have never visited the Mayo Rochester complex. For more about the history and architecture of the Mayo Rochester health system, two useful resources are the Olmsted County History Center and the Mayo Clinic History website.
My favorite door to a hospital building.
Amazing artwork and symbolism of health in the community and the practice of medicine.
See more photos here.

Early October 2019—submitted two distinct session proposals to the Academic Consortium's 2020 conference, The 2020 International Congress on Integrative Medicine and Health (ICIMH) 
  1. “Hiring and Credentialing LAcs”
  2. “Reimbursement Issues”
December 2019: ICIMH 2020 session proposal accepted! 
Our session proposal on reimbursement issues & revenue streams was accepted! I will lead the session, “Reimbursement Issues and Revenue Streams for Hospital-based Programs and Organizations with Acupuncturists: Current Practices, Innovations and Issues” with Christine Kaiser, Timothy Suh, Annie Budhathoki, and Paul Magee.  We are scheduled to present Friday, May 1st, 2020 at the 2020 International Congress on Integrative Medicine and Health (ICIMH) in Cleveland, Ohio.🎉

Integrative Oncology—what does success look like in an integrative oncology program?
The survey closed in late October 2019. Submissions still being processed. Current public HH Project resource page on integrative oncology is Research Thursdays: Oncology

I haven’t compiled answers. I did, at the June 2019 SAR conference, present and submit questions to the hospital-based practice session on EHR templates and use at the June 2019 SAR conference.

Sept 2019 webinar: “Issues in Hospital-based Practice: Hospital Contracting” with Dr. Timothy Suh was done live. I have received permission to publish and share part of the recorded session. I will share this soon.

Review of 2018 HH Project Goals and How They Led Us to Our 2019 Work

The main HH Project goals in 2018 were to
  • maintain the space for the community in closed social media groups
  • post share-able information on the blog
  • start the HH Project Learning Opportunities Directory and
  • publish monthly general newsletters in 2018
  • finish beta-testing the membership site community space option

The goal with the creation of the membership site
The goal was to have an online community space that is not dependent on social media and it is accessible through online direct login and/or by email with updates and reminders available to be sent via email. This, the membership site, was a strong request from about 25-30% of the community who are opting out of social media and 50% who have social media accounts but prefer email communication.

The New HH Project Goal in 2018
The new HH Project goal in 2018 was to identify types of people using the HH Project resources and brainstorm ideas on how to best serve them. So, in 2019 I created the following "user-flow" outline and started the “specific resource generation” work

This Leads to the 2019 Project Goals

Maintain the Basics
So, in 2019, I continued to nurture the community discussion groups (mainly Facebook and membership site in 2019; LinkedIn has not been actively engaging), the blog, the website, and the monthly newsletters.

The New 2019 HH Project Goal: Create Resources Specific for Identified User-Types in Community
The new goal that started in 2019 was to create stand-alone starting resources for the following user-types identified in 2018.

  • The new hospital (LAc) employee (0-5 years practice)
    • Resource packets on the process of getting hired, what it is to be an employee in a hospital/healthcare system, and more resources identified by the community as needed for the practitioner 0-5 years into hospital-based practice
    • The resource is in the beta-testing process. The online resource is available for early purchase at a low rate to help support the project while still in the beta-testing phase
    • The article on this resource is here
    • Sign up for updates on this resource here
  • The established hospital employee (5+ years)
    • Ongoing resource
  • The lead acupuncturist or program manager
    • Ongoing resource
  • The hospital administrator
    • Ongoing resource

HH Project Resources that Grew Significantly in 2019 
The following online resources grew significantly in 2019:
  1. Membership site
    • More resources added each month
    • Lots of pdfs and more available by request
    • Access to some courses from the online school on a temporary or rotating basis, depending on community feedback.
    • Want to join the membership site? 
      • You are eligible if you work at a hospital or other types of facilities that are accredited by or eligible for accreditation by The Joint Commission, and you have a sponsor/mentor to the group. Just send me an email with some information about where you work and who your sponsor/mentor to the group is. If you don’t have a sponsor/mentor, contact me, and I will endeavor to connect you to a potential sponsor.
  2. Online school
  3. Website
  4. Coffee/Tea/Cocoa support

   4. The Blog
  • 40 new articles in 2019
  • Many of the previous 166 posts were revised or updated

Volunteer hours I averaged working on the HH Project in 2019: 
32 hours/week 

I hope you have found some part of this work helpful.

You can help shape future HH Project work by giving me your feedback by email:
  1. What did you enjoy most or find most helpful related to the HH Project this year?
  2. What would you like to see more of in 2020 and 2021?
  3. Tell me more about the ways you would prefer to support this community work.

Thank you.
Megan Kingsley Gale, MSAOM
Founder and Facilitator, The Hospital Practice Handbook Project for Acupuncturists and Their Hospital Sponsors

"Transformation doesn't just happen. It requires intentionality."
Matthew Kelly

Friday, November 22, 2019

Paths to Practice Interview: Dr. Annie Budhathoki, DAOM, LAc of Huntsman Cancer Institute

keywords: interview series, paths to practice, integrative oncology, research, metrics, wellness center, Huntsman Cancer Institute integrative oncology, hospital practice acupuncturist

The Hospital Practice Handbook Project Interview Series: Paths to Practice
Focus on Dr. Annie Budhathoki

Interview recorded on March 1st, 2019
Go to our YouTube Channel to watch the video.

This Paths to Practice interview is with Dr. Annie Budhathoki, DAOM, LAc, doctor of acupuncture and Oriental medicine, and licensed acupuncturist at the Linda B. and Robert B. Wiggins Wellness and Integrative Health Center, Huntsman Cancer Hospital and Clinics, the University of Utah, Salt Lake City, Utah.

video interview minute 0 - 5  
Annie Budhathoki, DAOM, L. Ac. is the wellness education and training coordinator at Huntsman Cancer Institute’s Linda B. and Robert B. Wiggins Wellness and Integrative Health Center.
Her clinical specialty is treating cancer-related side effects. She helps patients maintain wellness and longevity after a cancer diagnosis. Dr. Budhathoki is a research investigator on the use of acupuncture in the oncology setting. Her areas of interest include oncology, integrative medicine, pain management, geriatrics, and neurological disorders. 

Since 2012, she has worked full time as an integrative oncology clinician at Huntsman Cancer Institute in Salt Lake City, Utah. Dr. Budhathoki spends about 10% of her time in teaching and outreach. She is adjunct faculty for the University of Utah where she teaches in the medical school’s integrative medicine program.

Dr. Annie Budhathoki

Dr. Annie Budhathoki’s Path to Hospital-Based Practice
See minutes 07:55—14:00 for the related section of the video interview
Dr. Budhathoki attended Pacific College of Oriental Medicine (PCOM) San Diego where she obtained her master’s degree in acupuncture and oriental medicine. Then, she studied healthy aging and longevity at Yo San University in Los Angeles, CA, where she received her doctorate degree in the field.

In November 2009 she opened a private practice in Salt Lake City, Utah, where she enjoyed working as part of a patient’s healthcare team. She started work at Huntsman Cancer Institute pro re nata (PRN), in the summer of 2012 and by October 2012 she was a full-time employee there.

A Doctoral Degree in Healthy Aging & Longevity: Everything at Huntsman is a Longevity Prescription
minute 16:00
Megan:  So, you said your doctorate was in healthy aging and longevity.  What are some things you love about your work at Huntsman?

Annie: So, getting that doctoral degree in healthy aging and longevity my goal was to marry the ancient concepts of longevity with life after cancer and with cancer.  So that our patients can get the very best results they have possible. I see everything in our hospital as a longevity prescription.  So, our entire goal as a hospital is about patient care and about allowing a patient to get those best days as long as possible to be increasing their quality of be with family, to be doing what they want to do, to be enjoying their days.

And that’s really empowering to me to be able to take these ancient pieces…, integrate [them] into what Huntsman is doing at large with treating cancer and giving patients these really amazing and sustainable results.

And that gives me goosebumps because I think patients feel that when they come to Huntsman, we are focused on them and their priorities of quality of life and improving their life for as long as possible. At Huntsman, we treat patients and caregivers. 

What is your favorite thing to do in hospital practice?
Annie: Working with patients at the wellness center. The Wellness Center helps patients regain their own power. The patients can work on themselves while the oncology teams work on their cancer.
Acupuncture helps these patients with their stress and improves their sleep. Acupuncture is empowering for them during a difficult time. We reach the patients where they are. Often offering them hope in a unique way.

The Linda B. & Robert B. Wiggins Wellness and Integrative Health Center at Huntsman Cancer Institute
Dr. Pamela Hansen began the Wellness Center in 2005 with the “power exercise” program. This grassroots program out of an auxiliary bathroom helped patients with exercise and movement while they were undergoing cancer treatment. This wellness center is one of the few wellness centers inside an academic cancer hospital. It has grown to include over 36-39 programs depending upon the season. And, the Wellness Center publishes a quarterly catalog for patients, caregivers, and staff.
In 2005-2007 the wellness center program was very small. Just an afternoon session, once a week.  And it had a big waiting list.  So, in 2012, they decided to bring acupuncture on full time.

This year, the wellness program has 4 acupuncturists and 9 massage therapists. The Wellness Center’s clinical services are available from 7AM to 7PM most days Monday through Friday. In the wellness center, acupuncture and massage have a daily treatment average of 20-25 patients per day for each program.  Last year, in 2018 the whole wellness center saw over 25,000 patients in our more than three dozen programs. [minute 13 of the video interview]

The Wellness Center is an outpatient acupuncture practice inside the cancer hospital.  The acupuncturists treat the side effects and symptoms of cancer and cancer treatment [such as] neuropathy, pain, nausea, insomnia, and hot flashes. Dr. Annie Budhathoki also does inpatient acupuncture for hospitalized oncology patients.

Wellness Center Funding and Revenue Streams
Annie: The Wellness and Integrative Health Center at Huntsman Cancer Hospital is a budgeted program supported and directed by our patient-centered administration. Most of our programs are low-cost to no-cost; programs with a fee are generally reduced costs similar to a copay. Acupuncture is a fee-for-service program and the cost to the patients, caregivers, and staff is $40. Additionally, Huntsman has a financial assistance program that supports persons living on a low income and our wellness center offers a sliding scale within this program. Currently, very few of the insurance providers in the state of Utah cover acupuncture, so we don’t have insurance billing set-up for our acupuncture services.  

The Wellness Center is a Place Where Patients Regain Their Power 
minute 22
Annie: You know, the Wellness Center [is amazing; ] we have all this programming. At Huntsman, we have a supportive oncology team.  Dr. Anna Beck is the director of supportive oncology; when she came to Huntsman [she reshaped] the models for integrative medicine. 
This wellness center is a place where people are empowered to take charge of their health while going through cancer treatment and beyond into survivorship.
As providers, we have the opportunity to support people affected by cancer to overcome various health and wellness obstacles. We ensure each person feels empowered to improve and maintain their individual health despite their cancer diagnosis or former health status. When championing the best care of each specific symptom, we work together as an integrative team supporting the goals and betterment of each patient. Often this includes referring them into various programs that also support their needs, knowing that this is how they can continue to regain their power.
In the Wellness Center, we are supporting the basic health needs and daily quality of life issues which affects a person’s ability to function.  We manage symptoms like nausea, fatigue or sleep while their physicians are working on the cellular level to attack their cancer or on a surgical level to get things taken care of.

[In oncology the side effects of chemotherapy, radiation, surgery can be disempowering] for a patient because medicine takes over. And rightfully so in many cases so that those specific diseases can’t become chronic illnesses or can be cured if you will.  But in wellness and integrative health and especially acupuncture and massage, fitness, nutrition—this is where patients really get a chance to shine on their own; to regain their power. 

Dr. Annie Budhathoki

Advice for those of you working in integrative oncology 
Annie: As you practice in a hospital setting, keep that in mind: how do the patients remain empowered with their own health care as they go through that? 

The Inpatient Acupuncture Program at Huntsman Cancer Institute
Annie:  We started the inpatient acupuncture program with an Imagine Perfect Care grant from the University of Utah.  The inpatient acupuncture program began in September 2018.
We started that program on the oncology floor, working with symptoms like nausea or constipation or ir-retractable vomiting.  [Any] symptoms that would keep a patient in the hospital and extend their stays and prevent them from going home. [Eventually the program] moved into the surgical ward and into other parts of the hospital.  But the initial work was symptom-based, treating any issues that would keep a patient in the hospital too long.

What is the goal of integrating acupuncturists at Huntsman?
Megan:  So, you’re using acupuncture as a complement to ongoing care to help people have shorter inpatient stays?

Annie:  Our goal, long-term is to show the efficacy of acupuncture in an inpatient oncology clinic in a hospital and to show feasibility as far as reducing costs.
We believe acupuncture is a cost-saving measure for the hospital overall.  Whether that’s a reduction of opioid use, whether that’s reduced hospital stays, or reducing re-admission rates; that’s really our goal.

Integrating Clinical Outcome Measures Seamlessly in a Clinical Research Environment
Megan:  Are you doing ongoing research studies related to either of these programs? 

Annie:  So, Huntsman is a research institution.  [Research is] a foundational force of Huntsman alongside our clinical care. Research is really embedded throughout the hospital. In the wellness and integrative health center, we have a number of research projects.

[Related to] the acupuncture program we currently have a mindfulness acupuncture research study with Dr. Eric Garland who [is] a leading mindfulness researcher.

We also have a chemotherapy-induced peripheral neuropathy (CIPN) study. Which employs an fMRI to [measure] the implications of acupuncture on CIPN.  And we have an inpatient acupuncture research study in the works.

Teaching and Outreach with Medical Students at the University of Utah
minutes 6-8 and minutes 25-26 of the video interview

Annie: The University of Utah has a very strong collaborative approach to medicine.  Recently, Dr. Amy Locke created and developed an integrative medicine pathway.  Prior to that, we had an integrative medicine elective for our medical students. I teach in both [the elective and the pathway].

What is the University’s Integrative Medicine Elective?
Annie: It’s an elective for medical students to [shadow] integrative medicine practitioners and [observe] integrative medicine in action.  So, they come and spend about 1-2 weeks with us here in the wellness center [where they follow me] in the acupuncture clinic and [other] practitioners in their clinical work.

What is the Integrative Medicine Pathway?
Annie: In the integrative medicine pathway, we [have several learning structures]. We do panel discussions about integrative medicine.  We’re developing a modalities class.  There are different ways in which we work together to educate medical students. [The vision is] to develop their [knowledge base on integrative health] and [improve their ability and confidence] in referring to integrative medicine and utilizing it in their future [healthcare workplaces].

minute 25:50
Megan:  So, as an instructor in the medical school and as a clinical observation site you are shaping the future of healthcare integration and help the physicians be informed and feel comfortable referring to different integrative medicine services.

Annie: I really love that. I think, you know, spending a day with a student, a medical student is very powerful. A whole day together in an acupuncture clinic where they can ask all the questions they have in the world. And they can try the needle and they can explore the ideas on how to find an acupuncturist; “what could I use it for in my specialty?”. For me, that also gives me goosebumps for the future. Because I think that being a template or a first impression on acupuncture for their field is very rewarding.

Advice for future and current hospital acupuncturists
minute 14:10
Megan: What do you see as the biggest work-related challenge or learning experience for acupuncturists?

Biomedicine Communication, Conventional Medicine Literacy, and Practicing Research Literacy
Annie: “I think when it comes to work-related challenges, I think that our education [programs] as a whole need to do a better job at the literacy of speaking with elite oncologists, amazing world-class surgeons, nursing staff, and then, of course, patients.”

Annie recommends you learn and practice research literacy, study your hospital-based specialty whether it is oncology or OB/GYN. When you do this, you are better prepared to be “at the table [and] present our profession in the very best way possible”. The key factor in good communication with someone is language. Integrate both the practices and languages of TCM and Western medicine to “create a synthesized dialog that medical professionals can understand.” 

Annie: “Many of the ancient tools we were given are amazing. But [you need to] bring those to the table and translate [their usefulness] in a way that makes sense for the medical professions at large and ultimately [how these tools] benefit the patient [by giving] them the very best results in their care.”

minute 18:00
Dr. Annie Budhathoki’s Advice for Students and Professors of Acupuncture Education Programs
The educators at acupuncture programs could do better at informing students about research literacy and how it relates to growing the acupuncture practice field. The language of research is essential to know and hone for communication with your hospital practice team, your physician advocates/physician champions, and your hospital administrators. Dr. Budhathoki’s doctorate degree, she says, helped her build and grow research in the field.

Take time, on a regular basis, to read the research in your field and related fields and discuss it with your colleagues.
Megan: This skill, research literacy, is one of the “5 ingredients” noted as essential in the HH Project resource booklet, Getting Your Foot in the Door of Hospital-Based Practice: First Steps.

Advice for the Student: Know Your Dream; Allow Your Dream to Grow & Expand
Annie: “Allow [your] dream to be as big as possible.  Thread every piece of [new] information you have into that dream as you learn.  So, as you attain that dream and those pieces come together, your dream then expands. And then, once you get that dream job, you [then] see all the professors, all of the people… that guided you and mentored you.  And, like in my case now I am guiding and mentoring.  And so, the dream expands.”

Dr. Budhathoki’s advice for the New Hospital Practitioner
Hone your patient care skills. “Sharpen your diamond”, Dr. Budhathoki says. “Become a masterful practitioner” in your facility, for your specialty, for your patients. Ways to hone your skills may include: completing a doctoral degree, practicing your research literacy skills, and reading acupuncture books written by physicians to better understand their perspective.

Patient Care First 
minute 19:50
On Gloving During Clinical Care: “Always Wear Gloves”
Dr. Budhathoki wants all her hospital-based practice colleagues, especially those working with immune-compromised patients to think about where the microbes are. Keep infectious disease at the forefront of your mind. Hand washing is extra important with immune-compromised patients.

Annie: Keep the patient in the forefront of your mind. Think about what is best for them and the risks involved. Align the safety of the patient with meeting their needs for symptom/condition. Keep the patient is as safe as possible. Always wear gloves. Hospital gloves are very thin and there are some good tricks to getting them to fit you well. Once you get used to them, it will not interfere with your palpation skills.
I never want to bring what I have from my life into a patient’s internal environment. So, as a protection for myself and as a protection for the patient, gloving is my number one [priority in my hospital practice environment]. Get to know your infectious disease nurse.  Get to know your infectious disease team.  [Contemplate] where things live and how they live on you and others so you are not putting a patient at risk any time, ever, including yourself.

Collaborate & Connect with your Champion 
minute 21:20
Dr. Budhathoki believes the collaborative connection to colleagues in the workplace are important.
Annie:  “So, who do you know who really loves acupuncture in your hospital? Who can become your physician champion?  And, as you find a champion, you know, what is their dream for your dream?”
Allow them [your physician champion] to help you grow and [expand your work/your program]. 
Find your physician champion. This is your advocate to help you grow and connect with others.
Ask your hospital champion what you can do for them. Don’t email your champion too frequently.
Be concise, courteous and respectful of their time. For example, when communicating with them, use three bullet points, no more. They are very busy and get hundreds of emails a day.

Luckily at Huntsman, we have had a number of physician champions through the years that have… really allowed acupuncture to become a very integral part of their oncology practice or surgical practice.

Megan’s note on “physician champion”:
Sometimes we talk about them as our “change agents” or our “advocates” or “hospital sponsors”. There are different terms for this. In the Project, I call them our “hospital sponsors” because sometimes they are not a physician, sometimes they are a nurse practitioner. Basically, a sponsor or champion is someone very established in the system who wants to advocate for you. This is a very important connection. More on this subject here.

Metrics and Integrative Oncology
How do you define success for an integrative health program within a mainstream oncology/cancer care clinic and/or wellness program?
Look at programs that have acupuncturists integrated as part of the treatment team. It is important to measure patient results, such as patient outcome measures and patient satisfaction. You should have research projects in place.

What are meaningful metrics for a patient-centered oncology program?
The website has an extensive set of oncology issue-specific questionnaires. It includes the following types of questions: pediatric oncology-specific, general adult functional assessments, metrics specific to the type of cancer, metrics specific to cancer therapy, specific to symptoms, specific to treatments, for patients receiving enteral nutrition and feeding, for non-cancer specific measures like dyspnea in chronic illness and palliative care.

Dr. Annie Budhathoki’s Recommended Reading for the Prospective or Current Hospital-Based Practitioner interested in Oncology and Wellness Center Work
minute 27:00
Annie likes reading material that helps her better understand other perspectives, such as the patient’s perspective and the oncologist’s perspective.

Annie: “I love to read books by physicians and patients about my specialty on cancer and oncology as a lay book or as an easy reading. I like to go outside of our box and get into the physicians’ minds. I really love reading books that are written by physicians about acupuncture and oriental medicine or integrative medicine.”  

Kitchen Table Wisdom: Stories that Heal

Book that Annie recommends to everyone reading this article or watching the interview is Kitchen Table Wisdom: Stories that Heal by Rachel Naomi Remen, MD. This is a gathering of short stories the author compiled as she learned to practice compassion in her oncology practice.

Annie: “These types of books inspire me every day to become a better provider. [They help me keep a patient-centered] focus. And they help me see the physician's perspective and the conventional medical perspective. [I like] reading material that helps me put [myself] in the shoes of a physician [or the] shoes of the whole team. And, [books that put me] into the shoes of [my] patients, of course.”

Megan: I love that idea… for perspective, to read what physicians write about what we (acupuncturists) do so to better understand their perspective. And so, improve our communication with them.

Closing Notes
What else do you want the hospital-based acupuncturist community to know about integrative oncology and acupuncture?
Annie: Please wear gloves and work alongside with your infectious disease nurse to develop patient safety protocols in your hospital.
I really love integrative medicine and acupuncture. I am excited to see the research move forward. We are right on the cutting edge of integrative medicine. It is a powerful place.

Want to learn more?

Video editing acknowledgments
Thank you to Albert Stern, MSAOM, for editing this video. 
You can review his Chinese Herbal Medicine formulas at his TCM Picture Book YouTube channel 

Definitions of terms used in this article
PRN = “pro re nata” or as the situation arises aka “as needed”. 

Related blog posts
Other Program Interviews
Oncology and Acupuncture 
Research Literacy and Hospital-based Practice, some Resources
Recommended Reading Lists
Dr. Budhathoki recommended this book in her interview: Kitchen Table Wisdom: Stories that Heal by Rachel Naomi Remen, MD.

If you follow the Amazon links from this blog and make a purchase within a few hours, a few pennies from your purchase will go toward supporting the Hospital Handbook Project at no extra cost to you.
OverDrive and Libby

You can request reading materials from your public library in person or through the Overdrive and/or Libby app.

More Reading & Listening Lists from the HH Project Community
Related tags and search terms to consider finding more subject matter information in this blog: research and metrics, hospital employee, leadership and workplace, interview series, integrative oncology, wellness programs, paths to practice, interview series

HH Project Resources by Practitioner Type

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