In recent years, participation in acupuncture social media groups online has steadily been growing. Being able to access the "hive mind," or ask questions of the acupuncture community on many topics, has been a boon for all – but especially for practitioners who might otherwise feel isolated in solo practice, and for recent graduates needing advice on starting a business.
The Web & Patient Privacy
The information shared in these informal networks often involves suggestions for approaching individual patient cases. One significant ethical concern surrounds patient privacy. Before the internet, case report access was limited to medical practitioners via subscription to professional journals or through medical libraries. As the internet has become more pervasive in our everyday lives, many professional journals now provide electronic access and have thus begun to require written consent for case report publication.
Any patient health information posted online, combined with the knowledge of an acupuncturist's identity and practice location, may result in the patient being identified. Ethical rules for publication of case reports state that for patient information to be published, written consent is required, and it is recommended that the patient be given the opportunity to review what information will be shared.1
Incomplete Information for Clinical Application
Many threads on social media involve a question posed to help solve a difficult patient case. However, these types of questions frequently lack enough detail to merit a useful reply. For example, "Which points are good for my patient with tinnitus?" cannot be answered without more diagnostic information about the patient.
Even with a sufficient patient description, responses to those questions are often missing important specifics required for proper application, such as needle technique or frequency of treatments recommended. Making practice recommendations or following suggestions based on incomplete information does not speak well to the professionalism of the field.
A Better Way: Case Reports
While questions and responses in social media posts regarding patient cases are often made with good intentions, a safer and more thorough way to share your experience with other practitioners is by publishing a case report: a detailed, written account of a patient case. While this type of observational evidence has been denigrated as "anecdotal" for decades, in reality, what we learn from clinical trials is simply a different type of knowledge than what we learn from case reports.
Clinical trials are population-centered research; the goal is efficacy – to find a protocol that benefits the average patient under ideal conditions. While clinical trials have been essential in growing access to acupuncture (supporting licensure, inclusion in health insurance plans and referrals from biomedical providers), the clinical trial as a research method falls short in providing guidance on how to create an individualized treatment in practice.
Case reports instruct readers how to go beyond a standardized approach to provide effective, patient-centered care in real-world situations.2 While the case report, as patient-centered research, might not be as powerful statistically as a clinical trial, the clinical trial is ill-suited to evaluate systems of thought characterized by complex diagnoses and treatments. The case report can capture the process of making effective choices within the wide variety of acupuncture styles, point combinations and adjunctive techniques available.
While the clinical trial is helpful in growing knowledge through isolating variables in experimental design, the case report is essential in growing knowledge of complex systems through observation. Observation is an important way to obtain new knowledge in science and medicine, and fields like neuroscience and psychology have amassed thousands of observational case reports as an evidence base that demonstrates how underlying theory can be used to generate effective treatments in real patients.
Valid Medical Evidence
The case report is not merely anecdotal – as a detailed document containing data that describes a single patient, it qualifies as a piece of medical evidence. The current biomedical culture prefers widespread application of a straightforward protocol, but that type of standardized treatment misses the mark in many patients.
A case report does not test which protocols may help the average patient, but rather provides an example of how to successfully tailor a treatment to the individual. Discussion of a case can provide guidance to readers beyond simply suggesting a set of points to try. Readers may learn which diagnostic questions are most important, and how to consider what information is relevant to their own patients.
When we learn from our teachers and mentors in person, we try to understand the way they think. By reading the explanations of care decisions in the context of a detailed case report, we can learn these habits of mind.
Transcending the Social Media Cloud
While writing a case report takes more time and energy than simply answering a social media post, the perspective and experience shared have a greater depth and better capture the true process of traditional acupuncture. The case report becomes a permanent part of the professional literature, available to more than just those who happen to be online at that moment.
Our collective experience as a field should not be bound to the social media cloud. The next time you find yourself aimlessly scrolling through your social media feed, instead think about choosing a case from your practice that might contain a valuable learning experience for a reader. The more we write these observational case documents, the better we fortify the acupuncture evidence base, preserving our professional experience in a format from which future students and practitioners can learn.
Author's Note: For more information on writing case reports, please visit www.acupuncturecasereports.org.
References
- Journals' Best Practices for Ensuring Consent for Publishing Medical Case Reports: Guidance From COPE. Committee on Publication Ethics.
- Chiu E. Writing Acupuncture Case Reports: Theory and Practice. Vancouver, WA: Acupuncture Case Reports LLC, 2020.
Dr. Edward Chiu has been teaching acupuncture case report writing for over 10 years at the Oregon College of Oriental Medicine. After earning his Master in Acupuncture from the New England School of Acupuncture and his DAOM from OCOM, he spent time pursuing traditional acupuncture apprenticeships in Taiwan and has also been involved in acupuncture research studies in the U.S. at both Massachusetts General Hospital and the University of Arizona. He recently authored a textbook titled Writing Acupuncture Case Reports: Theory and Practice, on the importance of writing case reports and with instructions on how to write one for publication.