Read the case study below. Then write an essay which says whether YOU think that

Question

Read the case study below. Then write an essay which says whether YOU think that the physician should report the mother to child services or not. Support your view by using TWO of the five theories we studied (Mill, Kant, Aquinas, Aristotle or Gilligan).

Case : You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.

Explanation / Answer

In 1974 many of vietnise families were adopting this technique in their children when the children were in some sort of flu or having severe headaches. Their parents were sent to jail by school as alligations of child abuse. But this techniques improves blood circulation also good for various diseases but tremendous painfull later. Definitely thinking of the situation the child protective services need to be summoned and then the mother must be properly be educated of this technique also the bad symptoms of this thing.Coining is a technique used in treating many illnesses since ancient times. It is a form of dermabrasion therapy still widely practiced in China and South East Asia. This ancient treatment method is employed to rid the body of “heatiness” or “negative energies”. Coining is associated with serious complications, and has been confused with child abuse by physicians unfamiliar to Asian cultures. Despite the availability of more simple and effective treatment for fever, coining is still widely practiced among Asians.

Understanding the socio-cultural dimension of a patient’s health beliefs will enhance relationship of trust and proper communication, avoid cultural blind spots and hence critical to a successful clinical encounter.1 Coining is a technique used in treating many illnesses since ancient times. It is a form of dermabrasion therapy still widely practiced in China and South East Asia. This ancient method of treatment is employed to rid the body of “heatiness” or “negative energies”.

Coining involved repeated downward pressured strokes in linear fashion over lubricated skin using a hard object with smooth edge, such as coin, jade or buffalo horn. The process is repeated until ecchymoses appeared which is interpreted as released “heatiness”.2 Hence, coining is believed to be more effective if more ecchymoses are produced. Coining that produced little ecchymoses is considered counterproductive because the pressured strokes were believed to have been incorrectly applied, and this trapped the “heatiness” inside the body rather than releasing it from the body. Therefore, this technique inflicts a tremendous amount of pain.

There are many other meta-theories behind the perceived effectiveness of coining. Coining is believed to stimulate different meridian points of the body, thus regulating blood flow in order to remove “heatiness” through the skin. We believe coining therapy could relieve fever to some degree. The pressure strokes cause capillary dilatation which in turn results in heat dissipation from the body, a process similar to tepid sponging for relieving fever. This is enhanced by the usage of lubricants such as camphor. The resultant dark red ecchymoses further radiates more heat from the body.

Coining is perceived to be safe despite reports of serious complications associated with the technique.1,3,4Camphor toxicity is potentially fatal and may mask the presentation of underlying disease. This treatment is not advisable for those with blood dyscrasias and those taking antiplatelets or anticoagulants medication. The ecchymoses had occasionally been confused with child abuse; by physicians unfamiliar to Asian cultures.5,6Although the ecchymoses was non-accidental, it was not intentional abuse either. In countries where dengue haemorrhagic fever is endemic, the ecchymoses can be a source of diagnostic confusion.

In the era of evidence-based medicine, there is little place for coining. Despite the availability of more simple and effective treatment for fever, coining is still widely practiced among Asians. Traditional medicine has been able to reach people in ways modern medicine hasn’t been able to. Traditional Chinese medicine is based on concepts such as qi (illness is caused by blocked energy channels), yin and yang (balance of energy), and wuxing (five elements). Ayurveda, which originated from

India, personalises the healing process. These treatments involved long consultation and treatment time, employ complex mixture of herbal preparations and variation of treatment technique, each specifically tailored for each individual.

Evidence-based modern healthcare, despite standing on solid foundations, is perceived by some as impersonal and uncompassionate. The stringent regulations for sterility and quality control require prescription of medicine in blister-packages or injections that come in standard vials. Unfortunately, this is perceived as a generalised, collective approach to patient care.

Indeed, the bulk of ordinary thinking depends on perception, and most of the fault in thinking is the fault of perception, not faults in logic (Edward deBono). Both traditional and modern medicine shares the common goal of improving health. Therefore, there is a need for change is perception towards both forms of treatment. The integration of ethnic and cultural considerations into the medical curriculum and modern health delivery system will improve care and health outcomes.

Even though there is no evidence for its effectiveness, cao gio can be analyzed through another perspective. Coining uses balms and oils, such as tiger balm or other oils that contain camphor, that are absorbed trandermally when applied or rubbed against the skin with a coin. The effectiveness of cao gio to treat ailments such as aches and pains can be attributed to these balms and oils. Tiger balm is a topical analgesic that is believed to have a soothing action that relives aches and pain and is sold nationwide in pharmacies and health stores (http://www.tigerbalm.co.uk/ )A clinical study was done by Schatter and Randerson to test the efficacy of this product for the treatment of acute tension headaches. The study was a randomized, double blind study with a three-group comparison. Patients were recruited by newspaper advertisement and by general physicians who first subjected these patients to pre-treatment assessments. The three different groups were given either tiger balm, topical placebo, or paracetamol and the outcome was measured by self report on a scale basis. The results showed a statistically significant difference (p<0.05) in headache relief between tiger balm and placebo; however, there was no significant difference between tiger balm and paracetamol (Schatter and Randerson, 1996).

Schattner P, Randerson D. (1996). Tiger Balm as a Treatment of Tension Headache

Another perspective that can shed light on the effectiveness of coining is the placebo effect. Cao gio has been one of the most common forms of healing among Southeast Asians for a long time. Its effectiveness is firmly established among these cultural groups. Thus, the strong belief in its ability to heal and the outcome can be explained as a placebo effect. In addition, some of the illnesses that cao gio seeks to treat are minor ailments, such as colds and coughs, that are usually treated by the body’s natural defenses and the symptoms will eventually disappear if left untreated.

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