Bells and Whistles and More on Face-time

“There is much more involved in the healer-patient relationship than just going by the books and looking up the appropriate medicine…. You do not have to acquire skillful communication from outside yourself; you have it already. It has nothing to do with mystical experience or any kind of higher spiritual ecstasy; it is just the basic working situation… It is possible to work with sixty people a day and have something click with each of them. It required a sense of complete dedication and willingness to stay alert, without trying to achieve a specific goal. I f you have a goal, then you are trying to manipulate the interaction and healing cannot take place… of course, it is always easier to look down on your patients and their predicament, thinking how lucky you are that you do not have their diseases. You can feel somewhat superior. But the acknowledgement of your common ground – your common experience of birth, old age, sickness, and death, and the fear of all of those – brings a sense of humility. That is the beginning of the healing process…. This is not a particularly mystical or spiritual process; it is simple, ordinary human experience.”

~ Chogyam Trungpa Rinpoche, from The Heart of the Buddha

In a recent Bob Flaws blog post, he questions whether the “community-style” treatment is less effective than a private room treatment because in the latter the practitioner spends a lot more time doing “a lot more than just put in needles, talking extensively with the patient and counseling on diet and lifestyle.”  Obviously, the person Mr. Flaws in quoting is making a lot of assumptions about what different patients need to feel better and get results. He is also assuming that a community acupuncture treatment somehow offers “less” to the patient in terms of care because of the short verbal interactions. Later on in Bob’s post there is this:

“Acupuncture is a multi-factorial exchange between two human beings within a particular environment, only part of which involves sticking needles into the body. Other factors include the patient’s beliefs and expectations, the practitioner’s beliefs and expectations, the practitioner’s bedside manner, their touch, tone of voice, friendliness, compassion, and everything else about the physical and emotional environment in which this exchange takes place. To categorically list all these factors is simply impossible. Nevertheless, they certainly include everything the patient experiences from the moment they decide to make contact with a particular practitioner, for instance, how the initial phone (or other) contact is handled/answered, the location of the clinic, its name, its decor, colors, lighting, reputation within the community, the way the practitioner is dressed and groomed, etc., etc., etc.”


If this paragraph was out of the context of Bob categorizing the one-on-one treatments as including all those factors and the community treatments lacking them, I might actually agree with a lot of what he is saying. But placed in the context of the post, Mr. Flaws is dead wrong. Why would he assume that in a community clinic we do not put care into the physical and emotional environment? He is also quite obviously speaking as someone who has not had the pleasure of being a regular patient at a community acupuncture clinic. If he really wanted to comment on the role of the patient-practitioner interaction in a community acupuncture clinic, why couldn’t he ask some community acupuncture clinic patients about their experiences instead of a practitioner who “practices in two different styles”, a person who is so clearly ignoring the basic principles of the community acupuncture practice model?

I want to focus a bit more on the whole idea of face time but from a slightly different angle than Melissa’s excellent blog post from last year. Recently an acupuncturist interested in learning more about community acupuncture asked me about how are we (community acupuncturist) able to develop the personal connection with each patient while having so little time to talk to them. I responded that my experience is that I have developed remarkably strong emotional connections with many of my patients by being able to see them and speak to them regularly for just a few minutes at a time. This connection feels way more organic than the forced extensive conversation I was trained to conduct with patients in acupuncture school (I believe Lisa called this “manufactured intimacy” in the Remedy, and this from Noodles: “Many people are uncomfortable with intimacy they have to pay for…”) — over time some patients decide to tell me more personal things, and I might feel more comfortable to open up more to some of them, although I always avoid a lot of personal disclosure. 

What’s really nice about having only 10 minutes to treat someone is that it helps me keep good focus and maintain boundaries, even with those patients who really want to hang out and chat, allowing them to have more time to be quiet and restful. It takes the attention / emphasis away from the practitioner and their “expert evaluation” and brings in on the patients’ relationship with acupuncture, as it is experienced by their body and mind. What’s also great is that the patients that are not comfortable with a lot of talking can easily stay within their comfort zone. The beautiful thing about those silent / quiet types is that I still get to feel closely connected to them after a while, because the entire time they are getting treated, I am right there with them in the same room, treating other folks. I see them relax and let go and become beautifully vulnerable and open. I have the honor of witnessing their participation in their own healing process. They share that with me without ever needing to say much, and this is also a distinctly intimate experience to me. They get to choose how to connect in the most comfortable way for them and they still get better without ever having the long conversation with me.

I think one of the reasons many CANers were annoyed with Bob’s blog was that it ignores the real answer to his 800 pound question – community acupuncturists all over are using simple consisitent clinic systems and proving that simple regular and frequent acupuncture without a lot of bells and whistles is actually really effective in producing results.


This maybe another kind of 800 pound gorilla, or perhaps an invisible elephant in the room, but I am going to just go ahead and say it. I think that a lot of the time acupuncturists spend all that time talking to their patients because they are nervous and not sure what to do and how to treat their patient (see p.77 of Noodles). They want extra time to figure it all out by asking many questions and kind of talking themselves into a place where they are feeling ready to put the needles in. They want to feel that they are great healers and they picked the perfect treatment – read: they are centered on themselves more than the patient. In retrospect there was definitely some of that going on for me when I first started practicing acupuncture. And since I am not especially awful or great at what I do, my guess is that there were/are others like me having similar experiences. One of my teachers said this to us in acupuncture school once – he said that the time we use for intake / diagnosis and the information we gather is more for our benefit than it is for the patient’s. I never forgot this, because at the time, it kind of prickled me to hear it.  Now I know he was right. I also know that I needed to get over my nervousness and worrying about having every possible bit of information before needling someone and leaving them alone, because it was getting in the way of doing my job effectively and doing it in a way that would make it accessible to many people. I needed to let the acupuncture do its job and let go of any concern on how it would reflect on me.

tatyana
Author: tatyana

<p> I grew up in the Soviet Union and immigrated to the United States as a teen, living in New York and Chicago before moving to the Bay Area in 1998. I began as a Yoga instructor and as a practitioner of Ohashiatsu bodywork and have been practicing Acupuncture/Chinese Medicine since 2003. Before switching to community acupuncture practice model I had a sporadic and struggling private practice, worked as an herbal pharmacist, as an instructor and clinical supervisor at an acupuncture school, plus did a two-year stint doing acupuncture at a public health clinic, working with mostly HIV/HCV+ populations in San Francisco. </p> <p> My discovery of Community Acupuncture practice model (via Lisa Rohleder's Acupuncture Today columns) profoundly transformed my life -- not just my work life but many other aspects of it. I gained a vocation, a community of friends and the most stable and rewarding job I have ever had. I see community acupuncture practice model as the most sustainable and most fitting to my values. It makes sense to me from the point of view of healthcare access, social justice, spirituality, and as an antidote to isolation. In 2008, together with another stellar acupunk Pam Chang I...

Responses

  1. information gathering and the healing relationship

    Thanks for your post Tatyana. There is a lot to contemplate here. I especially resonate with the word “humility”, and “the shared acknowledgement of being human”. 

    I remember getting treated once from a practitioner while I was a student. I don’t remember her name, but what I do remember is that she spoke very little. she worked efficiently, moved purposefully and with focus. She must have said something, but being years ago, I forgot what. I felt incredibly connected and the treatment was powerfully grounding.

    Perhaps she sensed that I didn’t need all the chatter,  that the relative silence would be more effective in my case. Is it therapeutic to indulge people’s tendency to be chatty? There are no clear cut rules or goals in my daily playbook. Each person is unique.

    That said, I do believe that the modern human spends far too much time in the head, and is not well connected with the heart, the physical body, the full range of energies of life. It tends to be locked in a narrow bandwidth. I suspect that too much chatter and not enough silence is part of our collective problem, and why, in a larger sense, we have lost respect for the larger range of energies of our biosphere which ultimately are the foundation of our existence.

    Oh, but there I go again…chattering away with my fingers…thanks for a post worthy of many reflections.

     Jordan

  2. Bingo…

    Thank you both, Tatyana and Jordan, for articulating this fabulous dichotomy that is so present in the healing zone – being silent and fully present while also entering into communication/communion with the Other.  Philosophers from many eras have written about this sense of being present with the Other – either as a way to differentiate a sense of Self from Other or as a way to connect and recognize the deep sense of Oneness that we all share as humans.  (I’m especially thinking of Levinas this morning and his call for us to gaze into each other’s eyes and to recognize our obligation to care of each other.)

     

    And while this act of communion borders on the ineffable — you know you’re there with a deep gaze into the Other’s eyes or with a deep breath, eyes closed perhaps — we are constantly trying to speak about it, to write about it, to participate in it with some kind of action/word/description.

     

    The other dichotomy that I find compelling is the dance between manifesting and surrendering — how to work towards something without pushing it through.  Whether in our own lives or as healers working with others, how do we stay in balance while we ask for change to happen?  Intent is key, of course, but too much intent starts to look like a “goal” for a certain outcome, and that’s where we can really get caught up in ego. Or, even if ego is in check, if we focus too much on a particular goal, we can miss the crucial scenery along the path that may actually be more important to us than the intended destination that we have set for ourselves or for our patients.  I like to think of it as holding space for change to happen.  It sounds a bit passive, but I believe I/we can actively invite positive change and then trust that whatever change does occur is indeed positive.

     

    And yet here we are, talking about it.  Because that’s what we do as humans – contemplation and expression are part of what/who we are.  And if you are reading this scratching your head, wondering what the hell kind of mushrooms I put in my omelet this morning, I invite you to find that place of compassion in your heart and send me a little prayer for clarity.  I’ll send one back – because surely we could all use a good dose of Clarity.

     

    Have a beautiful day…

     

    Julia in Berkeley

  3. Another possible reason that

    Another possible reason that private acupuncturists talk so much with patients – at least it was for me anyway when I had a private acupuncture practice although I didn’t realize it at the time, is that I felt guilty for charging $65 to stick needles in someone let them just lay there. I felt that if I talked to them and helped them solve all their problems blah blah blah, maybe it would be worth paying $65 after all. 

    Ashley

    You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.
    R. Buckminster Fuller

  4. Nice blog, Tatyana.

    Miriam Lee (from the information I got from several patients I have treated who had been treated by her in the ’80’s) and  Dr. Richard Tan both didn’t/don’t spend a lot of time talking to the patients before needling them. They both treated/treat many people/day and were/are very effective. Good enough for me.

  5. yep

    i was in a conversation with someone doing both private room and community treatments (not in the same location) and i heard the practitioner say “how to make it worth their $75” referring to the private treatment. i thought that was an interesting turn of phrase…

    -tatyana