Busy Without the Burnout

Lately, I have been using something I learned in school at Ad Astra.  I went to Tai $ophia and have the bill to prove it.  This blog isn’t about money or schools though.  Its about clinical practice.


At Tai one of the things we talked about a lot are stories, emotional causes of disease, and staying with phenomena.  We also talked with the patients a lot including a 2 hour “traditional diagnosis” in the student clinic.  I always thought it was funny to say that people’s stories are part of the cause of the disease and then to engage them in talking.  It can be useful sometimes but there are also pitfalls.  I remember one patient in clinic in particular that didn’t really want to retell her stories because she felt like it was re-traumatizing.


There are all kinds of opportunities to be coached and couciled but very few to be quiet.


One exercise that we worked on in school was the cameo.  The patient walked into the room and said hello and we built a treatment based on that initial impression.  This was mostly looking at which element they resonated with by seeing their complexion, character of their voice, expression on their face, posture and movement.  From a balance method perspective you can also tell by how someone moves and stands which meridians are affected by some kind of pain or physical limitation.


My teachers commented on how their “initial hit” on someone was more accurate than taking lots of information and trying to figure it out.  The same is true for pulse, tongue, channel palpation or any other diagnostic you want to do.  Diagnosis as a physical interaction and not a theoretical tangent.  Even if all you know is “there is something going on with earth” that is enough of a starting point to get the treatment rolling. 


So I have been doing a cameo intake.  Reception orients the person to the clinic systems and has them take a seat in the treatment room.  I review their intake paperwork and observe the person as I listen to a complaint or two, maybe ask a question, quick pulse impression and then needle.  My part of the intake can easily be done in 3-5 min.


Then I get out of the way and let the person join the room and rest.  There is no need to conjure up all of their stories about what is going on.  The important part is diagnosis based on the phenomena and then letting the person sit and get in touch with their body.  The person shares what they want and nothing more.  Most people really appreciate not having to go over all the details. 


I can tell that the treatment is working because their color, expression, breathing, posture all starts to change as the pins go in.  They are a different person when they get up and often when they return for their next treatment.  It is when someone is feeling better that I can really get to know them and start to refine the treatment.


From a burnout perspective, I have noticed that operating this way is much easier on me.  I can get into the flow and be present with the person for the few minutes I’m with them observing and needling.  I can then let them go.  They don’t need me.  The community qi takes over and gets to work.


Between the receptionists, the regulars and the clinic systems the space can often run itself.  I just step in to troubleshoot every once in a while.  I remember when 20 patients in a 4 hour shift felt hurried and rushed.  Now it feels easy.  Can’t wait till 30 in a shift feels easy 🙂



Author: Ztrukn

Related Articles

Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


  1. We did a similar exercise in school as well! It was so crazy to me at the time that we had teachers telling us we could diagnose based on the way people walked into the room and then others that thought you couldn’t possibly diagnose until 2 hours of talking and up to 3 treatments later.

    “Between the receptionists, the regulars, and the clinic systems the space can often run itself. ”
    I think this is something that is really important. “Troubleshooting” as you call it is a whole spectrum of experience based shift leading. This makes being really busy possible, even when crazy shit happens. It also allows other people to more easily assimilate into your clinic and work there.

    30 does have a nice ring to it. :)! This was a great post Nick, thanks for sharing. It is a welcome follow up to your Treating Lot’s of Patients is Fun post.


  2. I think that is the really great thing about 5E training – it’s super fundamental and uncomplicated. It allows for exactly what you’re talking about, and yet all of this stuff gets glommed onto it and mucks it up. It really helps facilitate a fast initial treatment plan and I’ve really enjoyed being able to utilize it since finishing school and opening my clinic.

  3. I think we communicate on many different levels. Traditionally in making a diagnosis, most of us have been trained to Look, Listen, & Observe – with a lot of emphasis placed on the talky bit. I think there’s another dimension to our diagnosis, and it operates and informs on a much more subtle level – maybe it’s gut instinct or intuition – or a melding of all of the above on some sub-conscious level? I don’t know, and the label isn’t really that important for me to define. What is important, is trusting in it when it happens and going with it (like needling a Lung point for sadness when the person just wants me to treat then for a bad knee – then a week later the same person tells me ‘her ex-husband may as well be dead – she’s been in grieving since the day they divorced) Go figure…

    We are not taught about this aspect of diagnosis and I’m not sure if it can be taught(or if it even needs to be)…I think it’s mostly an organic and evolving process. What I am sure of, is that it seems to work better when I’m not bombarding the person with questions, or reading over pages of intake stuff…basically, it works best when I don’t think too much and don’t get in the way…when I just go with the flow. This does not mean I don’t ask questions, I do…but it’s like ‘cherry picking’. Less can be more in some cases, and that’s certainly what’s bore out for me in my own practice and why the CA makes so much sense. When I read ‘Noodles’ I was like ‘Oh, somebody else get’s it too’…

  4. Nick and Spitfire and KimDC, is is possible to do a break out session on this for any of us non 5E people?

    Just as an aside, I was going to post this as a forum topic, but I think I will just put it here. On Saturday, at the end of my shift, I sat in the waiting room and chatted with a patient. I had treated him for knee pain and general wellness. He told me that whenever he comes in he forgets to mention that he is going through interferon treatments for Hepatitis C and the side effects of the treatments are very uncomfortable. He wakes at night with stomach cramps. He was happy to report that he has been able to maintain a regular schedule with his interferon treatments, which is apparently very unusual. Most people slow down their treatment plans because the discomfort is too unbearable. He had mentioned it in during his first treatment intake, but I had forgotten all about it. I just focused on his knee and then added some general points for wellness, your garden variety St36, sp6 LI 4…. Before he left he said “I get a lot of benefit from this place, and frankly I rely on it.”

    How do you not tear up when a patient says something like that?

  5. I’m thankful for this thread. I completely agree with you Nick and love the reminder about the initial observation via CF sans speech.

    I am happily winding up my 2 year private practice in 5 weeks and opening my community clinic knowing that what’s benefitting the patients is not telling their tape loop story over and over but, instead being open to their silence. In the past 2 years I have listened to patients rattle on and on and on and on about their lives, their complaints, their issues for 30-45 minutes per visit. And the one thing I have found is that the constant re-telling of their stories has not facilitated their healing one bit. Not to mention it drives me crazy.

    I often tell them “you can list your complaints but when I take your pulse I may find that your imbalances lie elsewhere” I also spend way too much time explaining the theory of Chinese medicine to them, telling them about the meridians and organs and what I hear in their pulses. I’ve had people tell me “I appreciate all of this information but I don’t really understand it” or “thank you for explaining but the results are what’s important”.

    Recently I took a 45 minute intake with someone who ended up having a husband/wife pulse. Another waste of 45 minutes!

    Honestly the main thing I gleam from such a long intake is “ah this person has spleen issues”, which could be discovered in 1 minute instead of 45. And if they are coming in to be treated for pain only, that does not take 45 minutes to explain! I can’t wait to be out of private practice, the tape loop isn’t helping anyone.

  6. What a great blog. I recently started a CA clinic and treat mainly with 5E and have found that letting go of the long and extensive “traditional diagnosis” has helped me to trust in my own skills.. and senses! I realized quickly that letting go of the “story” allows me to be able to assess a person’s needs quicker.

    I now love doing CA. It doesn’t drain my energy, if anything it gives me a nice buzz while I’m in the clinic. It’s great to be surrounded by all of this amazing energy we call qi.

    Thanks again for your post.