Classism and Marketing Conversation (Part Two): the Ravings of a Self-Righteous Hippie, or Cautiona

So for anyone who hasn’t been following the conversation over at Burton Kent’s blog (https://www.acupunctureclinicmarketing.com/sanborn-maxim/#comments), it’s gotten, um, “animated”. Which I think is a good thing.

There is potentially a lot to say about all of it, but I want to use this post to focus on responding to a specific set of comments, and to reflect back on some of the issues that started this conversation in the first place.

First, to Jared: I’m sincerely glad you figured out what works for you in your practice. I think it’s great that you love your patients and that you listened to them. The more people who get acupuncture, in whatever setting they get it, the better. And thank you for saying that you tried the community acupuncture model and it didn’t work for you. People need to hear that.

Second, to Burton: the exchange I had with Jared is a perfect example of why we need to have this conversation. Jared wrote that he read my book and he likes the idea of community acupuncture. Just like you, just like lots of people. And yet I bit his head off, in public, and I’ve done my best to pick a fight with you, also in public. I just want to clarify why.

Nobody in CAN wants to encourage acupuncturists to adopt the community acupuncture model when there’s no way in hell it’s going to work for them. There’s no way in hell it’s going to work for them if they are adopting it for idealistic reasons, if they are trying to do good. There’s no room in community acupuncture for idealism. Community acupuncture only works when it’s about reality. Reality means that acupuncturists who want to practice community acupuncture, if they want to make a living at it, have got to deal with their issues about class. The comments on your blog should be required reading for anybody contemplating a community acupuncture practice.

And about those comments…

I’m not trying to be Gandhi. Suggesting that I am is a great example of the classist dynamic that will undermine a well-meaning acupuncturist’s community practice. And I have to add, Jared, that I’ve gotten the Gandhi treatment before (or, alternately, the Mother Theresa treatment) from a lot of acupuncturists, and I’d much rather get it in the context of a full frontal attack like yours than as an actual compliment. Either way, though, the implication is the same: that if I want to serve working class people, I must be some kind of wanna-be saint, because who else would get down in the gutter like that? Only a really extraordinary person would willingly devote herself to all those losers, who as we know are lazy, dirty, ignorant, and gleefully spending their healthcare dollars on cable TV.

And although I love the phrase “the ravings of a self-righteous hippie”, and I can’t wait to add it as a tagline to my new book, I’m going to quibble with the “self-righteous” part. Is it really self righteous to get mad when somebody insults you? Irritable, yes; bitchy, probably; unsaintly, definitely; but “self-righteous” implies a kind of abstract moralism that I have to tell you, I don’t feel. My clinic’s success depends on me not feeling that. What I do feel is a very concrete, very personal kind of rage. Is it being “holier than thou” when your true desire is not to be holy but to give the “thou” a hard slap upside the head? I bet Gandhi didn’t talk like that.

Acupuncturists, and acupuncture business coaches, keep saying insulting classist things about people I really care about. I care about them not in some abstract, humanitarian way, but in the concrete, personal way you care about your friends, neighbors, and family. I don’t have a problem with an acupuncturist deciding he only wants to serve upper middle class people. That’s his choice, his business, none of mine. Sweeping generalizations about acupuncture, fees, and patients — my patients! — are my business, however. For instance:

“When I meet (an) acupuncturist that is charging far too low a rate it has nothing to do with trying to help people out but everything to do with a lack of confidence in ones self and (one’s) clinical skills. I choose to serve my community by volunteering every week not by devaluing (my) professional service”.

“The value and importance we place on something is heavily influenced by price. By underpricing your services, you make your patients undervalue your services. They’ll comply less, complain more, and actually be worse patients because of the price you set. Don’t cheapen yourself, your skills, or your profession.”

“…it is well known that your personal income will be the same as that of your average patient. If your patients all make $25,000 to $40,000 a year, that’s what your income will be as well…It may be wise to pick a town or area in which the median annual income is $75,000 to $100,000 a year… it is a proven fact that people who are not charged at all, or who are charged very low fees, rarely get well as quickly and completely as people who are charged more.”

Everybody get the message? Don’t treat people who can’t afford market rates, because they won’t get better anyway! And they’ll be disrespectful jerks! And if you are even thinking about cheapening yourself by taking care of people who make $25-$40K a year, it’s because you have no clinical confidence and no self-esteem! Because people who can’t afford market rates aren’t really worth anything anyway…

If that message doesn’t make you mad, please don’t even think about practicing community acupuncture. (Or using a sliding scale for any other purpose.) You can’t have it both ways. You can’t admire me, like my book, like the concept of community acupuncture, and simultaneously buy into the idea that you can “devalue” your professional services by charging “too little”. Well, you can, but the cognitive dissonance is gonna get you (and your business) in the end. The impulse to have it both ways is an idealistic impulse, I think, and I’m not an idealist. I’m driven by my commitment to specific, actual people who need a specific, actual service. If you insult them, I will do my best to be a specific, actual bitch to you, because it’s part of how I stay sane in the midst of people simultaneously telling me how much they admire me and how little self-esteem I must have to do what I do. You can’t say I didn’t warn you.

lisafer
Author: lisafer

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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.

Responses

  1. “If you have come to help

    “If you have come to help me, you are wasting my time. But if you have come because your liberation is bound up with mine, then let us work together.”

     

    From an Aboriginal activist group, and more recently my computer’s desktop.

     

    This idea that anger is antithetical to good practice is really incapacitating to acupuncturists in the US. Anger has its place. Anger has an expression that is appropriate (Not petty and insulting.) Anger lets people know when they violated boundaries and anger lets us find a way forward when tradition holds us back. Its part of the cycle of things, yet most of us have a sense deep in our psyche that anger should be avoided at all cost. We can see this in acupuncture schools when students are told that good practitioners are always serene. We can see it in ourselves when people wrong us and we don’t say anything because we don’t want to rock the boat.

      

    Where does this difficulty with anger come from? I don’t know for sure, but I would bet that it has something to do with our country’s history of slavery, indentured servitude, and classism. Because anger coming from an abused group of people is a very dangerous thing. Anger, expressed appropriately could lead to revolution, and people in power have historically done everything in their power to prevent that from happening. People have started wars to maintain their power over other people. Convincing people that anger is a bad thing is a great way to make sure that no one changes an abusive status quo.

  2. Carrying a classist torch, promotes division

    Sadly the concept of war cannot be fought with anti-war messages. When you are anti-war, you must teach people all about war, so that they understand what they are fighting against. In order to have a valid fight, there must be enemies. So after war is implanted in their hearts, and has damaged their spirit, they spit their hatred at anyone that resembles an enemy to gain power for their cause. The more wrong the enemy, the more right their cause. The way to fight war is not with anti-war, but with peace. Fill peoples hearts with peace, and they will act in peace and allow peace to flourish.
    The way to fight classism is not with anti-classist rallying. With this tact you must fill peoples hearts and heads with the segregation of classism first. You must seek out your enemies and spit your classist anger and hatred at them whenever you can. By creating and attacking enemies, you ensure that your enemies defend and attack in return…which to a rallyists pleasure, proves their point and develops further passion for the cause. The way to fight classism is with “inclusionism”. If you implant the idea of inclusion in peoples hearts, they will attempt to include others and allow the movement of inclusion to flourish.
    Community Acupuncture is a wonderful model which addresses the lack of inclusion of those that cannot afford expensive treatments. The promotion of community acupuncture does not need enemies. Perhaps an awareness of classism was required to get it off the ground, but we have now seen its success. The future growth of the Community Acupuncture model is dependant on the loss of identification with the segregation of classism and with identification of innovative models of inclusion.

  3. It doesn’t have to be idealistic…

    I respect you and what you have achieved.
    I observe that attacking those that don’t conform to your ideas, does nothing for your cause. If anything, it creates enemies to your cause and barriers.
    I observe that those that don’t agree with CA, are given plenty of air time and qi when you fight them, which could be put to better uses.
    I imagine that fighting enemies, while fueling your for battle now, cannot be good for you mentally, emotionally or spiritually. You are a key motivator and promoter of inclusion for all when it comes to acupuncture and your community does not benefit from you being drained.
    I believe that eliminating classism means removing segregation between classes. You can’t fight for one groups rights and deny anothers. This only perpetuates the separation. If you wish to be allowed to charge small fees without attack, then you must allow others to charge high fees without attack. If you want rights for yourself and your patients, then you must first be willing to respect the rights of other practioners and their patients.

  4. Great post Raven

    Yeah the acupuncture profession has a very hard time in dealing with anger.  That’s true I think with most of the US too.  We tend to suppress it and get upset with others are angry, not realizing that anger is vital to our growth as humans.  We can’t live without it but people sure try.

     

    But our profession I think has a particular problem with anger.  As you say we are taught that acupuncturists should be serene, which stifles our creative impulses, leading on the one hand a 50-80% failure rate, and on the other hand (an impotent) lashing out at others who try to change the way to practice our medicine. 

     

    Setting up a successful private practice is really hard. Even a successful CA practice. Trying to set up a practice using The Remedy as your only reference is really really REALLY hard since it isn’t a how-to book.(I’m referencing Lisa’s comment to Jared here.) Which is one reason we put so much energy into CAN, to encourage acupuncturists to get support from each other as well as sharing all those critical details. What needs to happen is a whole lot of open discussions amongst ALL acupuncturists about what really works and what doesn’t, but that isn’t happening since it seems that people are scared to voice their frustrations for fear of exposing their own shortcomings (at least to themselves). It’s not easy realizing that you are a failure, most acupunks don’t, but again 50-80% (closer to 80%) of them are and lots of the” successful” ones just barely pay their expenses.

    Burton Kent tries to address one of the problems of the BA model of practice without acknowledging it in full: that most patients can’t pay $75 or $100 per treatment.  He addresses that problem not by looking at the systemic problems of the BA model but by advising acupunks to just get rid of those patients who voice displeasure in paying that rate.  I think actually for some few acupunks that solution would work- those very few who have a practice full of upper middle class and rich people who don’t think to look for a cheaper treatment that is just as effective.  But for the 80%+ of the population of this country that don’t fit in that income bracket they just have to look elsewhere for acupuncture.  Since by definition the large majority of acupunks do not treat those rich folks, Burton’s solution is just wrong so they would do well to steer clear of his website — at least until he starts addressing reality.

  5. invisible intent

    dear guest

     

    respectfully I say 

    you are mistaken and

     may need to reflect on where your class is      

    and who is under attack 

     

    the silence of not speaking up about the disrespect shown by one class, race, other

    is so deafening it seems unhearable….so loud maybe ignoreable///////

     

     

    what happens to us all when you get the occasional phone inquiry

    about your other than  “small fees”////

     

    are those quippy justifications about who they are to you even more poignant?

     

    why change that? 

    what needs healing there?

     

    perhaps calling around yourself to other acupuncturists may shed light / 

    do you feel the kinship of being charged the reduced professional rate of $100 

    especially  if your needs are acute  / /

    Is there the urge to call anonymously? 

     

    fundamentally its about our relationships 

     

    they involve more work

     

    and love 

     

     

     

     

     

  6. stopped anger is called depression

    yeah its that holy smoke and mirrors of quasi-buddhism/ quasifungshway  that tells us  our anger is a barrier a waste of energy

     

    saving our gifts for highest bidders cheapens what we do

     

    sharing our gifts with those in need rich, poor, and everyone in the mythical middle class perhaps has no price only 

    an exchange seems fair

     

     

     

  7. Magical money, just ask and it will appear!

    That exchange was so frustrating to me because of the idea that people actually can afford high acupuncture prices, but they don’t want to or just think they can’t afford it. An example given of this is a woman who was paying an acupuncturist a lower fee, but she had to go see a new acupuncturist who insisted she pay $75 a treatment.  One might think this woman was screwed, but no! it turns out her mom had given her some money.  According to some people if everyone would just try harder the money would be there, if people really need acupuncture, they will find the money, if they just think abundance the magic money will appear! I guess poor people are either lying about how much money they have or too stupid to access the magic money.    

    I’m uniformed.  Where does the magical money come from?  I need to learn how to access this magic money and teach the people around me how to get it so my patients who make $8.00/hr can pay me the $75 I deserve because I am a good acupuncturist, only a crappy acupuncturist would accept less (that’s another valuable lesson from that thread.)  Add me to the angry list!  The magic money idea is stupid and insulting to people who don’t have a lot and struggle to make ends meet.

    I wonder if magic money is a class issue.  I welcome thoughts on this.  Does this idea come from being raised getting what you want?  An upper class kid might have to get strait As to get a new car, so the idea is planted that if you work hard and really want something you will get it.  Working and lower class kids will never get that car no matter how hard they work because their parents can’t afford it.  I grew up with a clear idea of limits that some of the wealthier kids i went to school with didn’t have.  For instance, I knew I could go to college, but it would have to be community college and then a local university.  Other kids took for granted that they could go wherever they wanted.  Other kids were told they couldn’t afford college at all and needed to get a job.  Do these early experiences affect how we view the world?

     

  8. Thank You

    Raven,
    Thank you for this discussion on anger. I grew up in a very conservative culture with a specifically defined power structure and the class you were a part of defined your level of “righteousness”. I was constantly shamed for my anger at the unfairness I saw around me. The times I have rocked the boat a bit at my acupunk school I have been told how much negative energy I have and how I cannot possibly help people with my attitude.

    This is a valuable post that needs to be read by many. Thank you again, I really needed to read this.

    -Chad 

  9. What makes me mistaken? The

    What makes me mistaken? The fact that you have a differing opinion? hmmm…
    And what does reflecting on my class have to do with it? What do you want me to say?…that I grew up with a single mum on welfare, or that I never had to worry about my entitlement…which would strengthen your case? Am I now the enemy as well? Because I’d prefer to focus on promoting inclusion, rather than aggression towards what you identify as opposing classes? Does the class you identify with entitle you to determine how others should practice?…

  10. Classism is the problem not the fees

    No member or founder of CAN has ever said everyone must have a community clinic with a sliding scale.  I don’t see anyone being attacked for charging high fees. If an acupuncturist wishes to have a high priced spa practice that’s their right and no member of CAN is going to attack them for it.  It is classist ideas that have been questioned.  The idea that a patient who cannot afford a $75 treatment is going to be needy and difficult is ridiculous and rightfully attacked. The idea that patients are nothing more than income generators for acupuncturists deserves questioning.  

  11. The price of a tx

    I have thought a lot about this quote: “When I meet (an) acupuncturist that is charging far too low a rate it
    has nothing to do with trying to help people out but everything to do
    with a lack of confidence in ones self and (one’s) clinical skills.”

    I have concluded that $75 is overpriced for an acupuncture treatment.  Self confidence has to be generated from within and does not depend on money and how much you charge. 

     Tom Riordan L.Ac.

  12. Magic Money

    Linda – Absolutely I think the magic money idea is classist – and racist, homophobic, sexist, and everyother -ist I can think of. This idea that we are where we are in life because of our thoughts/dreams/words is really cold hearted.

    My mother gave me “The Secret” as a gift, thinking it would suddenly make me OK with having a private room acupuncture business (I do like that phrase better than boutique, its much more accurate.) I was furious with her. If the secret holds true, all of the people affected by the genocide in Dafur are just victims of their own failure to think positively. The people doing the killing have no responsibility. If the secret is true, then people who are making good money at their job but don’t have a lot of money because they are caring for their aging parents are also apparently suffering from wrong thought. Doing right by their parents isn’t part of the equation.

    I do think that there is a part of the US population which really can get what they want if they just try hard enough. I was raised in a rich town, and it was amazing what some people were just handed by their parents. In the US, we are all privileged because to a certain degree, we all have access to some basic tools that we can use to create for ourselves what we want in life, but the truth remains that it is infinitely easier to do so if one is rich.

    The classist assumption that even I make often is that it is better to get stuff than to not get stuff. Why is it that we define success as having a lot of buying power? Classism, that’s why. Rich equals power in our society. Why don’t we recognize how many people enjoy their working class lifestyle and have no interest in pulling themselves anywhere? Some people enjoy working with their hands.  Some people work less so that they can spend afternoons having bar-b-ques with their working class friends, or having more time to spend with their children. Why can’t we even accept that some people enjoy spending time at a bar with their friends before fixing their cars or even, gasp, paying a fancy private-room acupuncturist? What is wrong with community over stuff?  What is wrong with living simply?

  13. I agree

    I won’t pay $75, and I am not a cheapskate.  I probably spend a lot more money than I should much of the time.  I appreciate high quality products, but the things I buy are rarely the most expensive because like most people who grew up lower middle or working class I do research rather than assume the most expensive is the best.  

  14. On not getting by in America

    Where is the logic in the argument that those who can afford $75 dollars are somehow more worthy and make more compliant patients than those who cannot afford that amount?

    Maybe a reading of “Nickel and Dimed..on not getting by in America “by Barbara Ehrenrich might be a good wander into territory that many Americans wander every day . Many of our patients put in a days work and they are not rewarded with a living wage or benefits,  and one small misfortune can cause the whole apple cart to come crashing down.

    The patients that come to CA clinics can often be  the same ones who come to BA practices except that a little misfortune has been compounded by ensuing misfortune and they have less or no “discretionary” income to throw at the problem/s to fix them .

    Or maybe a viewing of the recent PBS documentary series “Unnatural Causes” may prove to be a salutary tale for these bloggers in”there but for the grace of God ” may go I..

    Here is not only the tale of the ” working class” in impoverished areas living on average up to 20 years less than the monied classes that the Burton Bloggers try to attract, but also the stories of the “middle class” and the fact that their lack of large amounts of discretionary income also mean that they will live shorter and less healthier lives simply for the lack of as much money as the monied class to buy good medicine , good food ,decent housing , good schools good prospects for decent work with solid benefits…

    I am reminded of the ” Rich Dad, Poor Dad” book that was so popular a few years back and I remember thinking as I listened to the author being interviewed that it must be so easy to ” attract” money when you have it to start with and you are raised in an environment conducive to its continued manifestation ..rather than dealing with the “Sicko” world that is the lot of most Americans as they watch the buying power of their dollar erode and their ” benefits” become more hollow in what they will or will not cover. …and the rich dads and their offspring get richer and richer…

     

     

     

     

     

  15. Self Esteem

     Linda,

    Actually the point I was trying to make is that self esteem and treatment fees are two separate issues.  Charging more for my services will not generate higher self esteem and charging lower prices for my services does not mean that I have no confidence in my skills.   

     Tom Riordan L.Ac.

  16. I understand

    I know, I understood that, but I actually agreed on both points and I thought it was so cool that you wrote that.  I’ve never been comfortable saying so because people make it about self worth.  I guess I should just say it, the benefits of acupuncture are priceless, but I don’t think people should have to pay $75 a treatment.

  17. are you promoting inclusion

     

    Is asking anyone to look or feel something from a different viewpoint painful sometimes?

     

    Yes

     

    there is a mistakeness about what is being attacked

    and who is being included in the inclusion/

    classism and its hidden constructs have touched that nerve

     

    I personally wish you many blessings, truly / 

    Only you and your clients will determine how you practice 

      

    I see this blogging as a reflection of my own conflicts and dilemmas / 

    and thought to share a place

    where my discomfort with class issues arises in my practice 

    and we are not alone/

    or divided into class//

    but  must work hard to diseducate and unassume

    the ways subtle and obvious that cause disharmony 

    /see/

    https://www.yesmagazine.org/article.asp?ID=1166 

     

     

     

     

     

     

  18. Please elaborate

    Please show examples of someone being attacked on the basis that they have high fees if you feel this is the case, and I will check my vision.  There are many members of CAN who have high fee practices at least part of the time, they are not attacked. I refer to and respect many private room acus who charge very high fees.  It is always stated on the CAN forum that there is room for all types of acupuncturists. 

  19. Elaboration…but it’s going to have to be a process…

    I’d happy to elaborate, but what is going on has become SOOO complex. There is a massive train smash of “stuff” happening and with each person being guided by whatever they associate with in that train smash, everyone is fighting different battles and seeing different things. I truly believe that it would take me a good 20+ pages to highlight what I see and unravel, and frankly I believe everyone would just continue to get stuck on the thing that feeds their anger, making me the enemy, which is not helpful to anyone. So, given that everyone on here is intelligent, I’m going to get the ball rolling and let you it from there, if you wish.

    Let’s go back to “Classism and Marketing – Part One”. Someone told Lisa that CA and in particular, Lisa’s writings were mentioned/promoted on another site, that from what I can see is just a marketing site that tries to support all types of acupunks. The site is even incredibly positive and supportive of CA as a possible model of choice. Great News! So, Lisa goes to that site and LOOKS for the thing she could attack. Lisa herself admits to SEEKING and LOOKING for examples of “classist” stuff everywhere (even the fact that she has to teach people how to see it, is very intersting in itself). CONSTANTLY SEEKING. Hey, she thinks she’s found something. In a FREE version of his book, the guy who owns the other site has mentioned that some practitioners might want to look at their self value and talks about a concept of value in practice. If CA followers accept all acupunks in all types of practices, then he is within his right to discuss/suggest this. But NO, THE FIGHT BEGINS….

    This should be enough for you to start processing without my hoo-ha…

    It might be wise to keep evaluating anger, as has been done in another part of this thread. But let’s be clear on the different forms that anger has. One is internal, within you. The other is external, within society, which funnily enough, can only be fuelled by you and the anger that resides within. If you start with the basics, then anger is a response, within you, to some stimulus. The stimulus used to be external, but progressively in our society, the stimuli are seen to be more and more internal…people are spending a lot of time and energy fuelling anger within themselves, because to some extent, it feels good…it’s like a hit of adrenalin. If you look at the anger response in you, it’s supposed to be a response. It comes, it goes. You can then be motivated to act, because something angered you, but it is not necessary nor healthy to continue to be angry. Acupunks all know what is happening in our bodies! Problems arise when you don’t let go of that anger. It should come…then go. But if you like being angry, then you find ways to feed that anger and to continue to feel it….

    So, if you can step away from your own anger, not feed it, then it is simple. You use that experience to do something to change the situation that angered you in the first place. It is not necessary to continue to be angry. Nor is it necessary to instill and feed the anger in others. You are simply being a victim of your own anger and helping others to feed theirs… where is the liberation in that?

    Enough said. If you are capable of this, even for a moment, then go back and read “Part One and Part Two” and the other acupunk marketing site, and work out if you see anything different….

  20. Hey Mr. Guest (not

    Hey Mr. Guest (not verified). Maybe you could reveal the inner truth of your real name. Or you could try coming around here for more than just psychoanalyzing one of our honored members. You might find that you get a less angry response. Believe it or not, if you decided to be a participant instead of just an outside critic, people would respect your words more.

  21. Who’s motivation?

    Are you asking for my motivation?  I am a member of the Community Acupuncture Network, you know my name and where I live, it would be nice to have yours. I feel passionately about community acupuncture and what we are doing for acupuncture by bringing an affordable option to people.  I feel you see things from a very narrow angle, but I’m doing my best to look at this with a clear mind.  I started a response to your post, but like yours mine is quite detailed, and I don’t have time to finish it tonight.

  22. Too many guests…

    that last comment about the motivation is from another “guest”…it’s all starting to get a bit confusing….Perhaps they were asking for my motivation?

    I AM a member of this site. I chose not to make comments under my username because I felt you would not respond naturally if you knew me, and none of my comments have been about you and me. It is about questioning how these comments started, why people have been responding the way they have and what has come from that…which brings us back to the motivation of starting this debate in the first place and whether it is beneficial to anyone to continue down this path…
    (just a quick note that any further comments from “guest” will not be mine. I’ve said my bit. I am not your enemy and I do not see you as one of mine. )

  23. Okay, this is just getting

    Okay, this is just getting ridiculous, I don’t know who’s who.  I’m not viewing anyone as enemies, I think it’s an interesting discussion, but couldn’t the guests just use initials or fake names for the sake of clarity?

  24. Full Circle

    It’s interesting that this conversation got back to motivation, and the original point of this whole thing, because I was just thinking about that myself…

    As I said somewhere in the original post, the reason I started this all is that I’m teaching a class at OCOM, and all term we’ve been talking about classism and how it affects how you run a clinic, how you interact with patients, how you communicate. Because there are so many potential scenarios and because some of the most pernicious classism can be really subtle, all term people have asked me for examples and all term I’ve been trying to be as specific as possible. The most recent class we had was spent entirely on communicating with patients, and doing role plays. At the end one of the students came up and told me that what would be most helpful to her would be to have examples of what NOT to do, and is there any way we could make a video of people communicating with patients in ways that would ensure the patient would not come back. I completely agree with her about the value of a teaching tool like that, especially since so many patient interactions in community acupuncture are compressed into a couple of minutes, and every nuance, every bit of body language, every word counts. Unfortunately, I can’t imagine how I could set up a video like that (she suggested that I solicit acupuncturists with poor social skills to help) — so we keep coming back to the importance of really reflecting deeply on your attitude towards your patients, since you can count on your attitude being expressed in every possible way when you communicate with them. And you can count on them picking up on it.

    So in that way, a whole lot about this conversation has been extremely useful to me, in terms of being able to cite concrete examples of what won’t work. (For an egregious example, there’s Jeremy’s quote from the other thread, “it’s business first and healing second!”) This thread, however, and our unnamed “Guest”‘s comments are even better.

    I want to note here that my motivation in all this is to give students as much of a heads-up as possible when they are doing something that, in my experience, won’t work if they want to have a community acupuncture practice. That is part of my responsibility as a teacher. They may still choose to do it, and that is their right, but they paid for me to give them, at least in theory, the benefit of my experience. Also they have been showing up faithfully at 6pm on a Monday night after having been in school all day. They deserve my best effort. Yeah, classism infuriates me in general, but I actually do have an awful lot to do, and I really wouldn’t have spent so much time on this marketing blog thing if I hadn’t made a commitment to trying to get some stuff across, really thoroughly, in the OCOM class, and if I hadn’t felt like it was hard to accomplish. As we all know, community acupuncture is only financially viable if you can attract and retain patients in large numbers, so it is really, really important to learn how to do that, and — the negative corollary — to learn how NOT to alienate patients and drive them away. So this isn’t just theory. It’s about people’s ability to make a living.

    So I was very excited when I found that article on “Inessential Weirdness”, which is in another May blog post below, and which talks about the ways that people who identify as “alternative”, generally from upper middle class backgrounds, alienate working class people.  Dear Guest — the original Guest — I don’t know what your background is, or even if you are an acupuncturist, but the tone and the content of your comments are a perfect illustration of what that article was addressing. For all I know, you may have a working class background like me, but you have learned to communicate in the way that people with privilege often communicate to people without privilege. You may not be an acupuncturist, but you sound like one; and your comments are the perfect example of how acupuncturists should not communicate with working class patients, if they want to retain those patients. (Are any of my OCOM students here?) I said that I was angry about something concrete, statements about patients which I perceive as demeaning to my community. You responded with an abstract discussion about why anger in general is bad. There’s a strong flavor of you telling me this “for my own good”; you point out that what I’m doing is not necessary or healthy. I was personally confrontational; you are lecturing me from a position of higher wisdom and presumed detachment (without disclosing your identity). This is a beautiful example of a culture clash, the exact kind of culture clash that generally repels working class patients from acupuncture clinics. 

    I’m not surprised that you are a CAN member. This is my concern, as the community acupuncture movement grows, it will attract more and more people who are uncomfortable with discussions of class, privilege, and anger. I don’t have to live inside your head, so I don’t care that much what you think — that really is your business. As I’ve said, though,  for now at least I feel a responsibility to say something when I see acupuncturists doing things that will ensure that they will not attract working class patients; I still see that as my job. Because I want people to succeed. I probably won’t always see that as my job, and this little interlude for sure makes me think fondly of the day that I don’t. And maybe you have figured out a way to create a clinic where you can ignore class and treat it like it doesn’t matter. If you’re successful at that, great. I would hope that if you are, you would reciprocate my effort — and other people’s — and say exactly who you are, exactly what you do, and exactly what specific procedures made you successful — because that is the point of CAN, to share what works. My success came out of a determined focus on class, and I talk about it because that is my experience of what works. I see acupuncturists fail because they don’t get it, so I keep trying to find different ways to communicate it. If you are sincere, I would ask you to do the same — thorough, detailed explanations of how to make “inclusion” real, but without addressing class privilege and the anger of people who don’t have that privilege. I’m not talking about abstract theories here, I’m talking about myself, my experience, and my clinic. I ask you to do the same: names, details, procedures, scripts; and how about a video of your patients talking about their experience? I’m not joking. If you can make class disappear, a lot of people would be interested in exactly how you do it — but that is not a theoretical discussion.

  25. reeks of the counter-racism arguement

    This argument is a rewording of the notion that standing up for the rights of an under-represented or oppressed group = counter oppression of the privileged or oppressing group.  The existence and success of CA clinics is not an attack on one-on-one private room/higher fee acupuncturists, but on the fundamental assumptions that drive many of these practices (e.g. higher fees=better treatment, pts. simply need to prioritize treatment, etc.)  

    “If you wish to be allowed to charge small fees without attack, then you must allow others to charge high fees without attack. If you want rights for yourself and your patients, then you must first be willing to respect the rights of other practioners and their patients.”

    This is not simply a matter of “everyone playing nicely together.”  The private-room/boutique/ white-coat push for legitimacy in our profession by making laws and educational and financial hurdles, is an attack on our patients and on a particular group of (future) practitioners.  We are a diverse society with divergent needs and simply feeling like a united whole isn’t going to create jobs, or healthcare,or education, or justice.  Being angry and pissed off has a much better chance at making changes.

      

    Cris

  26. Full circle?…more like here we go round the mullberry bush

    Firstly, I’d like to address the invite to share my reputation and business strategies with you. It doesn’t feel like a sincere invite, more like a challenge. I’m seeing “lamb to the slaughter”, so thankyou, but no thanks. I know you tried to phrase it nicely, but you’ve proved your intent by suggesting that my comments are examples for your students of ‘what not to do’.

    However, feel free to use my comments for your purpose. But I think it’s just another example of gross manipulation of the facts for your cause. You are not my client…or at least, I didn’t think so when I made those comments. Therefore, it is not an example of client interaction (if your OCOM students are here, people often speak to each other differently than they would with a client). And as for Jeremy’s comments. I would agree with you that he didn’t express himself in the best way, but I’m sure he wouldn’t say those things to a client either. It seemed that he was attempting to express the fact that you need to succeed in business first, which meant paying the bills etc. before you could take on the cause of healing others, otherwise he would not have a business in which to help people. Suggesting that the idealism of ‘healing the masses’ will not pay the bills is the very same thing that you have said. You obviously use different words, but your education, nor ability to use the english language should not be used to persecute someone….that would seem like classist behaviour to me!

    If you want to manipulate peoples statements and then nail them with it, I have an example for you. You stated in a comment that at OCOM you teach people “to see through classist thinking”. That indeed you do. If the one wearing rose coloured glasses sees only the positive side of everything, then the one wearing cloggles (classist goggles) sees that everything is classist.

    As for your angering at something concrete. No one was insulting your clients. There was nothing to defend or get angry about. Burton’s book says that by underpricing yourself, your clients will undervalue you and complain more and that you should respect yourself and charge what you are worth. If you are looking for classist comments, then this might appear to be one. But if you are not, then he has a point. He doesn’t mention what you should charge, the practitioner decides that themselves. You may feel that $40 is plenty. And if the client undervalues you, then they will more than likely complain or not comply. This is all true. There were many examples given by practitioners in comments where this has happened. You say that your clients aren’t difficult, but they don’t undervalue you. And you certainly don’t undervalue yourself. In fact, quite the opposite. As a practitioner, you charge a minimum of $90+/hour (6 x $15minimum), putting you in one of the higher earning brackets for practitioners.

    Now, you mention that I responded to this apparent concrete reason that angered you (the one mentioned above) with a blurb on general anger. Did I? No. I responded with my thoughts on addressing what you see as classism and the idea of inclusion being something that would remove barriers, not attacking “classist” behaviour. If anyone is unsure, it’s all here in the thread. My blurb on anger came much later in a subsequent discussion with Lisa. And me saying that being so continuously angry over a cause is not healthy was not me coming from a place of higher wisdom at all. In fact, I believe it comes from the same place of wisdom from which you come…that of Chinese Medicine.

    You say that getting across to your students the ways in which classism exists in our practice is “hard to accomplish”. You say that it can be really “subtle”. I would agree with you, because it is interpretive. What YOU think is classist is definitely not what I see as being classist. Therefore it is always going to be difficult and will send most people on a mind bender trying to avoid being something that they don’t even really understand. Therefore, my money is on teaching people to be inclusive and honest and to understand that we all come from different places. This will be successful every time.

    It’s an insult to middle class people to suggest that we need to speak to them any differently, and that we need to be taught how to attract them and act around them. If a practitioner is honest with themselves, and with their clients, if they learn to accept the differences in all of us, then this is what their clients will pick up on. The rest is just unnecessary horse sh*t.

  27. But what are you being angry

    But what are you being angry and pissed off about? Being angry that someone wrote something in a book that you choose to misinterpret is not going to change laws, education requirements, financial hurdles etc. Claiming that acupuncturists are classist because you disagree with them is just not helpful. It separates the profession of acupuncturists at a time when we all need to unite.

  28. amen Cris

    The only person who can really get away with asking “can’t we all just get along?” is the person who’s been on the wrong side of the baton.

  29. two kinds of “demanding”

    Just to get back to a specific example of a classist thing to say – and I happen to believe that even if you don’t actually say it to patients, they will pick up on your belief in it – the “Sanborn Maxim” absolutely contradicts 98% of my experience. I’ve worked in various service jobs off and on for over 20 years (and yes, acupuncture counts), and in my experience it is usually upper middle class and wealthy people who are really demanding and entitled.  Sure, there are people who are annoyingly and unnecessarily penny-pinching, and still very entitled, but I think they tend to be very “old money”, and I don’t run into many of those.  People who have to work hard to get by tend, in my experience, to see and appreciate other peoples’ work.

    There are some patients who don’t have money (or don’t want to spend it) and are “demanding.”  Sometimes people are just broke from being sick for a long time and not being able to work much (or at all), and sometimes their illness or lack of resources means they will miss appointments, or be late, or be grumpy.  Sometimes patients HAD money and still hae a sense of entitlement; sometimes they might still have it, but they’re not sure how long they’ll have it, or not sure yet whether they want to spend it on you.  There are all kinds of reasons that patients can be demanding, but often it just seems to be part of their pattern of imbalance.  Seems like they still have to be treated with compassion, even if you can’t/won’t give them what they “demand”.  This is not the same as being a martyr, or an idealist, or a bad businessperson.  In my experience with this practice model, people either adapt to the clinic M.O. or they don’t come back.  Either way I have to wish them well.

     

    By the way, Lisa, I think I might have to make myself a tshirt that says “actual, specific bitch.” It’s so tiring being mistaken for someone who’s just generally a bitch to everybody, when as we know I’m just a nice white middle class girl from the midwest, who only brings the bitchiness when I really mean it.  Wink

  30. You are taking a piss

    I think this discussion has run its course with this last comment by INCLUSION.  People are talking across form each other.

  31. Unite around what?

    It seems to me that  the most prevalent commonality that we as acupuncturists all have, is to care for our patients first and foremost.  The claim isn’t that some acupuncturists are classist (homomphobic, racist, etc) is not one made to point fingers at a few while claiming indemnity from these real and human foibilities.  We all have them.  Perhaps this is the second commonality.  However, if we refuse to self-examine and reflect upon our actions as individuals, as a profession, as a community, as a society and culture, how will these things become evident?  How will they ever change?

    Cris 

     

     

  32. I agree with parts of what

    I agree with parts of what both sides are saying in this debate.  I think Lisa was rightfully angry at the some of the ideas expressed on that marketing site.  A lot of those ideas were stupid and classist, and I disagree with Inclusion that Lisa was just looking or a fight.  I was angry too, and when it comes to classist issues despite my working class background it takes quite a bit for me to get really angry.  Lisa is using her background and her current experience with working class patients to be a resource for other acupuncturists and we should use all the resources we have so I support her in doing that.  

    I also agree with some of the things Inclusion is expressing in the last part of the above post. I sometimes feel that CAN is trying too hard to protect working class people and it can come off as insulting to their intelligence.  I am in this interesting situation because I have recently moved back to my hometown and I have moved in with my father, we are living in the working class neighborhood I grew up in so I’m right here in the thick of it.  I can’t kid myself and pretend that I am working class though, my family and neighbors are quick to tell me I should move to Royal Oak and be with the rest of the Yuppies when they get annoyed with some things I say.  If I were to say those things in the clinic a patient would just leave rather than half jokingly tell me I’m being uppity.  I think that is what Lisa is trying to teach. A lot of people unknowingly say insulting things about working class people.  I get upset too because they are talking about my family, and me, even though I have “moved up.”

    At the clinic I am more aware and careful of what I say and how I act with patients than I am with my own family. I work with all different types of people so I do the best I can to be genuine and not make assumptions about them.  I assume that other practitioners do the same so I think that is what Inclusion is saying.  If we are honest and just treat everyone with respect we will be fine with patients from all backgrounds.  

  33. Clarifying our use of the term anger

    Anger in Buddhism has a very specific meaning, but it’s often used quite subjectively in common talk.

    Does anger as its being used here mean it’s beneficial to generate animosity or even hatred towards others? Does it mean that we are entitled to trash them verbally and speak divisively behind their backs? Is that ever conducive to personal and social harmony?

    Or is use of the term anger here simply being used to refer to a strong and forceful opposition against ideas or actions which we disagree with? I would generally agree with this usage, however, the problem inevitably arises that in unenlightened beings, opposition to ideas and actions often quickly (i.e. nanoseconds) morphs into hatred towards people. Check for your self.

    The deluded ego stakes its identity on the rightness of “MY ideas”, fortifying it’s position, inflaming the debate by inciting other deluded egos to retaliate and that’s pretty much the story of samsara – unenlightened existence and consequent suffering since beginingless time.

    Ehipassiko (Come and see).

     

     

     

     

    “Consciously restrain your mind from recollecting the past or anticipating, fearing, or hoping about the future. Simply focus on the present moment and do not allow your mind to chase after external objects or events. Do not objectify things, but rat

  34. What did I really say?

    Hi everyone,

    The interesting thing is, I never said any of the things I’ve been accused of. I haven’t even implied any them, though I’m sure if you want to read into what I said, you can see it that way.

    Even the “evil” Sanborn Maxim states “The people who are willing to pay the least demand the most.”

    I can’t tell you how many people seem to read that as “The people who pay the least demand the most.”

    Two VERY different things. Read it again if you didn’t notice. I explain this a bit in the latest posting on my site (“Is it about the money?”).

    It reminds me of one of my favorite quotes: “We don’t see things as they are. We see things as we are.” – Anas Nin

    As I told Lisa, I thought of her and CAN as I was writing that very thing that ticked her off. Charging a fair rate. A fair rate doesn’t mean “as much as possible.” It doesn’t mean boutique/private room or whatever you want to call it rates. YOU as a practitioner decide what a fair rate is.

    (I never made a single comment about CAN style pricing. I actually think that CAN is a very elegant business model – and that it helps underserved parts of society is a bonus.)

    What I don’t like seeing is discounting because you’re afraid, or feel the need to apologize for charging money. Your skills are valuable, and discounting them out of fear, low self-esteem or whatever doesn’t serve anyone.

    The whole point of the chapter where Lisa “found” my classism statement is to point out common fears/hangups that stop practitioners from reaching patients. Most practitioners that struggle to build their practice have at least one of these fears or hangups.

    See if I really am classist – make up your own mind for yourself. The chapters are freely available on my site.

    Just remember the Anas Nin quote.

  35. What does self-esteem have to do with it?

    By the way, Lisa, you wrote “…how little self-esteem I must have to do what I do.”

    I don’t see anything you do as requiring low self-esteem. Can you explain?

  36. I don’t think people were

    I don’t think people were implying that you personally said all of those things.  I was more upset by things others said on your website.  I read many statements where you praised community acupuncture.  

    I think I see the difference in being willing to pay only a lesser amount.  My patients are willing to pay as much as they truly believe they can afford.  My patients have been paying at the higher end of my sliding scale, and even apologize for not paying the top, I have to convince them that it’s okay, that I really mean my sliding scale and don’t care what they pay on it.

    I simply want people of average to lower income to be able to afford acupuncture, my fees have nothing to do with my self-esteem.  I am a good acupuncturist, I get results that would allow me to charge high prices and treat only rich people, but I would hate that.  I want to treat the people in my life and we are not wealthy or even upper middle class.  A lot of us get sick of hearing how someone who earns a low income actually can afford acupuncture if they try harder and we force them to. That’s bull, people in my family CAN’T afford $75 a treatment for acupuncture. The people who say we have to charge high rates and people can afford it are ignoring a large segment of the population.  If everyone could actually afford acupuncture the profession wouldn’t have such high failure rates.   

    I’m also sick of hearing how I’m a martyr, my business is new, but I plan to make good money.  We use quantity to make our money, we are not doing charity or planning to live like paupers, at least I’m not.  All anyone has to do is look at Working Class Acupuncture’s financial worth, that clinic brings in more money than almost all acupuncture clinics in the US.