Communication and Learning From Experience

I don’t know if it’s just coincidental, but there was a major slowdown in my clinic just after Memorial Day weekend, which I initially attributed to the coming of summer here in the Boston area, a metropolis filled with university students and enthusiastic summer vacationers. I saw several of my student patients leave (and whenever possible I led them to other CA clinics) and now need to work on getting the word out to the newly incoming population.
In any case, when the slowdown started to linger, I took time to also consider what is going on with my clinic and with myself, and what I might be able to do to improve it all. As I started to consider more carefully what difficulties I have had I realized that most of it had to do with my own way of communicating with patients – or lack thereof. Then, just at this time, Lisa wrote about communication in Finding Normal and I found some very interesting and helpful information in the CAN forums about communicating with patients as well.
One of the hardest things I have had to work on since graduating acupuncture school and practicing in the “real world” is communicating with patients. At first, when I worked at Manchester Acupuncture Studio, my difficulty was answering patient’s questions about how acupuncture worked, if I could help them with situation x, how long it might take them, etc. These are still sometimes difficult questions depending on my level of experience with a particular condition, but on the whole it has become much easier and I feel pretty confident with it. However, as most of us know, there is little mention in school of treatment plan suggestions. Also, I sometimes get so narrowly involved in thinking about everything else – what the patient is presenting with today; what points I am using; sticking to my schedule; getting the needles in, not talking too much and giving them their time to relax; making sure they’re comfortable, etc. It definitely took me awhile to just get the basics down when I began this work, transitioning from a student to a CA ‘punk, because suddenly I had to stand by the patient, come up with a point selection and go to it, all in 10 minutes or so. The idea of then discussing with a patient how often to come mostly slipped my mind; I wasn’t yet fully comfortable with point protocols and treatment strategies and that was my main focus. Now I am fortunate to say that the treatment part is the easy part, and so I am finding other stumbling blocks that need to be worked through.
So recently when I looked back to consider my patients who have been coming and going, I realized that one job I have been failing at is being clear with patients about their treatment plans and following through with it, emphasizing the importance that acupuncture is a process, reminding them how often they should receive treatment for best results, reminding them of the progress they’ve made along the way, etc. For me it is getting over my own guilt for asking them to come in often, or my own sense that they might not listen to me. On their first visit I might forget to tell them altogether how often to come – or I might be very vague and say “let’s try one to two treatments a week for the next few weeks,” instead of giving them a concrete number as a guideline and a future date to re-evaluate things. Sometimes when someone comes in with a severe condition and I have to break the news to them that they’d be best off coming in three times this week and possibly next week, for example, I feel this sense that oh, they’re too busy, or it will be too much of a burden for them financially or schedule-wise or they may just give up right now because it is asking too much of them. I find this particularly troublesome when I see the patient is coming from somewhere far away or if they mention to me that they are in a difficult situation financially (even though I’m willing to work with them on this if necessary). Then, as people have gotten better, I have forgotten to say to them “it looks like you’re making a lot of progress so I’d like to continue to see you, but how about we go down to once a week,” or something like that. On the flip side, when I look back and see how patients who have made a commitment to regular treatment have progressed, I am thoroughly convinced that this is THE way that acupuncture works, and that I MUST communicate this to patients if I am to do service for them.
Aside from the communication of treatment frequency to patients, I realized there is much more that needs to be communicated – both verbally and physically – if I am to draw people in and help them. First of all, I need to stay positive and be here for them. I had cut back my summer hours a bit, but I realized that if I am not here enough, they can’t all come, so I altered the schedule a bit to be more accommodating. Next I reviewed this (for the nth time), reminding myself (again) that I need to be present here. I find that when it’s busy it is easy for me to be present and I do a better job when I am busy; but when it is slow, I can get distracted easily, and not be as on top of my game. Unfortunately, oftentimes slowness –> distraction + apathy –> more slowness. And so I have to break out of the cycle. So again I am working on communicating – in expressing my care and concern for a patient who is in my clinic and in being present with them and focusing on them as we speak; answering questions and presenting information to the best of my ability in person or on the phone or e-mail; and doing my homework here on CAN.
Oh, and I did get my copy of Finding Normal and watched it (twice already). And I have tons of thoughts on that… but I may leave that for a future blog Smile

Author: Justine_Myers

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  1. Causality

    It seems that the general theme of the last dozen(?) posts often revolves around the ability of the acupunk to effect certain outcomes – both in ourselves and our patients. We want to project a more open hearted and alert persona, AND we want patients to understand our vision for their healing – a vision which is neither too restrictive, pedantic, or condescending on the one hand, nor completely lacking in any structure or unfocused on the other hand. Wow, that’s a tall order, and it belies both the highly refined art of acupuncture and our inner development as an integrated human.

    The other piece which is often never mentioned in public discussions on the whys and wherefores of clinic volume ebbs and flows relates to the laws of causality. No religion being trotted out here – we all seem to agree that there are causes for a full practice and those causes aren’t random. Please correct any misunderstanding here dear CAN colleague.

    In certain streams of thought, the time gap between cause – e.g. spontaneous realizations of open hearted love and compassion, and effect – being able to help many many people every week (a full practice), is highly variable. Also, cause and effect isn’t simply a linear change of phenomena occuring which leads from A to B. There is an infinite dance of cause – effect chains playing out each moment, all fluidly interweaving and mysteriously (to everyone except those having omniscience) bringing about the present moment’s experience.

    The take home realization in all of this is simply to be patient. Studying and practicing good acupuncture techniques, learning how to project love and compassion skillfully to patients – these are obviously some of the desireable skill sets to develop if you wish to be happy (as a punk) and have the ability to help ever widening circles of beings. But we shouldn’t expect that result to happen on any schedule. 

    Write me off list if you have any technical questions about how this works in Buddhism as I don’t wish to side track the discussion into areas which might disturb the general readership.

    I am empathizing with you Justine – if I understand your correctly.  It’s a daily challenge not to aspire for greater fulfillment of our infinite potential without measuring ourselves too critically against some external concept of where we are supposed to be or how our practice should be doing.  But perhaps this is only my struggle. And it’s definitely wise to slow down and do introspection whenever the opportunity arises – living as we do in this freeway paced world where having time for introspection is becoming as rare as the polar bear. Thank you for sharing that example.

    On a more practical note and perhaps more relevant to your post, I tend to follow Lisa’s specific recommendations in Noodles regarding telling patients how often I would like to see them again, being certain that my heart is connected to their well being and not grasping for some ego-centered idea around boosting my numbers (another good mindfulness meditation to do with every new patient you see).


  2. This is just another speed bump.

    You’ll be back in gear again before you know it, and you’ll have tweaked your practice a little bit to get even better.  But your musings inspired me to write my blog on such rhythms of a practice. 

  3. Justine,
    Oh boy were you

    Oh boy were you reading my mind when you did this post? I have the same issues that I am trying to over come. We have to learn good communication skills with our patients.

    Thanks for the great post