Conceiving of Community Acupuncture

I see that Lisa anticipated my blog post here in the last post of mine just below this one. What she wrote about there is the flip side to the numbers game that I comment on there also and so I’ll expand on it here. But please read her comment first. She’s a much better writer than I am.


Getting (understanding) Community Acupuncture (CA) is tough. Most Acupuncturists in fact don’t get it, including many here. Why is it tough to understand and how do Acupuncturists don’t get it? I’ll explain below.

 Patient vs Professional is more than just a slogan.

Almost every western-trained Acupuncturist first received, got enamored by, and learned how to do Acupuncture in what I’ll now call a Conventional/Boutique/Professional setting. (That’s CBP for you acronym fans out there.) That includes, me, Lisa, and most every member of CAN. It’s in our blood. Our first experiences of Acupuncture as patients happened because we were looking for something different from conventional medicine. We wanted something special. Very normal: it’s the human condition.

When we enrolled in Acu-school we did so because we wanted to do something different with our lives. We wanted to help people but not via the more common medical approaches in our country.  We wanted to do to other people what our Acu-practitioner did to us. That was special, unique. We wanted that understanding, an extension to what we experienced so positively as patients.

Our thinking automatically goes to how the Acupuncturist sets up the environment in which the treatment takes place. The treatment is dependent on the practitioner’s personal style: what techniques they use in needling, herbs, and other modalities. It’s a unique and special thing and most importantly it’s what we all experienced that made us fall in love with the medicine. When we enrolled in Acu-school it’s what we learned how to do. We wanted to learn how to do that.  It’s now our default mode of treating patients. It’s what practically every Acu-school graduate tries to do (and fails).

So our thinking automatically goes to this Professionalism and to ourselves as the basis for a clinic. But here’s the whammy: Acupuncture has nothing to do with the setting or that Professionalism. It has nothing to do with how the room is arranged or how long the practitioner stays with the patient or any of the environmental amenities that we as a culture associate with Acupuncture. Acupuncture has to do with sticking needles in a person.  That’s it. Those cultural things don’t help the treatment one bit. They are beside the point.

But we’ve become dependent on those cultural things, just like we are in the rest of our lives. Being in a separate room is one of those things that can be hard to shake. Realizing that it takes only a minute or two to treat a patient is another cultural thing that’s hard to shake. Realizing that treating a lot of patients is less consuming energetically is a third thing that’s hard to shake. Just those three things shake most Acupuncturists from understanding what is going on in a CA clinic.

Acupuncturists go one of two ways in misunderstanding CA (sometimes both). The first is that they think that CA is like HMO health care or public healthcare. Triage. Not deep.  They think there’s no possible way that a practitioner can diagnose and treat a “whole” person in five minutes or less. They don’t believe it’s possible because nothing in their Acupuncture experiences so far has taught them it’s possible. Thus they try to make an analogy with some other type of medicine that treats a lot of people and they go to HMO’s or public health settings. Since those western settings are exactly what drove them to Acupuncture in the first place it’s no wonder that they think CA is like that: very unsatisfying. They are wrong of course but it takes a lot of thinking to get to that realization. Acupuncture is nothing like Western medicine as it is now practiced.

The other misunderstanding Acupuncturists go to is more personal. They like having a practitioner dwell on them and their problems. That was a the key difference they noted back in the day when they first tried Acupuncture as an alternative and that’s what they want to do with their patients. They want to linger and they see CA as rushing from patient to patient. Again that’s wrong. CA practitioners who get it simply don’t need to take a long time with each patient to do a great treatment; one that the patient feels great afterwards. There’s a misunderstanding that the practitioner needs to do more than insert needles. That massage or talking, etc. are needed to satisfy the patient. That’s what our culture superficially values. That’s not what our souls value however. As The Spleen says in the movie Mystery Men, “BIG! DIFFERENCE!”

 Writing about this or talking about this are one thing. Doing it is another thing altogether. In my experience only a very few Acupuncturists really get CA right off the bat (and that includes the practitioners listed on Locate-A-Clinic. For most of us it takes time and effort to understand because it’s not what we were taught, what we grew up with. Lisa speaks of Acupuncture School Deprogramming and that’s part of the problem- Acu-schools don’t know what CA is about either and you the practitioner need to strip down your ideas about Acupuncture to properly understand where CA is coming from. Even the Chinese born practitioners don’t really get CA because they just think that the US is different and you have to practice in that Conventional/Boutique/Professional model here. (When they talk to us and we say they don’t have to treat one-on-one they are usually so happy. They often say they now can practice like they did back home.)

You can come to a WCA workshop. You can talk to CA practitioners. You can read CAN. But none of them can change your thinking enough if you (like most of us) are tied into the old way of thinking of how to practice Acupuncture. You have to do it and then be open to your glitches that keep you from fully grasping how to do CA. Almost all of us (including me) have some glitches, some snags. You have to work at regaining your innate populism, your connection to the world and all the humans in it.  It’s a great journey but one that so far is not well understood in the western Acu-world. If you read the CAN forums you see this work happening by various practitioners. It’s very cool.

Skip Van Meter
Author: Skip Van Meter

Skip is Lead Acupuncturist and Co-Founder of <a href="" target="_blank">Working Class Acupuncture</a> in Portland, Oregon. With the earlier part of his life spent acquiring knowledge about geology, urban planning and teaching high school, he has now been an acupuncturist for 19 years, using about a 1,750,000 needles poking his patients. He likes all things soccer, has three fabulous sons, the best wife in the world, and a great dog and two cool cats.

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  1. It’s happening to me.

    I was so impressed at finding a school even better than the others I thought were so good, I thought that Skip was being hard on the school system in his school rants.  I’ve come to agree with him, little by little, as the veils have lifted from my eyes.  I’m getting happier and happier with my work and more and more subversive in my thinking.

  2. Frying Pan (into the fire) Friday

    I have to say, I still don’t get all of this CA thing, I’m working on it and trying to grow with it, but I’m happier than I have ever been in practice.  I thought my first glimpse of some of this was visiting WCA.  Ha.  My first real glimpse into part of what I perceive Skip is getting at here was on my first day at TCA 3 months ago, our grand opening.  Larry and I have bloggled on about various aspects of that day before.  We each treated about 35 people in less than 4 hours.  For us, this was 70 new patients in 4 hours.  My point is not about bragging on we did this or we did that, or to focus solely on numbers.  Something else for me that was much more important about that experience was the mythic explosion that it wasn’t possible for me in my own mind before that day that I could meet, connect, diagnose, treat and chart a person in 6-7 minutes, and take needles out, fluff blankets.   At the end of the day I knew anything was possible.  It totally blew my mind.   I was no longer afraid of 10 minute intervals for returns, or 20 minutes for a new patient.  20 minutes now seems like a lifetime.  I guess if I have any point here, it is to recommend that all new CA practitioners set themselves up somehow on at least one day very early on and test your (perceived) limits.  I was lucky enough to not know how many people were going to walk thru the door on the first day, and I just had to do the best that I could, and shed a whole bunch of personal/professional luggage very quickly. What I’ve seen also in the first few months of CA practice are very good results with patient complaints, as good or better than in my previous CBP practice.

  3. re-programming

    i was just talking about this in my c.a. class, although i could not put it this clearly. but i do agree that there is this core, fundamental re-programming that has to happen to us acupunks in order to “get ” this model, and it this part that takes the biggest leap the most effort, concentrated and persisitent effort. not just because it is a radical shift form how we have been brainwashed to think, but also because habitual patterns are very hard things to break. on one hand this effort takes a lot of qi, on the other hand it is about letting go of something we are holding onto and it can be aleap that happens in a blink if an eye (or in one really busy open house day, where you don’t have time to analyze, but just get those needles hoppin’)


  4. We’ve had a few days like

    We’ve had a few days like this, and clearly it helps to deprogram the garbage mind thinking that patients need a lot of coddling for the treatment to work. The tricky part though is when things aren’t so busy. The old habits creep back in like a fog, threatening to sabotage the harmonious Chi naturally present in true community acupuncture.

     All true religions seek to gain access to that level of consciousness which is not ego-bound.</

  5. Hi You all
    I have been

    Hi You all

    I have been reading about this topic for some time and basically agreeing with most of it. However, this is not a posting to restate the greatness of your way of thinking.

    Being a medical technologist for over 25 years has taught me how to take date/input and diagnose a problem rather quickly. Acupuncture is a different language and method of analyzing, but it is still taking data (pulses, bowel movements-whatever) and putting it together to make a diagnosis. To be able to do this takes experience with the concept and most certainly a certain personality type. One who does not have gallbladder issues (indecision sucks in situations where you have to make quick assesments and treatment plans) is probably best.

    Having said all of that, I differ with you folks on one very important point. That point is lifestyle advice.

     Most folks come in with problems that are a direct result of lifestyle issues (unless they have been hit by a truck and if they were drinking when they did, well that too is a lifestyle issue).

    No matter how much acupuncture you do for heartburn/GERD, if the patient continues to eat jalepeno peppers and drink whiskey-they will continue to have heartburn. In a medical clinic where I see lots of people on western meds that cause heartburn, well, good luck with making it go away on any permanent basis.

    The same can be said of knee pain in a person who is 60 pounds overweight. Stick needles in them on a regular basis or not- their knees will hurt again cause they are putting too much weight on them.

     I can go on and on with examples of how a persons lifestyle affects their pathology and I am sure no one would argue that the lifestyle is a problem. So, my question to you is, is it ethical to ignore these problems cause you do not feel you have time to address them during the acupuncture visit?

    I have found ways to quickly address the issue with as much compassion as I can in a short time-so I can fit the advice in a 15 minute interview/treatment. This is not usually done on the first visit cause I have to assess where the patient is in their ability to hear it. Eventually, everyone I treat whose lifestyle is severely affecting their health, gets some advice about it.

    We are trained in nutrition at school (we took a year of it at NIAOM) and I personally have taken nutrition courses at Bastyr over the years. Exericse is not lifestyle advice that takes formal training. So, I do believe we have the training to talk to people about these issues and the moral obligation to do so.

    I support the ability to do acupuncture without fancy fountains and the clearing chakras mentality, I do not support doing acupuncture without giving life style advice.

  6. That is a very interesting

    That is a very interesting question, I don’t recall a lot of posts against lifestyle advice though.  I would be interested to hear how others feel about this.  I approach lifestyle advice very carefully because 99.9% of my patients already know they need to lose weight, quit smoking etc, and I don’t want to be just another “doctor” telling them what they already know.  I almost never approach on the first few visits because I think it’s better to have them feel accepted and comfortable rather than defensive while they are getting in touch with their bodies through acupuncture.  I often find as they start feeling better they will bring it up.  If someone is truly ignorant of how to properly care for themselves I certainly would do what I could to help educate them.  

    This seems to be a separate issue than fountains and playing psychologist for an hour.  

  7. lifestyle advice, my 2 cents

    Interesting point about providing lifestyle advice as you feel your patients are ready to absorb it. I also agree with Linda that most patients already know more or less what they could do to improve thier lifestyle and are clear how it affects their health.

    From practicing CA in a busy clinic for over three years I have found that overall, consistent acupuncture treatments affect patients on such a fundamental mind-body level that it changes the way these people perceive personal reality as time goes by. That is a heady way of saying they start to figure things out for themselves and to make positive descisions about their health as they move forward with treatments. Sustainable change seems to happen incrimentally for us humans. As a community acupuncture practitioner, I find there are times where giving a little advice is the right call, though mostly I find it is realistic to let my patients process on their own. Most of my long term patients come to clear and occasionally dramatic health transformations with the acupuncture alone. People say things like “acupuncture helped me make the discision to divorce, join a gym, change my diet, and so on…, and I have needed the courage to do that for ages, thank you.”


    My 2 cents,


    – Moses

  8. Yeah what Moses said…

    …can also share a few stories of patients coming back to me explaining, “…after that last tx, I realized I needed to quit my job”, or “I’ve come to realize how nervous a person I am, and how I put my needs far behind everyone else’s in my family”, or the ubiquitous, “I never let myself sleep when I’m tired” as examples.

    When the occasions arise when I feel like *something* needs to be pointed out, I tend to wait until I know I can give a patient a friendly ribbing over the topic that needs attention as a means to say what needs to be said.

    For whatever it’s worth…

  9. Yep,

    I’m with you on the friendly ribbing Andy, I find that is much more comfortable and effective for both the patient and me.  They hear me, but when it comes in a friendly way it helps them realize I know how hard it is to make changes, and I seem like a human rather than a professional “know it all”.

  10. Change comes from within

     I agree with all of the above replies.  Change only happens when the desire stems from within, not from an external source.  The deep awarenesses for my patients happen in the stillness of their acupuncture experiences. 

    In auyrvedic medicine, the teaching is for patients to change no more than 25% of their lifestyle at any one time.  It’s too overhwelming, too much change.  Getting someone to commit to regular acupuncture sessions is a lot of change to begin with.  When that starts to feel “normal” to them, they will look inward and begin the next “lifestyle” change that they are ready for.

    “Let the beauty we love be what we do.  There are hundreds of ways to kneel and kiss the ground.” –Rumi

  11. .

    a friend and i were just having this conversation the other day. we are both getting closer to the end of our time in school, both are very interested in the CA model, and both are very interested in the diet/lifestyle aspects of healing. the one big roadblock i thought i had found with the CA model was how can we still work on other major diet/lifestyle factors that often contribute to the conditions that our patients present with? i just couldnt see how it would be possible to do this in such a short intake session. HOWEVER, once we got to talking about this a few things that came from my experience doing ayurvedic diet/lifestyle counseling actually made me realize a CA clinic could quite possibly be the best scenario to work from this level. here is what we came up with:

    1.) patient overload- patients, even those interested in making drastic changes can only take so much input at one time. if you give them 10 dietary recommendations, a yoga routine, breathing exerises, and herbs, its likely they may end up giving up on the whole thing. the CA clinic helps in that you can simplify recommendations and say,”hey try this one or two things for the next two weeks”. over time you can SLOWLY build if necessary and increase your level of patient compliance when its an easy progression and once they begin to see some results in their changes.

    2.) multiple visits in the CA format- seeing the patient multiple times gives you more opportunity to check in and see how things are progressing, add/subtract things from their plan, and give them continuous support with questions and moral boosts. if you see a patient only every week or other week, or even once a month which is common in the ayurvedic world, there is more of a chance your patient might give up part way through that time period.

    3.) we also thought that it could be really helpful to ahve a library and multiple hand outs that patients who really were interested in going deeper could do research on their own with minimal guidance from you. hand outs of current seasonal dietary reccomendations, simple qi gong or yoga postures, neti pot instructions and indications, etc. aside from making copies and having an idea of what you have available you can pretty easily say, “go check out _______ packet out in the library.”

    4.) regular lectures/workshops- once a month pick a topic based on diet and lifestyle issues and have a sliding scale lecture. keeps it cheap, you still make some money if people show up, and you can go a little deeper and answer a few questions.

    5)know your community- know some good yoga/qi gong instructors in the area that you can refer out to if need be. hopefully using a communtiy framework as well! 

  12. WARNING!

    ZF, beware, don’t let Skip get anywhere near your shakras…your whiskey will never taste the same.

    Trust me.

    p.s.  please use the phrase “patient compliance” 400 times in your next blog post

  13. lifestyle and diet

    i do not find it difficult to work with lifestyle and dietary changes in CA setting. it is gradual and organic process, as it should be, so that it is not ovewhelming for the patient. for people who want to work on this stuff in a very focused way, i ask them to do a food diary for 3-4 weeks – very detailed with observations of any physical or emotional ups  / downs. usually they figure out a lot of stuff they could change just from doing this self-awareness project. if they still want my input, we have an herbal / dietary consult service – it costs the same sliding fee scale as acupuncture and it is a 15 minute appointment. i have patients bring me their food diary ahead of time, so i can review it a little before i talk with them. i also usually only suggest they start with changing one or two things, and keep up the regualr acupuncture, because it tends to expand their self-awareness process. i often ask patients to try dietary changes “as an experiment, not forever”, because many of us have strong emotional attachments to certain food and if we think we have to give them up for the rest of our life, we will not do it at all.


  14. oooh-great thread on this topic

    thanks you all for sharing your viewpoints-helpful in so many ways

    There have been times when I am too heavy handed with the advice-and times when it has been just right

    sometimes I will say something to someone (specifically this woman with eczema) that will cause a lightbulb to go on (yeah, right over her head!) and be the very thing that brings them back for more cause it changed their relationship to what was bothering them

    oh yeah, whiskey and jalapenos followed by a Big Mac or two is definitely the breakfast of champions!!!








  15. I say some of the deprogramming is deeply cultural ,too

    WCA/CAN indoctrination class has those three tenets

    1>simplify yur treatments

    first shut off my brains then Miriam lee and stuff

    2.LOWER the barriersok charge less, yup… treat people with respect….

    okyeah yeah I get it

    3> build community




    I think I am beginning to get it

    and its not a fancy 1990s marketing approach
    its old fashioned
    sort of
    you know, neighborhoods
    and staying out late playing
    cooking food
    sparing a cup of sugar
    saving for the future
    maybe we all do some of this…I could do more

    CA style reveals to me a lifestyle, professionalism, business ethic, neighborliness,
    that I know is timely for me and my community

    everyday, you know

  16. one more plug for lifestyle advice

    had a patient come return last night who came in for nausea after eating. She has Asian background and was eating lots of cheese. I gently suggested she stop cheese when I saw her last-and yes, that was the first time I saw her-we had time to talk a little. She said that my treatment was very helpful to settle her stomach and that stopping cheese seemed to stop the nausea. Everytime she tried it again, she got sick. SO, my fellow hokey pokeys-she was very grateful for the advice which pinpointed a major problem in her diet that she had not thought of before.

    having and dispensing knowledge does not have to be done in a ‘know it all manner’-they do come to us for our medical knowledge after all…

  17. It’s not simple

    One of the cultural shifts of community acupuncture ( as I understand it) is the shift in focus from what happens between the practitioner and the patient to what happens: 1) inside the patient, in silence, and 2) what happens between the patients in the room, also in silence. From what I’ve seen, practitioners either make that shift or they don’t. Putting energy into giving lifestyle advice takes energy away from creating the foundation for lots of people to come in to the clinic space where lots of things can happen in silence. To put it more crudely, I think giving lifestyle advice will most likely prevent your patient numbers from getting to where they need to be for the clinic to really work.  As Tatyana pointed out, there are ways to give “lifestyle advice” without putting much energy into it, and yes, I sometimes have patients keep symptom diaries too, because it works and it keeps the ball in their court. I’m aware when I have those conversations, though, that I’m entering potentially hazardous territory. Yes, patients do come in wanting that kind of advice, but giving it can have an adverse effect on the viability of the clinic. This is one of those places where acupuncturists can’t have their cake and eat it too — just to offer a little lifestyle advice.

  18. how does giving lifestyle advice in another room affect silence

    So, what I am hearing you say is -even if I do have the time to take (I always start in my office with a little chat before taking them into the acupuncture room to check in with symptoms/changes) it will take away from their treatment when they are sitting in the chair in the room with everyone else-in silence. What makes you think I put more than a little energy into giving the advice I give? I have on occasion suggested diet/symptom diaries too. This is all about getting the patient well, I thought, with whatever it takes to do that.

    So, you are saying if I take that time with (some) patients-when I have it- I will not suceed as a CAN practitioner? It sounds like you think you have the only formula for successfully running a CAN but I respectfully submit that we all find our way and sometimes that way is not  exactly as you have outlined.

    My clinic is small-only 5 chairs in a setting where I have to set up and break down daily. However, I believe that would be the factor that determines more whether or not I succeed at this CAN endeavor-not the fact that I take the time (when I have it) to help people figure out how to make some healthy changes in their lives.



  19. “So you are saying if I take that time …I will not succeed “

    Yes. That is exactly what I’m saying. Of course, all you need to do to prove me wrong is to succeed.

  20. No one can decide whether

    No one can decide whether you will succeed or not without a lot more info on you situation, expenses and other things.  It’s just opinions at this point so I hope you stay strong in your own convictions while considering the advice and experience of others. It sounds like you may have a set up similar to mine, although I have room for a couple more chairs.  

    I have a quick chat before going into the treatment room, many practitioners I talked to also do that with no problems. I have looked carefully at my situation and decided exactly what success means to me emotionally and financially, and I’m using all my past experiences in acupuncture and business to achieve it.  I don’t doubt for one second that I will succeed so I see no reason off hand why you won’t.  I did decide on a $20-$40 scale, my plans work around that, I lower it for multiple treatments per week though.  Email me if you want to share business ideas.     

  21. My “Go-to” people

    From my clinical experience, I have little time to give dietary advice… I refer them.  I’ll say check out this article, check out Healing with Whole Foods in the Sp Deficiency / LV excess chapter… enjoy.  Some patients have no clue what to eat, i.e. Zang Fool.  I don’t bother… they’re here for the needles (not my glowing personality) and most likely they already know what damage they are doing to their bodies, but can’t break from free constitutionally from the cravings that continue their habits.  Also, most patients can hardly remember the date when they fill out their checks after their treatments  and I’m sure they’ll have a hard time remembering my dietary advice.  If I do say something it is 1 pearl of wisdom, something like “don’t mix jalapeños with whisky!”  


    However, there is another small segment of my patient population who really want to go the extra mile on cleaning themselves up and I know if I mentioned anything about there diets I would be opening up a whole new can of worms… yummy!  This would be an enormous time suck, much more than my less than 5 minute intake could handle.  With these folks I refer them to someone… I have a dietician and a family psychologist that I actively refer to and it’s so helpful.  They do there thing and I do mine and I’m time and most everyone is happy.


     I think the main point here is that we all have a finite amount of time for each treatment and if there is too much counsel, something is going to be sacrificed and it should not be anything that has to do with diagnosis, needle technique or time spent in the chair, period. 

  22. Hey, Lisa.
    I think what you

    Hey, Lisa.

    I think what you wrote is a clear expresssion of one of the cruxes of my tussle with CA, i.e.

    “One of the cultural shifts of community acupuncture (as I understand it) is the shift in focus from what happens between the practitioner and the patient to what happens: 1) inside the patient, in silence, and 2) what happens between the patients in the room, also in silence.”

    Obviously just sitting in silence once or a couple times a week would be beneficial for just about everyone. Sitting in the midst of other people who are also focused on healing would probably be even more beneficial. But surely you don’t think this is all there is to acupuncture? This could just as easily describe a yoga or qi gong or meditation class. So, in your mind what distinguishes those things from acupuncture? And how can the skill and experience of the practitioner not be the foundation for everything that happens in the treatment room, even if it isn’t emphasized or showcased? I look forward to your response.


  23. Thanks to you folks and your hard work/ dedication, the next generation, which includes me, is being prepared right here for CA.

    My first treatments were only a few years ago at The Pin Cushion in Seattle. It was wonderful, and I am sad that CA doesn’t exist in my area and I have to pay $50/visit and lie face down or prone, in a room by myself, which is usually not as comfortable as sitting in a chair, and less likely to lead to a nap, and waking up feeling refreshed.

    Because of this forum and all of your comments, I feel like I’ll be ready for a community setting right from the start, and that this line of work will be perfect for me.

    For one thing, I’ve wanted for a longtime to experience the well-documented depth of mindfulness that allows awakened people to be a step ahead of everyone else and coordinate many things at once. This is clearly the art of the community acu-punk.

    Working under pressure/ stress is still a problem that could excite my anxiety, but I feel that goes away once someone reaches a certain degree of spiritual/ personal maturity.

    So anyway, thanks for sharing this stuff. It means a lot to a patient who may become a punk, but has to focus on finishing the undergrad first.