Face time

I was just musing on this idea of face time and how it is often brought up as a possible shortcoming of practicing CA. Those of us practicing CA know it's not true, and every day in our clinics sharing people's lives in such a daily, genuine, open way we know how crazy the whole idea is. But for those of you that are thinking of practicing like this, or patients trying to grasp the potential advantages of this type of practice, here's a little math to start the thought process:

let's take the idea of a private room practitioner (and i kind of do prefer this term, not to get this whole thing started again!! because i think other terms are equally useful, Skip, i really do! but because  in many aspects that’s what it is—private: for the patients, for the practitioners, and, as a result, for the profession.)

And I will say again, I know of several private practitioners that are good, good people, good practitioners, and are helping the patients they have and working with good intention and a good heart. I know some of them get great results and some wish they could get better results and are often aware it is because their patients cannot come as often as they’d like them to. I do not know a lot about the rest of their practices because they keep that information private, mostly.

so, anyway, let's say this  private practitioner sees a patient:

–once per week for 4 weeks 

–at $60 per visit (on the low to middle end of the going rate for treatments)

–Let's say the practitioner spends 30 minutes of “face time” with the client: intake, questioning, lifestyle advice, etc which I would venture to guess, from talking to other practitioners, that that may still be a lot.

–This does not include the time the patient rests with needles or has other modalities performed on them, which is on average another 30 minutes.

Total cost = $240

Total face time = 120 minutes

over the course of 4 visits, over one month.

The same patient could be treated in a CA clinic:

–three times a week for four weeks

–at $20 per visit (the bottom of our sliding scale; lower middle for some other clinics' scales of $15-35)

–and we have face time with them of 10 minutes per visit (this is if we are treating six patients per hour (sort of the average for a busy CA) really right now for us, it's more like four per hour average which would = 15 minutes, and doesn't include the initial interview which would be longer, but also this is presumably true with the private practitioner as well…so just for the analogy, we'll say 10 minutes per visit)

–This does not include the time the patient rests with needles, which may be unlimited.

Total cost = $240

Total face time = 120 minutes

over the course of 12 visits, over one month.

Same price, same face time, 12 visits versus 4 in the same one month time period.

In terms of results, hard to say, i suppose, but doesn't it stand to reason that the patient would benefit from three times as many visits in a one month period? isn't that what we were all taught in school?

And i don't know about you, but if i see someone twelve times in a month versus four times in a month, we are making a connection and we are getting tuned into what's going on with each other. Not to mention what happens in terms of community, and feeling a sense of participation and ownership of this space they visit this often. our patients love being part of the community, privacy is just not their biggest concern.

Also, as Skip pointed out somewhere here a million years ago, due to the treatment frequency and lack of time in between the treatments, we are able to move into the treatment easily with a quick reassessment and then we are chatting–if they want to–while needles are going in–ABOUT PATIENT'S LIVES! not just their illness or imbalance. What they're working on, who their families are, where they're traveling to, what they enjoy, where they're from, who they ARE. and they want to know about us, too. and we tell them. no hiding behind a weird professional distance. they get to know us, which aside from the fact that they are seeing results, helps them to get to trust us and feel good about sending others to try the whole thing out. acupuncture stops being somethig weird and scary and unknown and we're just regular people, doing our part to help them do the work they need to do to feel better. it's a blast.

anyway, just throwing it out there, since there seems to be some question about the face time thing. 

Author: melissa

Found community acupuncture in my last year of acupuncture school and it was like cool water on the dry desert of aculand. It addressed all those nagging questions of how to make acupuncture accessible and inviting to people like me, in my own communities as well as actually make a living and I knew I would practice this way for the rest of my life. I have learned more (about acupuncture, about people and community, about myself) in the past few years of running a CA clinic and being an acupunk at another BDC clinic than ever before. It's one of my all-time favorite places to be. I am eternally grateful to this community for its welcoming support, its passionate determination and its irreverence for useless sacred cows. I look forward to our continued work in supporting community acupuncture clinics worldwide!

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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.


  1. thanks melissa

    i played an open mike the other night at a local coffee/tea house.  of the 12 folks that went to watch, 9 patients, 1 trade/patient, 2 business partners…all friends met through TCA. 

    those minutes can add up into genuine relationships.


  2. “acupuncture stops being

    “acupuncture stops being somethig weird and scary and unknown and we’re just regular people, doing our part to help them do the work they need to do to feel better. it’s a blast.”

    and we are all so lucky!

  3. i love this!

    i often marvel at how well i know the folks i treat and how does this happen when we barely talk! numbers can be so useful. thanks melissa- and by the way, i am stealing this idea for my CA practice development class.-tatyana

  4. Made up guestimations at best…

    I think CA has the wrong impression of other PRA clinics. Most clinics do a longer initial intake and then spend 5-10 minutes checking in with their patients during follow-up treatments. If you spend 60 or even 90 minutes of face time with your patient initially, then you have enough information to form a proper diagnosis and proceed with treatment.

    If a CA clinic only spends 10 minutes with their patient initially, you may still get some results. However, you could be missing something at the root of the dis-ease. It would take a CA clinic 6 to 9 treatments to have enough face time to actually have figured out the appropriate treatment course.

    I have seen many patients who have left other clinics (including CA clinics) because they didn’t feel like they were being heard. They felt like acupuncture didn’t do anything for them.

    At my clinic patients have experienced results right away because they receive the right treatment for their constitution. You can’t understand a patients constitution in 10 minutes.

    Why not offer a sliding scale and spend some more face time with your patients? Its sustainable to do that. I’m doing it and its going well. Reducing your fees should not mean that you reduce your quality of care. Working class people deserve affordable treatments and quality care.

  5. yes! to patient connections and have at the info

    Kelly is having lunch to day with one of fairy godmother patients, who likes acupuncture but loves us and actually just wants to support CA–and us. we’re having whole families come in more and more. we’re being invited to graduations, parties, family events, etc. (what a great open mike that must have been for you, Larry! with all your communities together, right on!)

    glad it can be useful info for your class, Tatyana, although i doubt they will really believe it until they are living it, i’m not sure i did.

    and yeah, that’s kind of how i came to it–how can we be so intimately connected to our patients already if we supposedly aren’t getting  “facetime?” and what i also know is it is mostly due to the vessel that has been created by having a community of people being treated together. people seriously walk in the door and remark how good it feels before they even sit down. and, you know, our decorations are lovely, but it’s the group qi. baby!



    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  6. “You can’t understand a patients constitution in 10 minutes”

    i suppose that depends on who is the “you” in that sentence and what exactly you mean by patient’s constitution, guest (unverified). i think it is you who has the wrong impression. if i came for acupuncture and the practitoner made me talk to them for 60-90 minutes, i think would want to shoot myself. 

  7. I love your arithmetic

    I’m trying to figure out how much facetime I’ve had with my patient whom I’ve been seeing since I was an acupuncture student. (Sixteen years and counting…) I think by now we might have BECOME family members.

  8. Guest Not Verified, How Long Have You Been In Practice?

    “You can’t understand a patients constitution in 10 minutes.”

    Sure you can. In fact, a lot of veterans would say that if you need 10 minutes, you’re taking too long. Michael Smith says you should know what to do for someone once you’ve watched them walk across the room. Shudo Denmai, the great Japanese meridian therapist, spends 8 minutes TOTAL with each patient (according to my friend who visited his clinic in Japan. Also, the TV is on). Miriam Lee saw 17 people an hour! 


  9. Taking TIME to understand the methods of diagnosis.

    You can discover these methods in more detail in the Su Wen.
    Following a macro philosophy of disease, traditional Chinese diagnostics are based on overall observation of human symptoms rather than “micro” level laboratory tests. There are four types of TCM diagnostic methods: observe (望 wàng), hear and smell (闻/聞 wén), ask about background (问/問 wèn) and touching (切 qiè).[18]

    The pulse-reading component of the touching examination is so important that Chinese patients may refer to going to the doctor as “Going to have my pulse felt.”[19]

    Traditional Chinese medicine is considered to require considerable diagnostic skill. A training period of years or decades is said to be necessary for TCM practitioners to understand the full complexity of symptoms and dynamic balances. According to one Chinese saying, A good (TCM) doctor is also qualified to be a good prime minister in a country.

    Palpation of the patient’s radial artery pulse (pulse diagnosis) in six positions
    Observations of patient’s tongue, voice, hair, face, posture, gait, eyes, ears, vein on index finger of small children
    Palpation of the patient’s body (especially the abdomen, chest, back, and lumbar areas) for tenderness or comparison of relative warmth or coolness of different parts of the body
    Observation of the patient’s various odors
    Asking the patient about the effects of their problem.
    Anything else that can be observed without instruments and without harming the patient
    Asking detailed questions about their family, living environment, personal habits, food diet, emotions, menstrual cycle for women, child bearing history, sleep, exercise, and anything that may give insight into the balance or imbalance of an individual.

  10. Jennifer, your point is well-taken.

    In response, I can tell you as a practitioner who worked boutique/private room for 7 years before CA for the last 2+, that all of the info you listed above will not be retained during a first visit by the majority of practitioners. Rather I found myself remembering some of these observations/info in subsequent treatments (if the patients could afford to make follow-up visits) and incorporating them into my evolving understanding of the patients Sho/presentation at the time of the visit

    What I do for the thousands of treatments I give each year at our CAP is the same.  In fact, I’d say the shorter intake process is much more agreeable for me personally – and for many patients as well, as I’ve been told. Ultimately this is what community acupuncture is all about – ease of access to safe, effective treatments on both side of the needle.

    In response to our anonymous guest, I reject the idea that a practitioner should know definitively by the end of a single initial visit what their patients’s complete medical history and diagnosis would be.  Rather, having a clear idea of where/how to begin the process of change through a working diagnosis strikes me as a better way of honoring fluctuations in the human condition as detailed in many Chinese medical classics.

    More to the point perhaps, is most of the CA punks I know of aren’t interested in becoming well-rounded TCM styled-doctors.  They’re most interested in being useful and effective meridian-styled acupuncturists.  As you may know, there is a rich history of difference between the two.



  11. apparently it works both ways…

    it’s funny, i actually have quite a few people come in to our clinic who have expressly told me that they got better results in one treatment in CA style than they ever got at one session in a private room.  who knew.

  12. just my experience, but many

    just my experience, but many times back pain is just back pain,  “I bent over and OW!”,  and neck pain is just neck pain, “I woke up and OW!” or something like that.  in retrospect in school, i wasn’t allowed to treat based on this and the location.  i had to do a Zang Fu workup for simple back or neck pain even when i knew it was pointless to do so.  

    Maybe it just is what it is , but  I get a lot of patients who don’t want to spend a lot of time talking, they want quick direct action to help relieve their symptoms or resolve their condition or they just want to relax.  And also, honestly, the more treatments, the faster the diagnostic process becomes, pulse, tongue, questions, etc. One day last week, i treated 12/20 patients for the same location of neck pain. “it hurts here, can you make it stop hurting?” .  seriously , that’s the conversation, and all things necessary are said.  just my experience.  and i thought the universe was having a big laugh at me after neck pain patient number 5 came in, by patient 10, I was laughing.

  13. word

    I am in acupuncture school so I know what to expect when I go into the student clinic and I still loathe having to tell someone about my cycle and all manner of other uncomfortable stuff just to get needles put in.  I am glad for everyone involved that both options are available.

  14. Sorry, Guest

    Considering PRP practices were the only game in town until the CA movement, I think we CANners have a fairly accurate impression of how it goes, although I would suggest that such a long initial intake isn’t necessarily the norm. Most CANners had PRP practices of their own first. It’s not really much of a mystery.

    My Japanese and Chinese mentors always diagnosed very quickly using tongue, pulse and main complaint, with a few well targeted questions. Their point was that with experience comes knowing which questions to ask, instead of asking all of them.

    I think its safe to say that we’ve all had the experience of having patients tell us that they’d tried acupuncture before but it didn’t work for them until they came to us. That’s wonderful. It means people are finding what works for them. Why disparage what’s working for our patients?

    And finally, how low is your sliding scale if you’re spending 60-90 minutes with a new patient? As I mentioned above, if your scale is working for you and your patients, great. But we prefer a very low sliding scale so that we can help more people. We do it by trading out very long intakes but not by sacrificing quality care.

    Please understand that we try to be patient but this particular angle for discrediting CA becomes especially tedious.


  15. Yes! We are ALL so lucky!

    RCA is growing daily and through face time, I’ve been able to learn about my home town. Patients have asked me for help outside the clinic, and have volunteered to help paint our walls, to help each other, have offered to share rides and recipes.  I’ve been able to hook up patients with other services they seek. I helped find a wedding deejay, a carriage service for a prom couple, veterinary services for many pets. My Walk for Wishes team consisted of patients and friends. Our patients pitched in when I shaved my head for St. Baldrick’s. They donated their hard earned dollars, they came to watch, laugh and cheer. We share stories, learn from each other, share hugs, laughter and tears. I simply didn’t have that when I was a private practitioner.

    Every moment I’m grateful for these stories, for the common ground and the safety in numbers. This community grows every minute – all over the planet. It’s a phenomenal way to share and heal. And these blogs continue to give me permission to carry on with business as usual (or perhaps, unusual) even when our physical neighbors aren’t being entirely friendly.

    Thanks for your help CANers!

  16. Intership at school taught me non-verbal communication

    One of the internships I did while in acupuncture school was at a place called Mt. St. Vincent.  It was an assisted living/full care facility.  We saw staff, people who had their own apartments, and then 24 hour a day, full care patients, many of whom were non-verbal or had enough shen disturbance or wind that spoken communication was useless.  I was scared out of my mind at first!  How could I possibly treat someone without asking 10 questions, without them telling me their full medical history?  Or, even their chief complaint?!?!

    My amazing supervisor taught me.  Sit and look at them.  Smell them.  Note their color, their body type.  The rigidness or softness of their flesh.  Connect with their spirit.  Look in their eyes.  Be quiet and still with them.

    I started  doing this with every patient and found their was no need for all the nonesense talking and questioning.  Stopping and being still with my patient tells me so much more than bombarding them with question after question.  I came to this conclusion long before I considered CA.

    Please do not assume that my patients are not getting quality care.  The care they receive is top notch.  I care deeply for my patients.  Deeply.

    And truly, back pain is often just back pain.

  17. speaking of the su wen…..

    chapter 25

     “the key to acupuncture treatment is to concentrate and focus. ” 

    concentrate, focus, connect, improvise, take your time.

    what seems out of place there? 

  18. If you have really mastered

    If you have really mastered your technique and know how to treat a patient by observing only their gate as they walk across the street, then good job! Seriously, I’m impressed. Really and truly, I’m impressed.
    For the most part, I believe it takes many years to achieve that kind of skill. My teacher, who studied the Su Wen at the age of 16 and whom I studied with at school and privately for 3 years, would tell you that kind of diagnostic ability is only a legend. He would tell you that Chinese medicine is not mystical, and it requires concentration and time to understand its principles.

    Chinese medicine is a logical system that should not be replaced with an intuitive system. I’m not disregarding intuition or intent, but I’m making a clear point that Chinese medicine has an approach that requires a practitioner to ask the right questions to reach differential diagnosis. Having the patient tell you “it hurts here, can you make it stop?”, does not really uncover the reason why it hurts. Chinese medicine has the ability to uncover the reason why the patient has neck pain. Not just because it would be a nice to know, but because it is a need to know. We need to try to understand the pathogenesis of the pain in order to help our patients prevent the pain. I never said this could be done in 1 treatment, but it doesn’t hurt to fully evaluate the condition with extra face time.

    Keithanada, did you consider the weather? When I have patients that all appear to have the same pain, I consider the exterior factors. This way I can guide and educate my patients on how to appropriately dress. My teacher would have suggested covering the wind-gates or wearing a turtle neck if the neck pain presentation called for that. Why? Because Chinese medicine isn’t just about needling and eliminating momentary pain. Its about helping our patients prevent pain on their own, so they don’t have to become reliant on just one way.

    What if your patient can’t come in for treatment? Have you provided them with other tools of relief?
    This type of patient education needs to be nurtured and it takes time. Time that CA clinics claim is not beneficial. Yet, none of my patients think cupping or other modalities are weird. As many Canners have suggested their patients do. Most of my patients request cupping, moxa, and other modalities. Not because I’m spoiling them, but because those modalities are just as valid as acupuncture in helping them heal. They compliment each other, and I have patients accepting that compliment with ease. So maybe you are the ones projecting to your patients that cupping is weird. Maybe if you took more than 5 minutes to explain the process to them they would surprise you with interest and acceptance.

    Again, I offer a sliding scale and believe in low cost care. I also believe working class folks deserve my time and energy regardless of their income. I believe our Western healthcare system has lost sight of the significance of face time with their patients and how healing that time can be for a patient. I hope acupuncture doesn’t loose that sight too.

  19. You’re patients are lucky to

    You’re patients are lucky to have you.  I’m glad you’re able to provide the sort of care you do with them.

    As one of my fellow students liked to remind me all the time when we were in school together, “It takes all kinds.”

  20. ?

    What I find equally amusing and irritating about you is your ostentatious discoursing of the most basic theoretical knowledge and clinical skills and subsequent presentation of this information as if it is being heard for the first time.  You make a lot of assumptions about how we communicate with folks.  There are nearly two thousand threads and around ten thousand posts in the forums.  Ah, the ten thousand things.  Maybe you should get (verified).

    I also admire how you preach and claim correct knowledge of the Su Wen in a fashion similar to how conservative religious people and authority figures do so of the bible, koran, torah, etc, in an attempt to silence and establish power over those whose practices you view as straying from “THE RIGHT WAY”.  You also attempt to establish personal power by voicing the words of a powerful Other(your teacher).  It’s you speaking.  Own it.

    From wikipedia:

    ”  Fundamentalism refers to a belief in a strict adherence to a set of basic principles (often religious in nature), sometimes as a reaction to perceived doctrinal compromises with modern social and political life.”

    There are many streams that flow from the ocean of knowledge of the ancient East Asian cultures.  You are wading in one of them.  

    And while we’re on the topic of projection, did you ever think that just maybe you are projecting your need for face time onto the people that come into your clinic? 

    Think about it.


  21. Please just stop this everyone…

    Jennifer Flynn is just arguing for its own sake.  Why don’t you Jennifer Flynn go to Tuscon or any number of clinics that are extremely busy and just see for yourself.  Please stop this constant haranguing about how to treat people.  If you ask me, how to treat people is really between the acupuncturist and their patients.  If they didn’t get results, they would not have any patients.  And really CA guys!  Please stop arguing with this woman.  You are doing superbly well in your practices, do not give this argument any more air space!  There is no need to support what you already knows works well.  PLEASE! Let me be the last word!  PLEASE!

  22. Don’t Mess Wit Da Classics

    Su Wen means “simple questions”, as in the Yellow Emperor asking Qi Bo about medicine and metaphysics.  NOT Qi Bo boring the Emperor to death with question after question about his bowls in a vain attempt to come up with a psuedo diagnosis based on a communist interpretation of herbalized acupuncture.  

    DO NOT mention any of “the classics” unless you have a citation and know what you’re talking about.  Some of us have read the Su Wen, Ling Shu, Nan Jing, Shang Han Lun, AND the Jin Gui Yao Lueh.  Some of us even read a little Han Dynasty Chinese, so we’ll call you on any bull shit.  Some of us actually respect what the classics say and try to treat in accordance with them.  

    Now, if you have legitimate arguement, great, bring it.  Otherwise, don’t go spouting off about how the classics say this or that with out backing those statements up.  To do otherwise is to disrespect those store-houses of knowledge.  This goes for both sides. 

    BTW I have yet to read in any “classic” about how the length of time spent with a patient will impact the effect or effectiveness of a treatment.  Those are Western ideas projected onto Chinese Medicine.  

  23. Su Wen is a conversation…

    Conversation is dismissed by Canners, get the point? Maybe you should stick to reading higher quality textbooks like “Acupuncture is like Noodles.”

  24. Oy Vey – With Apologies to Tess…

    Jennifer – the only thing that’s getting dismissed on these public pages are the (mostly) patient attempts at highlighting your obnoxious know-it-all tone and heavy-handed attempts at ‘teaching ‘ community acupuncturists how to do our jobs.

    Let me put this to you very plainly: If you enjoy how you bring your efforts and knowledge to your patients, great – go to it.

    Please spare our readers your spiteful and condescending directives. I think it’s time you started your own public forum to trumpet your values and actions.

  25. Ironic

    Punk Wegman- Would you call me “holier than thou?” Or perhaps “Malibu Barbie”. Don’t even think you can make me re-consider my conduct when the entire “movement” you support is obnoxious on levels I can’t possibly match.

    If you don’t like other opinions, why have a open blog? Oh, that’s right… You did close the last blog with the great words of the clever composer who coined the phrase BA clinics.

  26. Larry, Larry, Larry…

    Your post seems upset. You don’t like me making assumptions about your clinic? I’m shocked and can’t really relate to that feeling.

    Boy, you punks really love definitions. I won’t insult you by posting the definition of irony, Larry.
    I think you might be capable of figuring that one out on your own. I suppose I would be less of a fundamentalist if I only quoted your Lord Lisa.

  27. nice!

    KeithaNADA instead of keithananda.  saw-weet, that’s got a ring to it…thanks, i like it!  better fit for me as a treat and street ’em  acupunk.  and generally my Liver’s been running hot lately…bye bye bliss, hello 5NP for everyone… silver lining in every cloud….

  28. If only…

    we had met under different circumstances, I’m sure we would maybe even like each other. Instead of ending this blog with more finger pointing, I will wave a white flag and get to the point. No pun intended.

    Look, we could all use a little NVC training when it comes to communication on this blog. In general, I think CAN could benefit from a little NVC training and that’s not an insult, but rather a solution.
    Here are my requests of all you, and you can accept or deny them as you wish.

    1) Please stop referring to your fellow acupuncturist as Boutique. Thank you Melissa for doing that in this article.

    2) Please stop referring to other non-CA clinics as an expensive bowl of noodles or other non-sensical terms. Its just embarrassing for all acupuncturist.

    3) Please focus on your selling points as a CA clinic rather than promoting your business via demeaning your fellow co-workers with insults that are not based in facts. For example, the “Malibu Barbie” article is really not based in reality. Its a made up character so CAN has an imaginary target to rage about. I don’t know a single “Malibu Barbie” practitioner. Most acupuncturist chose this career to help people. You DON’T have to be apart of CAN to offer a great service to your patients, but you could be. See what I did there? I extended my hand.