Fluffing it, or thoughts on ability to pay and how hard I’ll work

     Last week, or maybe two weeks ago, I was in my clinic on a busy day working my way around the room. It was a typical shift of two or three new patients mixed in with regulars. I found myself sitting next to a patient who was on her second or third treatment while she filled me in on the state of her chronic pain. I listened, nodded, did my acupuncture thing. When I gave her shoulder a little pat and whispered “Have a good rest” she looked up and said, “Thank you for helping me. I don’t have much money and this really helps.” I smiled and left her to sleep.

     Later, sitting on the couch in the waiting room after my shift, I sipped tea and thought about all the people I’d seen that day. The woman I mentioned above had lingered in my mind, and I relished the thought of lounging and thinking on it. Usually I’m running out the door, or keeping books, or doing one of the other 5000 things punks do in their clinics, but on that particular day there was something niggling at me, and I wanted to see if I could tease it out of hiding. It was snowing (no surprise there) and I spent some time staring out at the curtain of white. In my mind an idea, a comparison began to rise to the surface.

     In my last life, I was a BA practitioner who saw a healthy number of private-room patients at $65 per treatment. I had a mishmash of people ranging from those who could afford it to those who could not. I felt a lot of pressure during those years to figure out how to get patients in my office often enough to get adequate improvement. Elected officials, MD’s, shrinks, engineers – they followed my treatment plan (or at least if they didn’t it was not because they could not afford it. It was usually an issue of time, rather than cost.)

     That snowy evening two weeks ago I was remembering my many wonderful patients at the old clinic, and the work I had done with them – acupuncture, moxa, herbs, cupping, tui na, electrostim, gua sha, ion pumping cords, letting – you name it, if I learned it in school I did it in my clinic. I did what I could to improve the condition of every patient that walked in my door. I tell you this because I don’t want you to think I made judgements about which patient I thought would return and which patient would not based on financial ability. I want you to think I didn’t, but of course I did. And here’s how: sometimes, when I was at a loss for the magic bullet (after having tried all my secrets and tricks), or when I was super busy and knew the patient would be back next Thursday, or when I was at the end of the day and the end of my rope, I fluffed it. I moved Qi and spun the needles and had a little chitchat and was done, moving on to the next person, or to my charts so I could get out of there, or to the phone to finish reminder calls. And here’s the thing that sticks in my mind: I never skipped out on the patient who had the ability to pay for one, or maybe two appointments. It was the ones I thought I knew – the ones that I had decided, in my mind, could afford my services and would be okay with a little Four Gates and Yin Tang treatment until next week. I guess I saw a lot of internal medicine patients. I know I didn’t see nearly as many acute or chronic pain patients as I do now. I mean to say, I saw plenty of pain patients. But I also saw many with more vague complaints. Yes, there’s thinly veiled derision here. I don’t mean to be this way, but it’s what I became. Too many patients seeking spa-like treatments and mental health counseling and not enough ability to give treatments to men and women who just needed to cop a break, get free from some of the pain holding them hostage and unable to work or care for their families.

     The woman I treated in my CA who looked up at me and thanked me so kindly has chronic pain. The first time I saw her I watched her struggle in the door, watched her struggle to sit down and stand up, watched her struggle with our sliding scale versus her treatment plan. I had the feeling she was not going to be able to visit CCA very often, for a myriad of reasons. I suspected that no matter how low I made my cost, I had just a few chances to get it right, to get her up and running with less pain. I stayed there with her mentally, talked her through her first experience with acupuncture, and methodically plied my craft until the pain began to shake loose a bit. She had a good needle nap and awoke smiling. We shook hands goodbye and as the door closed behind her the mental gymnastics began. It was only later that I had time to sit down and formulate my thoughts.

     It’s sort of a backwards prejudice I’ve developed, honed in my years in BA. For those patients for whom I am pretty sure acupuncture is a luxury – even at an honest rate – I work my butt off. I never fluff. I have no idea if they’ll be back, when they’ll be back, what new problem will have arisen since I last saw them. It’s like my daughter’s osteopath told me several years ago when we wrangled endlessly over vaccinations: “We lose so many to care that when we have a child in our office, we give them everything we’ve got, every inoculation we can at that time.”

     The thing is, I’m not sure why it is any of my business how much patients can afford. Of course every patient deserves and should be able to expect my total dedication to their care. The annoying patients, the victim patients, the diamond-draped patients, the patients that push a broom for a living, the munchausen-syndrome patient, the gorgeous-legged patients, the time-has-not-been-kind patients, the hangers-on patients, the gruff old guy patients, the angry disabled vet patients. Over time I’ve noticed certain characteristics which seem more prevalent in certain demographics – and what can I say, other than Oh Well. Get over it. Give them all the same care, the same love, the same dedication. I naturally find myself working really freaking hard to get my lower-economic patients better because I am making assumptions about my chances at getting them back to finish their treatment plan. There’s probably some truth to the concern. But honestly, it’s not my job to discern who gets more, who gets (a little) less. I’m going to paste this on my wall at work – for about the tenth time in the last 9 months. “Love more. Love more. Love more.” No matter who they are. No matter what they do. No matter what they say. No matter the clothes they wear. No matter the vacation they just went on. No matter the bills piling up behind them. The answer is to love more. To do my job equitably and fairly and with presence of mind. For that I need to take darn good care of myself so that I have a ready smile each time the door swings open at the clinic – but that’s a topic for another blog, now isn’t it? Love more. It’s a simple concept. Luckily, we have thousands of patients in CA to practice it on.

Author: jenniferwoolf

Graduate of SWAC, ran a private room clinic for five years before going to work at MAS to see what this community acupuncture stuff was all about. Now a part of the POCA team in New Hampshire with a clinic in the state capitol.

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  1. ‘Lovely’ Blog

    Quoting the poster on the wall in my clinic: ‘What is it in us that looks for love? The answer is so simple, it is love itself.’ 

    Steve Kingsbury

    Ashland Community Acupuncture, LLC

  2. Just now catching up

    …and this hit me particularly hard right where I live.  I struggle with this every day, and I am sure I lose many opportunities to help people because of it. I think right under the “love more” sign I’ll put one that says “with humility”, and under that another that says, “without judgment”.  And just keep adding to the list.

    Well done, Jennifer!