“There is much more involved in the healer-patient relationship than just going by the books and looking up the appropriate medicine…. You do not have to acquire skillful communication from outside yourself; you have it already. It has nothing to do with mystical experience or any kind of higher spiritual ecstasy; it is just the basic working situation… It is possible to work with sixty people a day and have something click with each of them. It required a sense of complete dedication and willingness to stay alert, without trying to achieve a specific goal. I f you have a goal, then you are trying to manipulate the interaction and healing cannot take place… of course, it is always easier to look down on your patients and their predicament, thinking how lucky you are that you do not have their diseases. You can feel somewhat superior. But the acknowledgement of your common ground – your common experience of birth, old age, sickness, and death, and the fear of all of those – brings a sense of humility. That is the beginning of the healing process…. This is not a particularly mystical or spiritual process; it is simple, ordinary human experience.”
~ Chogyam Trungpa Rinpoche, from The Heart of the Buddha
In a recent Bob Flaws blog post, he questions whether the “community-style” treatment is less effective than a private room treatment because in the latter the practitioner spends a lot more time doing “a lot more than just put in needles, talking extensively with the patient and counseling on diet and lifestyle.” Obviously, the person Mr. Flaws in quoting is making a lot of assumptions about what different patients need to feel better and get results. He is also assuming that a community acupuncture treatment somehow offers “less” to the patient in terms of care because of the short verbal interactions. Later on in Bob’s post there is this:
“Acupuncture is a multi-factorial exchange between two human beings within a particular environment, only part of which involves sticking needles into the body. Other factors include the patient’s beliefs and expectations, the practitioner’s beliefs and expectations, the practitioner’s bedside manner, their touch, tone of voice, friendliness, compassion, and everything else about the physical and emotional environment in which this exchange takes place. To categorically list all these factors is simply impossible. Nevertheless, they certainly include everything the patient experiences from the moment they decide to make contact with a particular practitioner, for instance, how the initial phone (or other) contact is handled/answered, the location of the clinic, its name, its decor, colors, lighting, reputation within the community, the way the practitioner is dressed and groomed, etc., etc., etc.”
If this paragraph was out of the context of Bob categorizing the one-on-one treatments as including all those factors and the community treatments lacking them, I might actually agree with a lot of what he is saying. But placed in the context of the post, Mr. Flaws is dead wrong. Why would he assume that in a community clinic we do not put care into the physical and emotional environment? He is also quite obviously speaking as someone who has not had the pleasure of being a regular patient at a community acupuncture clinic. If he really wanted to comment on the role of the patient-practitioner interaction in a community acupuncture clinic, why couldn’t he ask some community acupuncture clinic patients about their experiences instead of a practitioner who “practices in two different styles”, a person who is so clearly ignoring the basic principles of the community acupuncture practice model?
I want to focus a bit more on the whole idea of face time but from a slightly different angle than Melissa’s excellent blog post from last year. Recently an acupuncturist interested in learning more about community acupuncture asked me about how are we (community acupuncturist) able to develop the personal connection with each patient while having so little time to talk to them. I responded that my experience is that I have developed remarkably strong emotional connections with many of my patients by being able to see them and speak to them regularly for just a few minutes at a time. This connection feels way more organic than the forced extensive conversation I was trained to conduct with patients in acupuncture school (I believe Lisa called this “manufactured intimacy” in the Remedy, and this from Noodles: “Many people are uncomfortable with intimacy they have to pay for…”) — over time some patients decide to tell me more personal things, and I might feel more comfortable to open up more to some of them, although I always avoid a lot of personal disclosure.
What’s really nice about having only 10 minutes to treat someone is that it helps me keep good focus and maintain boundaries, even with those patients who really want to hang out and chat, allowing them to have more time to be quiet and restful. It takes the attention / emphasis away from the practitioner and their “expert evaluation” and brings in on the patients’ relationship with acupuncture, as it is experienced by their body and mind. What’s also great is that the patients that are not comfortable with a lot of talking can easily stay within their comfort zone. The beautiful thing about those silent / quiet types is that I still get to feel closely connected to them after a while, because the entire time they are getting treated, I am right there with them in the same room, treating other folks. I see them relax and let go and become beautifully vulnerable and open. I have the honor of witnessing their participation in their own healing process. They share that with me without ever needing to say much, and this is also a distinctly intimate experience to me. They get to choose how to connect in the most comfortable way for them and they still get better without ever having the long conversation with me.
I think one of the reasons many CANers were annoyed with Bob’s blog was that it ignores the real answer to his 800 pound question – community acupuncturists all over are using simple consisitent clinic systems and proving that simple regular and frequent acupuncture without a lot of bells and whistles is actually really effective in producing results.
This maybe another kind of 800 pound gorilla, or perhaps an invisible elephant in the room, but I am going to just go ahead and say it. I think that a lot of the time acupuncturists spend all that time talking to their patients because they are nervous and not sure what to do and how to treat their patient (see p.77 of Noodles). They want extra time to figure it all out by asking many questions and kind of talking themselves into a place where they are feeling ready to put the needles in. They want to feel that they are great healers and they picked the perfect treatment – read: they are centered on themselves more than the patient. In retrospect there was definitely some of that going on for me when I first started practicing acupuncture. And since I am not especially awful or great at what I do, my guess is that there were/are others like me having similar experiences. One of my teachers said this to us in acupuncture school once – he said that the time we use for intake / diagnosis and the information we gather is more for our benefit than it is for the patient’s. I never forgot this, because at the time, it kind of prickled me to hear it. Now I know he was right. I also know that I needed to get over my nervousness and worrying about having every possible bit of information before needling someone and leaving them alone, because it was getting in the way of doing my job effectively and doing it in a way that would make it accessible to many people. I needed to let the acupuncture do its job and let go of any concern on how it would reflect on me.