Community Acupuncture as a Chess Game

I was thinking more about the issue of not getting behind in the treatment room and helping new employees increase their speed so they are comfortable with seeing many patients/hour, sometimes not in a smooth steady flow, but often in tsunamis – you know…one person is ten minutes late, one ten minutes early, one on time, and two walk ins, and you are the only one covering the shift.

I think this is something that just takes time to figure out the right balance.  In acupuncture school, we are trained to lavish so much attention on the patients and naturally, this unconsciously causes us to think that point selection is critical, that listening to the patient's story is necessary, etc. We were never exposed to the idea that simply being in a community room charged with Chi, and receiving simple but frequent acupuncture treatments can facilitate a powerful healing. So naturally it takes time to trust this simple idea that forms the basis of community acupuncture.

If you are doing an intake with a new patient – it is definitely important to listen to their story. But according to a recent thread on CAN, usually the full story takes about 2 minutes. Sometimes you may need to interject with a question to keep the story moving. So, I will sometimes interrupt a person and ask a very general question like, “how's your sleep?”, or, “how long have you been having this pain?”, or “how's your energy?”. It may not be the most critical piece of information I am searching for – often my mind is still zeroing in on what the key questions are, is, but needs a little verbal space in order to dredge that out of my brain.
More often than not, I already have all the information I need, and realize that I need to somehow shift the patient's expectation that this is going to be another 20-30 minute interview like all the 'alternative medicine' first office calls they've done in the past.  I realize that I need to gently interrupt the person because their unending monoluge isn't providing useful information to for me to decide upon a treatment plan. So, using the chess game analogy, it's a way of throwing the person's story off balance, to interrupt the story which if allowed to run its course, ends up checkmating you – the acupunk.
You've just had 3 people walk in unexpectedly and although these people without appointments understand they aren't necessarily going to be seen right away – you don't want to keep them waiting too long. And why should you keep them waiting long? Do we really need as much time as we think we do to provide a quality treatment.
Of course this technique may sound harsh to some…like I am throwing the person off balance, possibly even manipulating them for my own ends….words get difficult here. I'm not trying to throw the person off balance, just their story, which is very different than the person I am trying to reach. The story is often (usually?) part of the dysfunction/energy blockage  – a smoke screen obscuring the whole, true, authentic person from being seen by everyone, including most tragically, themselves.
Of course, here it's also helpful to have some wisdom in terms of being able to judge the mental predisposition of the patient. You never want anyone to feel rushed because its likely they won't come back. Again, back to rellating the verbal interview to a chess game – sometimes I will make seemingly innocuous verbal moves and I am just putting out verbal feelers, looking for information which may tell me whether or not I am in the “end game”.
The classic question in this regard is “so, do you have any more questions?” And if they say “no”, usually I can then say – “okay, shall we get started?”…and proceed to the treatment room to start putting in needles. As I am putting in the needles I am also explaining things like how long the treatment should last ideally, how to get the attention of the acupuncturist if you need something, etc.
The End Game –  Putting in the needles after you have completed the interview. Sometimes when it is slow, I will take a little more time, but when it is busy I often put in fewer points. For example, if there is plenty of time, and someone presents with a concern of anxiety, I wlll often do a number of body points…e.g ML10 (Miriam Lee 10), and the 5NP in both ears. If there is a lot happening – people waiting to get up, people waiting to get treated, I often choose to skip the 5NP and just do body points, or do the 5NP only and say add the 4 gates, but very few body points. 5NP alone can be very effective for lots of emotional issues – 8000 treatments in New Orleans after Katrina by Acupuncturists Without Borders…mostly just 5NP.  Again, western conditioning is operating here: “More is better” is the American mantra. I think we do a disservice to our patients and the world if we routinely reinforce that mentality. More is better is what is behind the rape of the planet and the disregard for all life.
So am I short changing the patient by adjusting the treatment based upon what is convenient in the moment for the overall flow of the clinic? I don't think so. In fact, when the clinic is busy (which is more and more of the time fortunately), I consider that a bonus for the patient…they are getting the added benefit of being in a room full of people co-creating a powerful group Chi field. 
Also, regular patients will understand and be comfortable with that pattern increasingly over a course of patients. They will understand that you can needle them in a short amount of time and they will still receive a quality treatment. And many of the patients also seem to develop a lovely group consciousness – not wanting others to have to wait a long time. Or when they acknowledge that they are ready to have their needles removed, spotting a new patient walking in the room, they will say, “but go take care of that patient first”. It's really beautiful when that happens.
I was going to try to close with another chess analogy, but we aren't looking to checkmate anything or anybody, except perhaps our own short sighted mental conditioning which has taught us to think and act in certain ways as practitioners which do not serve the mission of a community acupuncture clinic. Queen to G7, checkmate boutique thinking! Have fun playing the game!
river Jordan
Author: river Jordan

After graduating from the Northwest Institute of Acupuncture & Oriental Medicine in 1997, I had a hobby practice for a few years before moving to Northern India to study Buddhism. During this time, I volunteered in a local clinic, giving acupuncture to Tibetan refugees and Indian nationals. <p> Returning to the U.S. in 2002, I started a typical insurance based acupuncture practice catering to the upper middle class. In 2005, following Hurricane Katrina, I volunteered with <a href="" target="_blank">Acupuncturists Without Borders</a>, using community style acupuncture to treat trauma victims in a natural disaster setting. </p> Inspired by the power and efficacy of acupuncture in a post-disaster setting, I began to contemplate issues of socioeconomic class. What could be done to make acupuncture accessible to everyone and still provider a livable wage for an acupuncturist? After attending WCA's first conference in October of 2006, I had found the answer to that question. In January 2007, together with my partner Serena Sundaram, we founded <a href="" target="_blank">Communichi</a>, Seattle's first dedicated community acupuncture clinic. <p> As a Buddhist, I believe that healing begins in the mind. As the positive qualities of wisdom and compassion are cultivated in the mind of a practitioner, this...

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  1. This is right in sync with my day today.

    Every so often I would remind myself to stay “in tune” and be present, to resist the temptation to rush when the waiting area is getting crowded, two patients want to say “one more thing” before I walk away from needling them, and this chair is needed, but the patient is sound asleep.  Even when my new patient asked if I had something he could vomit into, I was calm enough to remember that my cleaning gal had brought in her kitty litter bucket for the mop, and was happy to bring back a nice big bright yellow receptacle for his vomit, which never surfaced.

    A busy, busy day but as the needles came out, some declared they had really had a Powerful Treatment! and somehow they had sunk into a deep, peaceful place where they could heal.  I made a lot of those decisions that Jordan describes, had a lot of questions that he voices, and ended with the same happy results.  I’ll bet he speaks for so many of us!

  2. Smoke Screen

    “The story is often…a smoke screen obscuring the whole, true, authentic person from being seen by everyone…”

    Beautifully expressed.  The story gets in the way of our connecting.  It is not an inherent part of the intake process, but rather serves as a protective filter.  The chitta-britta (talking) keeps us in our heads and out of our hearts. 

    Quiet the mind, settle into the heart, and let the connecting begin… 

  3. this makes me think of

    this makes me think of something that I was told by another participant in my qi gong retreat at Shambhala at the beginning of the month.  a woman I met says that she spends up to 40 minutes talking with her acupuncturist but then only rests with the needles in for 20-25 minutes.  she calls it her cheap therapy.

    there are no words.  well, there are, a lot on her and her acu’s end.  not on mine.