A few weeks back, in my Clinical Seminar (aka “Homeroom”) class, a topic came up that got some people, including myself, a bit roused up. We were sitting in a small circle and discussing specific patient cases when one student explained a predicament that they were in with one of their patients. The patient repeatedly came back to the clinic to see this particular student but each time they came they requested a certain part of their treatment. For example, the patient wanted a certain set of ear points that a previous student had once done and in which the patient had received incredible relief from their pain from having done, week after week.
So, of course, there are a few different potential problems with this situation. First, the patient is in control, to a certain extent. They want certain points and they are not willing to have a treatment without having those specific points. Secondly, the practitioner now seeing the patient is not the practitioner who first administered the “miracle points.” So, no matter how much the patient is receiving relief from these set of points, the new practitioner is not the one who thought of and started these points. Thirdly, is the patient having a placebo effect? Perhaps they received the points one week, they got lucky and had a great pain-free week, and now they attribute that to those certain points. (But, I do believe that people know if they are still in pain or not and that it is not all in their heads) And lastly, and what got most people fired up in the group, was the belief that by doing what the patient wanted, week after week, versus doing what you wanted as a highly-educated practitioner, that you were insulting yourself and your education. You, as a practitioner, are better then that. You didn’t go to school and pay many thousands to be told how to help someone and then just do it. Some students felt that if the patient was not willing to accept another treatment, then the practitioner should refer the patient elsewhere, to someone who would be willing to do what the patient asked for. Also, some students believed that, in the long run, if you do not employ another, possibly more complex, treatment at some point, then you are actually not providing the best service to your patient. After all, another treatment could cure them of their ailments, or reduce the pain by 90% versus 80%.
As the students were discussing this issue, there was clearly different views among them. Some felt that, yes, this was an insult to the practitioner and why, oh why, would you spend so much time and money and then not employ all the theory and skills that you learned? I was among the group of students that felt that if that was what the patient wanted, and if that was what helped the patient to be in less pain, then why not give them those points? And then throw in a few new ones every now and then? The patient is not coming to see you because you spent lots of time and money on your education, but rather because they really want relief from their pain. During the discussion, I blurted out, “It’s not about us, it’s about them!” (the patients).
After the class, a few of the students continued the conversation. One student related an experience where she saw a patient and they complained during the whole treatment because she didn’t do what the other student before her did. Yes, I could see this being annoying and uncalled for (disrespectful) on the patients part. And, if they want that practitioner, then go see that certain practitioner.
Where does the line start and end? How far do we go to compromise what we want to do to give the patient what is actually working for them, even if it requires no thinking on our part? Is it an insult to the practitioner or is it another instance of acupuncture working in simple yet wondrous ways? I could even see some practitioners being happy that the patient knows what works and what doesn’t. It makes their job, to relieve suffering, easier.
Though I am sure others have explored this issue before, I am interested in hearing other thoughts and experiences concerning this. Thanks!