5 Minutes is a LONG TIME

Time is different in community acupuncture. It stretches out forever, if you let it. Five minutes doesn't sound like a lot, but I can assure you, you can get a ton done in that time. It's all about focus, confidence, and living in the moment.  Last year, I started a community acupuncture clinic in San Diego. All by myself (with my family's incredible support). Right now, just 17 months later, Beach Community Acupuncture has 6 employees: 2 staffing the front and 4 (besides me) providing the poking. 

One of the main reasons for this growth is understanding how to use time in the clinic.

Many of you have had the opportunity to take advantage of WCA's CA workshop. Remember the exercise where we pretend-needled each other in a few minutes? For me, that was worth the workshop money all by itself. Because at the school clinic, we saw *max* 3 people on a 4-hour clinic shift. Knowing that I wanted to open a community clinic, I did every internship possible off-site, seeing more people...the free clinics, the open-space university ortho clinic, the hospital clinic... and we got to see up to 6-8 people in a shift. Wow! A few people an hour! We were amazing. Lightning speed. 

So then, when BCA had a free day and I saw 17 people in a shift, I was blown away. And posted it right up on CAN (thinking, well, a free day will generate twice the people I could hope to see in real life). And people responded, there will come a time when you are seeing 25, just wait. 

I was skeptical. Maybe others are amazing acupuncturists, with special skills and knowledge I could never hope to gain. And here I am today, routinely offering 25+ treatments in 4 hours.

How?

Focus. Commitment. The knowledge that I am not serving anyone by dragging out the process of hearing what's wrong, clarifying the details, and popping the needles in. And then offering a warm blanket, or a few tissues, or whatever that person needs for comfort. And being right there, completely focused on that person, time just stretches right out. Here's what you need to do: look at the person. Hear what's wrong today. Assess in the way that's the most efficient for you (I start palpating channels on the leg while peeking at the tongue and quickly checking the pulse). Determine the day's plan (e.g., she's exhausted, black circles under the eyes, thready pulse, super stressed...gotta find some qi/blood...ST 36, SP6, LI 10, yintang, GB 41 for the temporal headache...). Pop in the needles. Look at her. All good. Quick verbal check that she's OK, roll on to the next chair.

And begin again. 

And soon, roll back to the first person (who just woke up), big smile, pull needles and reinforce treatment plan, straighten chair cover and greet the next person. All in just a few minutes.

Recently, I worked with a new acupuncturist who was taking a really long time with each patient. Like 10-15 minutes. She treated me too, and gave me a wonderful treatment. Except that it was shortened by the 10 minutes it took her to insert all the needles. At the end of the shift, she took a seat in a recliner, made up a chief complaint, and I practiced the WCA 'figure it out and throw in the needles in a few minutes' exercise. Later, over sushi, we talked about time and how, at BCA at least, patients do not value extra time spent before the needles get in. Many of them are squeezing in  the treatment and just want to get on with it. 

Also, 5 minutes is the very maximum we have with someone. Because, at just 6 people an hour, there are six being treated, and six getting up. So that's 12 patient interactions an hour (never mind new patient intakes, a potty break, etc). 60 minutes in a hour... 5 minutes each. 

This new acupuncturist had previously maxed out at a highly stressed out 18 treatments. Yesterday, she saw 25.

5 minutes. It's all you need. And you all are invited to BCA (and probably any other busy CA clinic) to get a treatment and/or shadow us.  We'll prove it.

Oh. And PS? Our patients, for the most part, are satisfied, some even thrilled beyond their wildest dreams, with the results. Even without the cupping/estim/moxa/counseling/ back shu points/tui na/small talk. We know this because they tell us, and because they refer everyone they know to us, keeping our shifts hopping.

This story was posted on October 18 2010 by obnicole.

Comments

  • October 18 2010 at 9:54 PM
    patricialott writes:

    Great Post!

    Thanks Nicole! I am inspired!!!

      0 likes
  • October 19 2010 at 12:26 AM
    Lisafer writes:

    Yay!

    25+ in 4 hours! We knew you’d be doing it! Yeah, to be absolutely realistic, is IS 5 minutes—because you never know when somebody will be late, or early, or decide to bring their grandmother, surprise! But when you’re used to going fast, 5 minutes feels like plenty of time. Thanks for a great blog!

      0 likes
  • October 19 2010 at 5:24 PM
    andy wegman writes:

    Testify!

    Well written - I’ll be using this as a teaching tool in the near future.

    Thanks very much.

      0 likes
  • October 19 2010 at 10:43 PM
    Naomi writes:

    love reading this

    and it’s just what I needed to read! Thanks Nicole

      0 likes
  • October 20 2010 at 2:04 AM
    JuliaC writes:

    ObiOneNicoleby

    You rock, Nicole!  Thanks for the enthusiastic inspiration. 

     

    And congratulations on your success!

     

    love from up north,

    Julia in Berkeley

      0 likes
  • October 20 2010 at 5:30 PM
    calambert writes:

    I totally agree Nicole

    I was skeptical of this after the CAN seminar I was in 2 yrs ago.  After all, in my 4 years of practice, weren’t my patients partially feeling better cause they could talk to me about their feelings and life stresses???  WRONG!  That was a huge part of why I was at the CAN seminar, I was burnt out and felt more like a counselor at times than a Acupuncturist.  Plus I wasn’t trusting Acupuncture enough to ‘do its job’. 

    In my practice now I really try not to ‘over’ talk with patients, because I don’t want them to be used to that when I am really busy and then they feel like they aren’t getting as much attention.  Plus it really makes a difference if they spend the most time possible with needles in.

    Great job Nicole, we hope to be as busy as you one of these days! 

    Christina

    Alpine Community Acupuncture, Flagstaff, AZ

      0 likes
  • October 20 2010 at 10:01 PM
    obnicole writes:

    thanks for the comments!

    ...and for jinxing BCA!

    We had a record slowdown this week. I could have had 15 minutes per patient, easy.

    I don’t really blame you. I blame the rain. Downpours in SoCal, I’m sure you’re shuddering just imagining the difficult time these poor people have had wink

      0 likes
  • October 21 2010 at 5:43 AM
    royg writes:

    LOVE IT!!

    Roy Green Pach

    Jerusalem Community Acupuncture

    14 Hillel Street, Jerusalem

    972-50-3007209

    www.dikur.net

      0 likes
  • October 21 2010 at 7:51 AM
    Nora writes:

    good points all around

    Great post Nicole - I especially like the point that it’s six getting needled and six getting up - and potty breaks are important!!!  Plus charting (which also must therefore be succinct), fluffing chairs, getting someone who’s having a coughing fit a sip of water, squeezing in drop-ins in acute pain, etc. etc.  

    And Christina, great point about not getting the patients USED to long intakes when you’re slow, just because you have the time.  Sometimes we find ourselves chatting with folks before or after when it’s slower, but not so much doing longer intakes.  The priority is letting the patients have their needle time.  

      0 likes
  • October 22 2010 at 6:01 PM
    Pauline writes:

    Mould allergies from the rain…

    THey’ll all be back in in droves next week. I have a question about how long most people take with the initial assessment. I’ve been booking a half hour for it, but that’s way too long. Peole talk too much, and I find myself feeling really stressed on a week like this week when I had 15 new pts and peeps in chairs needing to get needles out and I felt like I was behind all the time. I wish i could have all my intakes on one day a week but of course that’s not possible.

    I’m coming round to thinking the initial intake should focus on the main problem only—like if they have a frozen shoulder there’s no need to palpate the abdomen, a la Kiiko. WHAT was I thinking???

    Most of the time people will ask me if I treat their problem of X.Y,or Z after 2 or three treatments, even though that wasn’t what they came in with. They hear peeps in other chairs getting allergy tx and realize I can do that too, so they ask for it.

    Note to Self: Like it says a million times in these threads, I don’t have to know the whole story up front.

    Pauline

      0 likes
  • October 22 2010 at 6:23 PM
    obnicole writes:

    5 minutes

    ...max.

    They complete the intake, I look it over, saying, “let’s see what’s going on here,” then call out a few important things not related to the CC if necessary. Then say, so we’re working  on this today? Point to where it hurts (or if an internal med problem…how long, rate the pain etc), then “OK I’ve got an idea where to start, come on back, let’s get needles in.’ 

      0 likes
  • October 22 2010 at 6:49 PM
    melissa writes:

    agree with Nicole,

    we thought it would, but it really doesn’t take longer than five minutes unless we get a real talker. in santa fe is almost always of the variety that they have some knowledge of acupuncture or other “natural medicine” and want to get into what meridians they think are affected, how their other acupuncturist treated, etc. this has actually been a struggle for me lately ( i think i’ll post a separate thread). but we usually smile and keep it extremely brief while simultaneously getting them comfortable and needling.

    btw, we do all our intakes in the recliner they have chosen to be treated in. it’s always been comfortable except with a few very hard of hearing patients, (pointing to paperwork or pantomime work, if needed. this also works for any sensitive topics “how is this condition?” pointing at intake) and it saves tons of time already having them in a chair and settled.

     

    Melissa

    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.

      0 likes
  • October 22 2010 at 6:58 PM
    obnicole writes:

    Melissa, We should have a

    Melissa, 

    We should have a thread about working with people a little bit interested in TCM. San Diego, home of PCOM and 5 million acupuncturists, gives us patients telling us, “I need to work on my Spleen and Kidneys today. And dampness.” 

      0 likes
  • October 23 2010 at 12:38 AM
    melissa writes:

    oh yeah! and my least favorite question lately:

    “can you explain what all my pulses say today? have they changed? what does it mean exactly?” hmmm, four years of acu school into under 5 minutes. mostly i hate trying to answer it because it just feels like it gives people one more thing to worry over.

    slightly off topic but we actually did have someone tell us last week that their “astral energy” was disturbed by all the other people’s treatments so that they couldn’t sleep that night. sigh.

     

    Melissa

    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.

      0 likes
  • October 23 2010 at 12:43 AM
    melissa writes:

    and congratulations

     

    on your slamming clinic!! yippeee!

     

    Melissa

    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.

      0 likes
  • October 23 2010 at 8:14 AM
    Jessica Feltz writes:

    That’s when

    I sell them one of Andy’s books.

      1 likes
  • October 23 2010 at 12:13 PM
    melissa writes:

    yes! brilliant

    we just got some recently. it usually comes from folks that are pretty sure they know what it’s all about, but that’s still the perfect idea. thanks, jessica. (and Andy and Manchester folks for such a good tool!)

    Melissa

    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.

      0 likes
  • October 26 2010 at 10:06 AM
    andy wegman writes:

    check’s in the mail Jessica.

    FYI - also free .pdf and audio versions of the book on our site…

    Honk, honk!

      1 likes
    • dlapiers
  • October 28 2010 at 11:14 AM
    Naomi writes:

    what if they have also listed

    chronic conditions - besides main complaint - and they ask (in the initial interview) about treating those?

    I find myself saying we’ll focus on the main complaint but also wanting to suggest that in the course of the treatment plan  we’ll address the other complaints too. I sometimes wonder if I’m giving a mixed message. Any sounds bites, Nicole, Melissa, anyone?

    Do your intake forms ask for just one main issue?

    thanks for any input, this is a great thread!

      0 likes
  • October 28 2010 at 11:42 AM
    Jessica Feltz writes:

    Forms

    My registration form asks about the “reason for today’s visit”.  That helps me understand what the 1 or 2 big things are, b/c they have to write it on a single line.

    My health history form has a checklist (updated with some of the great suggestions above—thanks!) to get a better understanding of overall chronic conditions.

    Sound bites: I tell them that I love acupuncture because it treats the body as a whole.  It’s impossible to “just” focus on one thing; the body is all connected.  Putting a needle in for back pain will also help with stress, sleep, etc.  Scanning their health history helps me to pick-out points which do “double-duty”—those that focus on the primary complaint as well as support underlying conditions. 

    Hope that helps…

      0 likes
  • October 28 2010 at 1:25 PM
    keithananda writes:

    although we are focusing on

    although we are focusing on your ___ ,  acupuncture stimulates the body’s natural, innate, internal healing mechanisms, which means you may also see improvements in other areas that are not the main focus of today’s treatment.  keep on an eye on all of your symptoms and update me at the next visit.

      1 likes
  • October 28 2010 at 1:44 PM
    Pauline writes:

    You guys are brilliant!

    I managed to get it down to 10 minutes today. I’ll keep working on it. I’ll be down to 5 minutes by the end of next week. For return visits, I have no problem doing 6 peeps an hour. If people are just in for pain there’s no need to even check pulses if using Tan or Tung points. That speeds stuff up a lot. In fact I don’t do much tongue and pulse unles I’m going to be prescribing herbs.I probably spend more time madly going through Young’s Tung book because I know which point to use but forget where it is. What I “love” are those pts who, during intake, when you ask, how long has your knee been swollen, need to give you their whole life story, and the doctor said this and his nurse said OH my, I’ve never seen a worse knee in my whole life and on it goes if you let it. I have to interrupt and say ” I’m sorry to interrupt, but there are other patients waiting and we have to get through this paperwork so we can get on with your treatment.“Pauline

      0 likes
  • October 28 2010 at 1:54 PM
    melissa writes:

    similar

    our intake (which came directly from Rochester’s with their permission—thanks gang!) starts with “what are the primary reasons for coming in for treatment today?” has three short lines for them to list. then it gets into health history with check boxes. it’s easy  to scan and allows for making a pattern and meridian DX and treatment plan that will have multiple-use points.

    i may say something similar to Jessica about how acu treats the whole body, there is often improvement in a number of areas, even if we are just targeting one. and then i say, while beginning to needle, for example: “since your main complaint today is back pain, we’ll be focusing primarily on that. we’ll also put some attention towards your sleep and then as these improve, we can start working more on your other areas of concern. sound okay?” 

    also, for areas that we will not be doing local needling, i usually throw in a quick line at some point (while needling), that even though we won’t be putting needles in the back, we are using points throughout the treatment that address that area.

    Kelly’s influenced me a lot in the use of intradermals left taped in painful areas for the person to  take home for a few days. this and ear BB’s are a great way to extend the treatment.

    on the way out the door, we give folks our welcome letter that outlines treatment frequency, how things in the clinic work, etc. we send a brief follow up letter to each new patient also.

    all the forms except follow up letter are on our website, i’m happy to email the folow up if you’re interested.

    overall, i thinks it’s really important to remind yourself that less talk, more needle time is of greatest benefit to the patient! happy treating!

    Melissa

    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.

      0 likes
  • October 28 2010 at 3:21 PM
    Nora writes:

    yep

    I say something similar to this.  Sometimes I offer that the body might have a different agenda than we do and might need to take care of some other things first, before it gets to the things that are our priorities (or something like that).

      0 likes
  • October 28 2010 at 6:06 PM
    EricaL writes:

    Melissa,Can you email me

    Melissa,

    Can you email me your follow up letter?  I’ve been thinking about this for awhile.  I like the idea of something in writing after the first visit (besides my welcome letter).

    .(JavaScript must be enabled to view this email address) 

    Thank you! 

     

    Erica Leaton

    Central Coast Community Acupuncture

    Newport, OR 

      0 likes
  • November 6 2010 at 12:47 PM
    Naomi writes:

    thanks all

    very helpful. Kind of what I’m doing but I was getting hung up on speaking to all the complaints. Nora, I love “the body has its own agenda”. So true. I had a couple last year I was treating for fertility as they were going through ART. It was unsuccessful, and I was sad for them. They totally got the CA thing about little  talking, and it was usually busy when they came in at the end of the shift. One time we chatted as they left and they told me all the things that felt better since they’d been coming. Nice moment.

      0 likes
  • December 16 2014 at 11:52 AM
    BamainAtlanta writes:

    To the OP: how do you integrate herbal medicine into your patients’ treatment protocols? I like the idea of efficient use of time, but I am a bit disconcerted by the lack of discussion about herbal medicine, the heart of Chinese medicine.

      0 likes
  • December 16 2014 at 12:02 PM
    BamainAtlanta writes:

    I’m thinking that setting aside separate times for herbal consultations (like twice a month at 10 to 15 minutes each time) might allow for the better treatment of many internal and chronic issues.  So a practitioner could use acupuncture mainly for pain relief and herbal medicine mainly for the chronic internal problems, though of course there would be overlap.

      0 likes
  • March 31 2016 at 11:00 AM
    rklipton writes:

    Hi!

    I am just about to start working at a CA in Toronto, and this article was so great to read as I am worried about being able to keep my timing on the mark.

    I am left wondering, though: what are your strategies for patients who want to share a really detailed explanation of their ills? Start palpating as they speak to redirect? Any little tips to help move them past the extendo-chat?

      0 likes

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