But Wait there’s More

 

I was really annoyed and irritated by Peter Deadman’s recent remarks about community acupuncture in this http://www.deepesthealth.com/manual-of-acupuncture-author-peter-deadman-on-ipad-apps-community-acupuncture-more/interview.

I was particularly bothered by Deadman’s comments since he had just recently spoke of Community and Multi-bed acupuncture as one of the most exciting innovations in the profession in decades.  And after a recent visit to the UK for the purpose of attending ACMAC’s conference where Lisa, Skip and I were well received as messengers from the land of Community Acupuncture and POCA, I have been more excited about the acupuncturists over there.  There was indeed “a buzz about Community Acupuncture” at this conference, where a subtle distinction was made between CA and MBA.  Deadman, who is a much revered figure by his UK cohort, was notably absent from this conference where he had been scheduled to deliver a speech following Lisa’s keynote address.  I would have like to have had a chance to talk with him more about his experience of CA clinics.

Earlier this year the Journal of Chinese Medicine, of which Deadman is the editor, published an article written by Lisa.  Deadman’s presentation at the ACMAC conference was to be a rebuttal to Lisa’s assertion that the acupuncture profession sees the practice of acupuncture much in the way a Ming vase might be viewed, precious, exotic, and to be protected, where CA has taken this Ming vase made use of it to carry water to those in need.  Perhaps Deadman’s undelivered rebuttal is revealed in his comments in the interview linked to above.  I hear that he is working on a written rebuttal, due in the next issue of the Journal of Chinese Medicine so I suppose the conversation will go on.  Here is my take on a number of points Deadman makes in the interview above.

Deadman dismisses Community and Multi-bed acupuncture as less than best practice, criticizing the amount of time taken with a patient in these settings.  Deadman is not explicit in stating what amount of time he considers to be best practice, but it is clear he does not think 3 minutes is enough.  I wondered when reading Deadman’s words if he has in fact ever been in a CA clinic, or treated in one, or been a patient in one?  And to be clear, I am not speaking of the Multi-bed practices in the UK.  I have only visited one UK MB clinic, and had others described to me by the practitioners who run them, and I believe that MB clinics are substantially different that CA clinics in a number of ways.  But not to digress too much, my point being that in CA clinics across the US most patients stay for treatment for a lot longer than 3 minutes.  And while Deadman is pretty dead-on in choosing 3 minutes as an average time for assessment (and needling too for that matter!) what he does not mention is that CA patients are able to afford and therefore come for many, many more treatments than they would ever afford in a private practice.

 In the vast majority of CA clinics, patients are encouraged to cook as long as they like.  Not over cook, not burn or be undercooked, but to check in to the part of themselves that knows how long to stay, whether it is because the needles need that long to work optimally for them, or because they are chronically under-rested.  I like it if I can keep my average return patient intake/needling to 3 minutes. This short intake time allows that person to get to the place where they’re connecting in with themselves, or the group energy of the room.  It allows me to be able to move between a room full of patients, sometimes 12 or 14 people in the clinic all at once, with one practitioner.  I’m happy to get out of the way as quickly as I can, so that healing can happen.  The healing is not happening in my head for goodness sakes, it’s happening in all of those people, and in the collective energy of the room, an energy of which I am simply one part.

Here’s an analogy:  Suppose a chef in a fancy restaurant, one known for the “quality of its food”, is working when you come in and order something to eat.  How long does it take for that chef to get that $30 entrée going?  Probably 3 minutes.  Sure it takes much longer to prep the food, and of course there is cooking time, but how long does that well trained individual need to ponder which pan to put the veggies in, or when to start the meat cooking?  And how does the chef know this?  From experience.  Which back to my point:  you don’t enjoy a meal because the chef took 20 minutes rather than 3 minutes to decide how to cook your meal.  The majority of the work was already done, or in the case of acupuncture, yet to be done.  The chef doesn’t decide how much you enjoy the meal, you do.  The chef doesn’t sit down and watch you eat your meal either.  And in fact when I do spend the money to eat out, one of the things I enjoy is taking my time to eat my meal, and to enjoy being out with other people nourishing themselves, and enjoying each other’s company. Time is only one of many factors that converge in the making of a good meal, and the effects of time are not simply cause and effect.  Deadman is confusing fast-food with efficiency,  and haut cuisine with soul food.  You only need simple ingredients to make a good meal.  A fancy chef may make a great meal but it’s important not to forget about the dirt and the farmer, the servers, the dishwasher, and all the people who eat in the restaurant, that make it a good place to eat.    There is a lot more credit that can be given to ALL the players in the healing process than what the practitioner knows or does. 

Deadman implies that quick is not good, or that taking longer is best, but this is an opinion, that as Larry clearly points out in his excellent blog  https://www.pocacoop.com/prick-prod-provoke/post/class-cultures-poca-and-peter-deadmanabout all this, whose context is one of particular class values, that seem “normal” or “obvious” to the speaker. As Deadman’s audience, we all can benefit from a closer look at the “normal” stance, that is the context which Deadman’s comments are made.  Basically, acupuncture is in the West, even in countries like the UK that have a nationalized healthcare system, an underutilized mode of treatment.  By underutilized what I mean is that it could be used more by practitioners of whichever healthcare system is in place, and I mean underutilized by the people who look to a healthcare system, in part, for their healthcare needs.  As we well know here in the US more and more people are not able to afford a ticket to the healthcare system, that is private insurance, and that those people who are not able to afford this, are disproportionately poor, people of color, recent immigrants, women, children or some combination of these.

 

It is a privileged stance to suggest that acupuncturists, or any profession that exists to serve others, need to learn more, study the classics more, spend more time with patients, etc. because that assertion is made in a context that excludes the fact that many people have NO ACCESS WHATSOEVER to those very services.  Is it not ironic to think that we have all of these helping professions striving, striving to improve (and I have nothing against them improving), while so many people cannot access the most basic care that can prevent illness to begin with?

What Community Acupuncture as a movement, as a political stance, and as a practical map for navigating this territory says is: here is a way to provide much more care to many more people.  We don’t disdain books, or knowledge simply for the sake of disdaining them.  We are not rebutting stances that call us to dig through “the Classics” because we don’t want to do the hard work of scholarship.  We are rebutting them because we are doing the hard work of treating lots of people in our clinics everyday.  We are rebutting the call for best practices that allow for more lifestyle advice, or more time with patients, not because we don’t care about our patients or want to give them all that we can, but because we are giving them all that we can, which includes sharing with each other how to best do this, and to bring as many others as we can into providing this kind of care.

If we all have to strive in some way to bring our best practices forward, let’s at least be clear on the context, and the goals.  So much of the rhetoric against the CA model as such is that seeing many patients at once, with short contact times is doing the patient a disservice.  Our patients, hundreds of thousands of them, appear to disagree.  Knowledge is only going to help the individual practitioner do a better job when they can apply that knowledge and if that knowledge helps the practitioner feel more secure in providing care.  But making the practitioner feel secure is superseding the priority of providing care to others in the educational systems that we have for acupuncture.  This focus on the practitioner’s security applies not only to knowledge but to money as well.

Deadman says he thinks that CA is a betrayal to the medicine. I say it’s a betrayal to do a whole long intake before a person actually gets to experience acupuncture.  If an individual doesn’t actually like getting acupuncture, it’s going to be hard to convince them to come back.  Why waste their money or set up expectations to be dashed.  Now if I were a 3 needle wizard, I could just fix everyone up the first time they come see me.  But if I were that wizard, would I need longer than 3 minutes of intake time?  Wouldn’t I just know, and could I learn to be that kind of wizard by studying the classics, or would it be more likely that I’d discover how to do that from treating lots and lots of people?  I’m not aiming for wizardry, I want to set reasonable expectations and to treat loads of people

Here is how I handle a short intake: I gather the most pertinent information related to why a person says they are coming in and then I move them into a chair as quickly as I can so not to beleaguer any needle-phobia or anxiety.  I gather my information over time, both verbally, and non-verbally.  I note if they are getting better or not over time, and either adjust my treatments or know that it often takes some time for things to get better, for many, many of the people I see and acupuncture is not the only factor that is going to effect the outcomes desired by the patient or by me.  I try to check my desires at the door when I am at work.  People don’t come in to get better by my standards, but by their own.  Managing their expectations is my job… whether to encourage them to stick with a treatment plan or to face the reality that acupuncture can’t help everything.  I thought I learned that Chinese medicine was born from a mode of inquiry based on observation.  How is observing our patients for short bits of time over longer periods of time a betrayal to that?

I’m concerned that Deadman’s opinions about CA would steer new practitioners away from it. This would also have consequences for so many communities that still lack access to this care.  Students are particularly vulnerable to the opinions of their teachers, and at least in the acu-schools in the US, lack enough patient relationships to be able to gauge their own effectiveness.  For Deadman to suggest that  CA is akin training wheels for the “real” thing is a betrayal of acupuncture students.  We’re used to viewing “success” in the acupuncture profession as a few good lads and ladies making the teaching circuit, maybe with a real practice, maybe not.  What would happen if students started striving for a busy, simple practice with 3 minute intakes.  Then bam- much less of a need for the modern masters teaching circle.  Is that then the betrayal?

Is it just embarrassing to some acupuncturists that CA shows aspects of acupuncture that are un-glamorous and un-mysterious.  Acupuncture in its underwear with bed-head?  Stripped down, acupuncture is quite simple, and easy, and can be made accessible, even to non-acupuncturists.  Would minimal theoretical training, simple tools, used frequently and in a generalized way, kill people, harm them?  Is it a betrayal for me to suggest that practitioners with less training may be as effective as those with more?  Especially if those with less training create more access for patients through existing systems?   Is this a betrayal of the Judas variety? or just  downright blasphemy?  Take your pick, I’d like to just get on with treating more people.

 

 

 

 

 

This story was posted on June 25 2012 by crismonteiro.

Comments

  • June 25 2012 at 1:23 PM
    Lisafer writes:

    “We don’t disdain books, or knowledge simply for the sake of disdaining them.  We are not rebutting stances that call us to dig through “the Classics” because we don’t want to do the hard work of scholarship.  We are rebutting them because we are doing the hard work of treating lots of people in our clinics everyday.  We are rebutting the call for best practices that allow for more lifestyle advice, or more time with patients, not because we don’t care about our patients or want to give them all that we can, but because we are giving them all that we can, which includes sharing with each other how to best do this, and to bring as many others as we can into providing this kind of care.” OMG thank you! Saving this quote for future reference.

      8 likes
    • estermarie
    • suzzanne.lohr
    • sizzlek
    • maceywebb
    • Nic
    • mollyfread
    • PLB*
    • Sharon
  • June 25 2012 at 4:21 PM
    Demetra writes:

    Seriously, this is fantastic. I love the way you frame these questions at the end. And I am now very motivated to find more ways for our patients to start framing the conversation about acupuncture. Our patients are the experts on how community acupuncture works, more than anyone else. I want to hear what their experiences are, collectively. I want those experiences to guide the conversation about acupuncture, acupuncture education, and acupuncture practice.

      8 likes
  • June 25 2012 at 6:35 PM
    suzzanne.lohr writes:

    So right on, Cris.  Thank you!

      3 likes
  • June 25 2012 at 10:50 PM
    andy wegman writes:

    There are a bunch of great lines here, Cris. 

    My favorite:  ‘I thought I learned that Chinese medicine was born from a mode of inquiry based on observation.  How is observing our patients for short bits of time over longer periods of time a betrayal to that?’

    You’ve started to effectively pick at the scab of indifference for our patients the Deadman’s of the acu-world harbor. 

    I sincerely hope these folks like Deadman are not without relief and/or hope when they need it.

      4 likes
    • Lisafer
    • andy wegman
    • spitfire
    • Sharon
  • June 26 2012 at 2:24 PM
    bottley writes:

    I’ve believed for a long time that CA marks the birth of a new species of acupuncturist, one with fundamentally different goals than the hybrid acu/herbalist/everything else that most of us were trained to be. Cris, this post is one of the most coherent examinations of that idea anyone has yet produced. Deadman and so many others speak to us in CA from the height of their (usually unexamined) assumption that theirs is the “right” way. Sometimes, they pat us on the head and say that we’re doing some “exciting” things right before the “but” that prefaces some self-congratulatory screed that reinforces and justifies the acu status quo. But as CA/MBA start taking hold, they are increasingly making the mistake of thinking that the acu status quo and the CA movement have the same goals. That makes the comparisons sound really silly a lot of the time.  Brick by brick, articles like this one are building the case for the fact that CA is working in a functionally different reality than the standard North American/European model does, and comparisons designed to determine which way of doing things is “right”, in addition to being a complete waste of time and energy, are fast becoming irrelevant, because Chinese medicine is not and never has been a monolithic body of ideas that can be “owned” by anybody. It’s always changed and grown and been reshaped by new thoughts and cultural movements and social needs. CA is just one more of those developments. The status quo of acupuncture in the west is another, but doesn’t represent anything permanent or eternal or complete. It doesn’t even represent an approach to Chinese medicine that’s universal in it’s own period of history. It’s just one relatively recent historical iteration of a vast and venerable world tradition that will continue to grow and and change and cross-pollinate as time goes on, long after me, or you, or Peter Deadman or any of the other Acu-brahmins are gone. We are working to incorporate the dimension of social justice and basic human need into the equation, and that parameter fundamentally changes the way the practice hits the ground. End of story. Thanks for articulating the idea so beautifully.

      10 likes
  • June 27 2012 at 10:53 PM
    Roselle writes:

    I love the chef analogy. Thanks for a great post.

      2 likes
  • June 29 2012 at 8:38 PM
    maceywebb writes:

    I suppose if I were actually Chinese, I’d be a little offended at all the white old guys telling eachother how Chinese medicine is supposed to be done.

      8 likes
  • July 1 2012 at 2:00 AM
    Clayton Willoughby writes:

    One thing no one seems to want to say/ask is what if he’s right?

    We’re really quick to start shouting and attacking that he’s classist, racist, sexist and probably gluten intolerant. But no one wants to step back and wonder if there’s any truth in what he says. I don’t really know what he said in full and I’m too lazy to look; sure I’m curious but that doesn’t change the fact that there are other… diversions on the internet that would waylay me in my search.

    At any rate, maybe what we do in our community practices is measurably less than the gold standard of acupuncture practice that Mr. Deadman practices. I have to wonder though that if his acupuncture is the one true acupuncture, that we would all be practicing it already.

    And just for the sake of argument, let’s say that Deadman’s preferred classical acupuncture is the 100% effective treatment, above and beyond Dr. Tan’s Balance method (the most effective treatment), Master Tung’s acupuncture (also the most effective treatment) or any other school of acupuncture thought and practice (all professed to be the most effective style of treatment).
    Let’s also be very generous to old Petey there and say that what we do in our assessment & treatment is only 80 - 90% as effective as his. I would say that any deficiency, if at all, is going to be covered by the ability to come many, many times for the same price as one visit to see him, or any other master of the trade.

    There’s always a chance that he could be right, but not as right as me.

      3 likes
  • July 1 2012 at 10:08 PM
    TessBois writes:

    Clayton, always slightly on the outside in appearance but on the inside where it counts.  It is important to keep a bit of that query in mind, “what if he is right?” What is quality?  Repetition or exquisite attentiveness?

    I do get concerned about comments made against community acupuncture in print because it does seem that our profession has so few ways to gather information about anything in general to do with acupuncture since there are so few sources for “facts”.  When I read Deadman’s article I simply dismissed it as uninformed opinion but if it is the only opinion available in the acu-desert, it can certainly turn off a potentially valuable acupuncturist for CA.

    In our profession, I hear “I heard that…” more than I hear about something known through direct experience.  And this is no different in the world of community acupuncture.  The only true way to combat this is what we are all doing in our practices; frequency and consistency = positive results.  Since this movement is growing, I assume it is a successful method to employ to win over hearts, hands, and heads.

    Well written as ususal Cris.

      1 likes
  • July 6 2012 at 7:15 AM
    acupunkgirl writes:
      0 likes

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