Out of Patience

Somewhere in the intersection of Cris's blog on Boutique Acupuncture, Lisa’s Blog on CAN's anger, reading over Dr. Tan notes and finding gems like a 72 yr old woman avoiding a pacemaker and getting off ALL her cardiac drugs, me without health ins., all the comments on the AAAOM forum about the FPD, several of my friends inviting me to events that I would have gone to when I earned more $ but don't go to now (and don’t feel the need to go to), and 2.5 years of doing CA, I've lost my patience.

It’s gone for those who think acupuncture is an adventure (and they love herbs, tui na, etc and can't give them up), who think AOM is "complementary" or "alternative" medicine, that their practice is OK because they bill ins, that they can make huge salaries and be big consumers at the expense of the planet and patients, or that practicing medicine is about them.

I’ve lost patience with acupuncturists who foist off information on nutrition, exercise, stress management, and psychological, emotional and spiritual issues unless patients want this information. I’ve also lost patience with those who think any of the big acu orgs are EVER going to give a damn about patients. I’ve lost patience with anyone who doesn’t get it that medicine is about relieving patients of their suffering and it’s our duty to do this for as many as possible. That is the contract between society and medicine.

Here’s how I got there.

Acupuncture school was a delight. We were special. We knew a different language that no one else knew. Spleen qi deficiency. Liver qi stagnation. The flow of Yin and Yang. I treated people in school clinic at weekly intervals. Sometimes I saw the same people back. Sometimes I didn’t. I had little idea if my treatments worked or not and I graduated from a 4 year program not knowing what acupuncture could do. I didn’t see it in 4.5 years of private room acupuncture, either. The prices were too high for most people to come frequently or for any duration of treatment. Then CA came along.

I could immediately see that CA was a business model that would enable many people to get the benefits of acu. It also could potentially be my sole means of employment, rather than the hobby it was as a private practice. Since I think health care is a human right, this business model was much closer to health care for everyone than the one I learned in school. I was still taking it on faith that acu would actually relieve suffering.

As a “good” medical practitioner should, I “read the literature.” For about 5 years I read Blue Poppy’s translated synopsis of the Chinese language scientific literature on acupuncture and Chinese herbs. The herb protocols were easier for me to replicate, although they usually called for raw herbs decocted daily, which none of my patients would do. My teachers had made it clear that raw herbs were the gold standard, powders second and patents close to a placebo. The acu studies were set up as a 10-day course of daily treatments with 2-3 days off and then another 10-day course. Usually cures were reported in 2-3 courses of treatment.

The model I was taught was weekly acu treatments, not 10 days in a row. Could I even use the protocol on a weekly basis and have any hope that it would help? How was this literature even relevant to my patients? I couldn’t rely on the studies as a guide to practice because I couldn’t replicate them. At going market rates, the most I could talk any patient into coming for acu was twice a week for 1-2 weeks then weekly for a few weeks. If they weren’t better by then, they quit because they weren’t willing to spend more money on something that didn’t seem to be working. I couldn’t blame them. I wouldn’t spend $65- $100 a treatment and more for herbs if I weren’t seeing results.

I still can’t replicate the acu studies in CA. I’m not open 10 days in a row. But I have learned a more effective way to do acu than TCM acu. Dr Tan’s Balance Method works – in 5-20 treatments for most things. Chronic, severe problems take weekly tx for months to years but one of the big things that gives me no patience is that PEOPLE WITH CHRONIC ILLNESS GET THEIR LIVES BACK with CA and I didn’t see this in private practice.

They hurt less or become pain free. They stop being depressed due to chronic pain and fatigue. They have more mobility. Some of them lower their meds or get off of them. Some avoid surgery. Some recover more quickly from surgery. Some with advanced cancer live longer and better.

It works for people without chronic illness. Acu can keep them going to their jobs, shorten recovery from injuries to get them back to work, eliminate sick days due to colds, bronchitis, sinusitis and GI flu. WM is finally admitting that stress underlies chronic illness. Acu deals very well with stress. This is preventative medicine and it really does treat most things fairly well – if people can afford to get enough treatments. I’ve seen for 40 years what ppl with chronic illness go through in WM. They can get their life back with weekly acupuncture. That’s not alternative or complementary, that’s HOPE and an IMPROVED QUALITY OF LIFE that they don’t get any other way.

So I don’t have any patience any longer for those who advocate acupuncture for face lifts, who don’t charge on a low sliding fee scale, who set up hybrid practices that alienate patients with limited incomes, and for those acupuncturists who won’t serve anyone but those who can afford $65 and up or who bill insurance paid for by only certain types of work. If you are really practicing medicine, you should be making your services available to the widest number possible. Before CA that was difficult. You have no excuse now.

I have no patience with acupuncturists who “love herbs and won’t give them up” to do a CA model because it appears there’s not time to diagnose, prescribe and mix herbs in CA. I have seen that many conditions don’t need herbs. Acupuncture 2-3 times a week in a group setting for 2-3 weeks and then weekly until better works extremely well for many complex, multifaceted problems. If you really think herbs are necessary, you will figure out a way to do them and still do CA. Medicine isn’t about you and what you love. It’s about relieving suffering.

I am out of patience with acu professional organizations that are promoting a first professional doctorate. They haven’t shown that the masters level practitioners are unsafe or incompetent so there is no reason to require advanced education – especially considering that the education we get now isn’t relevant to successful acupuncture, the cost is already too high and at least 50% of the graduates fail in business. CAN has been in existence for 2 years, proving that CA is successful for many practitioners and patients. Acupuncture Today canceled Lisa’s articles on CA. AAAOM, CCAOM and the NCCAOM all want the doctorate. When CAN, the only acu organization in the US that is advocating for patients, is mentioned it is disparaged, vilified and dismissed.

I have no patience for any of this any longer. If you are practicing any kind of medicine you should be about relieving suffering. Medicine is not about your ego, the white coat, to be called doctor, making tons of $, or to be able to think of yourself as special because you practice an exotic medicine.

CAN has clearly shown how to put patients first and also make your living and pay back your exorbitant student loans. We have shown you the statistics on numerous CAPs. We have shown you what works and what doesn’t work and why and how to do it. You get support and problem solving on top of that. It’s not easy to set up and run any acupuncture business but setting a CA is not much different than setting up a BA. The differences are in the results: you will be helping a lot more people; you will get a lot more experience and thus be a better practitioner; and you will, more than likely, be able to support yourself with CA.

This story was posted on January 12 2009 by annmongeau.

Comments

  • January 12 2009 at 11:25 PM
    kiapprentice writes:

    Thank you, Ann

    I hope people who don’t understand why CA “can’t just be friendlier and adjust to my special needs…I have a different situation” read this blog.

    I also had to give up a long form of hari acu that I loved (equating to herbs, advice, etc) but it was a cinch when I realized it would be traded in for the love of HELPING MORE PEOPLE MORE OFTEN!!! BIG  DUH!!! It was as simple as knowing it wasn’t all about me.

    We named our clinic We The People because we believe healthcare is an inalienable right. In the one week we’ve been open, we’ve seen the impact that frequent treatments (that are EASY TO GET from people who are HONORED TO DO IT) can have. Nothing fancy. The rudimentary first treatments from new Dr. Tan practitioners.

    I am not as eloquent (obviously…I just said “duh”) at articulating my
    anger and why I love CA and CAN, but I am soooo gratified when someone
    else can sum it up.

    Why the incessant need to make CAN something else? Just make your own site.  Make your own business model. Best of luck. 

     

     

      0 likes
  • January 13 2009 at 12:18 AM
    Linda inDetroit writes:

    Great post Ann!

    I can’t say I agree with everything in this post, some things about CAN drive me nuts, but I understand where you are coming from and respect it.

    I do have one question though, why not facelifts?  If acupuncture can help a 50 something person feel better about herself while trying to get back into the workforce and social scene after a divorce, I’m more than happy to help.  I love that someone doesn’t have to be well off to enjoy vanity treatments at my clinic.  I get very upset when people criticize someone who uses food stamps and buys chocolate.  Why is there this prevalent idea that people who struggle with money don’t deserve the little pleasures the rest of us enjoy?

     

      0 likes
  • January 13 2009 at 10:32 AM
    Guest writes:

    Thanks for asking the question, Linda

    I wasn’t clear about this.
    If anyone doing a CAN (Locate a Clinic defined) clinic wants to offer facelifts, fine with me as I doubt this will be a large part of the treatments.  I agree that it can be a psychological boost to some.  
    What irks me is marketing acupuncture for facelifts.  This is fashionable these days and is a desperate attempt of BA practices to attract clients.  It trivializes what acupuncture can do.  To me, anyone who is not upper class or upper middle class who saw an ad for this would dismiss acupuncture as not for them.  With the unemployment rate 7.5% and pensions/retirement accounts shrinking, facelifts aren’t number one on your list of things to buy.
    I don’t think most of us, even those of us doing CA, really appreciate what acupuncture can do for people.  I’m just starting to get the notion after seeing 30 a week for a year and now 50 a week for another year and a half.  I’m recommending that people come in 2-3 times a week for 2-3 weeks for most problems.  They either are better and can quit, need to go to weekly appointments for some time if they have chronic illness or if they are better they can come in for “tune ups” now and then.  I leave it up to them.  They figure it out quickly because acupuncture works and they know they feel better.
    People come in saying they have tried everything else and acupuncture is their last resort.  Pain or anxiety or depression or lack of energy has kept them from working or functioning in their life beyond going to work and collapsing at home.  Or they slog through their days depressed and dragged down with pain and limited range of motion.  People with chronic illness are consumed with the management and cost of it and the hopelessness of thinking that they will be on meds that help but also have side effects they can barely tolerate – for the rest of their lives.
    http://www.cdc.gov/nccdphp/  
    Chronic diseases—such as heart disease, cancer, and diabetes—are the leading causes of death and disability in the United States. Chronic diseases account for 70% of all deaths in the U.S., which is 1.7 million each year. These diseases also cause major limitations in daily living for almost 1 out of 10 Americans or about 25 million people.
    Simple, affordable acupuncture changes lives and relieves suffering.  It works where nothing else does.  That’s the message I want out about acupuncture.  Even the psychological boost of a facelift pales in the light of this.

      0 likes
  • January 13 2009 at 12:07 PM
    Linda inDetroit writes:

    I knew what you meant about

    I knew what you meant about the marketing of facelifts which is why I enjoy offering it on our affordable sliding scale.  You might be surprised, working class people are vain too, sometimes above all else.  If they have heard of it they do ask for it, and I have training in it so I’m happy to do it for an affordable price.  I don’t market it.  Of course they usually have other problems I will treat as well.

      0 likes
  • January 13 2009 at 12:30 PM
    Skip writes:

    Linda? Argumentative? Again?

    Sigh.

    Oh Linda. Are you just posting to have an argument again? Just can’t stop using little digs like, “I knew what you meant” and “You might be surprised”? Hmm. You might be making Ann’s volunteer CAN Board service something less than utterly delightful. Not good. 

      0 likes
  • January 13 2009 at 1:08 PM
    Linda inDetroit writes:

    No

    It wasn’t meant that way at all.  I was saying I enjoy being able to charge less than the BAs who screw people with facelifts, clearly it was misinterpreted so please just forget it.  I consider Ann a friend and I don’t get off on argumements, I was being jokey with the whole thing, but clearly it didn’t work, but I can’t delete it.      

      0 likes
  • January 13 2009 at 1:21 PM
    peoples writes:

    Thank you Ann

    Hi Ann, thanks for this.  and thanks to many other CANers who write things that really keep me inspired, because it’s TRUE!!!

     I was at a Tan meeting on Saturday and a boutique prationer told me that she treats multiple things at a time in her treatments, and made a comment that with CA, I can only treat 1 thing at a time.  I couldn;t even respond, because what is the point? no pun intended.

     

      0 likes
  • January 13 2009 at 1:53 PM
    Skip writes:

    I strongly suggest, Linda

    that when you have the urge to post something that’s basically argumentative like you’ve done here to just try to have some patience and not click the “post a comment” button quite so fast cause often your comments don’t come out the way you say you intend them. You say you consider Ann a friend. Friends don’t post replies like that.

      0 likes
  • January 13 2009 at 2:27 PM
    priceless writes:

    Pokers,Crackers, Rubbers and Prescribers

    Thanks Ann for articulating the anger and frustration that  CANers feel at the enormity of the need out there for all the things that acupuncture can uniquely treat well.

    I feel it every day when I come to my office and I am working on complex chronic problems that I would love to just  be an ” adjunctive ” treatment for in tandem with that patients Primary Care physician/s.

    Most of my patients  do not have a PCP or if they do they see them very irregularly to put out the ” fire of the day"rather than work on a co-ordinated personalised health care plan for the specific needs of that patient’ physical and mental health

    .Wouldnt it be lovely to have CAN exist in a co-ordinated health care system where a patient arriving at a health care professional’ office would be triaged to the department of the practitioner/s who uniquely met their needs in the most timely manner. This all is predicated on all our services being both affordable and accessible to every patient.

    We could be the Pokers working with the Crackers and the Rubbers and the Prescribers on the treatment plan of our patient.

     

      0 likes
  • January 13 2009 at 3:03 PM
    Linda inDetroit writes:

    Ann, I only say you might be

    Ann, I only say you might be surprised because I was surprised when people found out I had taken a course in facelifts in school that they brought in a bunch of their friends for them.  Initially many people seem to care more about looking better than their pain or other serious illness.  I enjoy that I can give people of average income people something other acus charge thousands for a course of. I agree with your disdain for that marketing ploy.  It is kind of frivolous, but people who start from there usually end up wanting to address more serious issues.

      0 likes
  • January 13 2009 at 3:35 PM
    Darlene writes:

    Dammit Jim, I’m only a pinhead!

    Thanks for the post Ann, and for the ringing endorsement of acupuncture without herbs. I am one of the few students who graduated without the herbal section—because I could in NY. I am still glad I didn’t spend money learning to prescribe something that most patients don’t want to take and which is often unneccessary with adequate acupuncture. 

    Darlene Berger

    Community Health Acupuncture Center

    801 Livernois, Ferndale, MI 48220

    248.246.7289

      0 likes
  • January 13 2009 at 3:49 PM
    chaitime writes:

    .

    beautifully written ann, thanks for the bop pill!

      0 likes
  • January 13 2009 at 8:17 PM
    Guest writes:

    next time

    ask them if they trained in the PCOM SD community clinic.

      0 likes
  • January 14 2009 at 7:14 PM
    urbanapuncture writes:

    I nominate this the top post 0f 2009

    thank you

    I have had a few interactions recently with bapracticers and they seem to just run away…

    Now, I know why. 

      0 likes
  • January 14 2009 at 10:19 PM
    Guest writes:

    Thanks, everybody

    for your strokes.  I’m glad I’m not the only one whose lost their patience and just can’t seem to find it no matter where they look.  It sure felt good to just say what was on my mind.

      0 likes
  • July 15 2009 at 6:10 PM
    kcasey44 writes:

    Yeah, what she said…....

    I read this blog in January and it rang true for me on many levels, but I didn’t feel the need to write.  I did a search today for something else and it popped up.  Reading it again it made me think “Hear, Hear!!”.

    I noticed that Ann mentioned that after 2 1/2 years of running a CA this is how she feels.  I am just coming to that milestone as well and now I feel that I too am out of patience.  Maybe this is a growing pain of running a CA.  I’d be interested in hearing from Skip or Lisa if they went through this or continue to feel this lack of patience.  What’s on the other side of this feeling at say the 3 or 4 year mark?

    Kerri Casey L.Ac.

    MN Community Acupuncture

     

      0 likes

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