Pain Management 4: Privilege

I was really thinking that my last Pain Management blog was going to be THE last, but then last Friday turned out to be a perfect storm of things I like to blog about -- pain management, acupuncture culture (s), amazing patients, and my church. And thenthis video started making the rounds of the Internet. And, you know, there's just so much to say.

This is what happened: I decided that I really wanted to make sure that all of the WCA punks had met their Oregon Pain Management requirement, and I really, really wanted them all to hear Teresa Keane's presentation. I figured that WCA could pay to send each of them individually to the class, or we could just hire Teresa to teach a class for us and save about $300. If we opened the class up to other L.Acs who also needed the requirement, the whole thing could pay for itself. This is how I pitched it to Cortney, who organizes WCA's workshops. She told me that she thought a lot of people would sign up, and my bright idea about holding the class at WCA might not actually work. No, really? I said skeptically. What's a lot? The front room can hold 15 people. Just put the announcement up on the website and see what happens, we can always take it down if it fills up.

So she did. Then Shauna helpfully linked to the announcement on her alumni list serve. And then within a couple of hours it became clear that Cortney was right, I was wrong, and we had 27 people signed up for a room that could only hold 15. And lo, it came to pass that the Pain Management for Community Acupuncturists class was held last Friday in the Parish Center of St. Charles Church, which thank God was available that day, because 40 L.Acs showed up.

Teresa did her presentation for four hours in the morning, we broke for lunch, and then I presented for the last two hours in the afternoon. When I got back after lunch, I looked around the room, glanced out the windows, and realized that I was watching worlds collide -- my worlds, anyway. There were the 7 acupunks from WCA. There were 4 other CA comrades I knew: Nancy from Salem Community Acupuncture, Leyna from Corvallis Community Acupuncture, Whitsitt from Acupuncture for the People in Eugene, and Michelle all the way up from Chico Community Acupuncture. There were lots of other acupuncturists that I didn't know. There was Father Schwab, smoking a cigarette in the parking lot. There were the white-haired ladies of the Altar Society, carrying in handmade quilts and trays of cookies, getting the church gym ready for their Annual Bake and Treasure Sale. There was my patient Ruby, wheeling her chair up the ramp to the Parish Center, coming to speak about chronic pain from the perspective of a community acupuncture patient. I felt a little dizzy.

It's tough to write accurately about issues of culture, and even tougher to do it without offending anybody, but I'm going to wade in and try, because as I stood in the midst of my colliding worlds I saw some things it would be hard to see from any other angle.

I should add that I had been standing in the exact same spot less than 48 hours earlier, on Wednesday night, making a presentation at the Pastoral Council meeting. This post is going to be long enough already, so I won't go into the details. The short version is that the Pastoral Council is the lay leadership of St. Charles; they guide the parish. They called a big meeting to discuss the future direction of the church. St. Charles is almost exactly 100 years old and its makeup, like the makeup of the Catholic Church in general, is changing radically. It's exactly what's happening to the population of the US, only faster: white people are becoming a minority. Anyway, it wasn't the easiest meeting I've ever attended; people asked challenging questions, and it's clear that we're struggling with certain issues, but the level of commitment and dedication among the people in the room was palpable. Electric might be a better word, a passionate low hum underneath the spoken words, with friction throwing out the occasional spark.

I thought about that meeting as I listened to Ruby talk about her experience of chronic pain and getting acupuncture in a community clinic. I asked her to speak to the class because I knew she'd be super-articulate, honest and thorough; what I didn't know was that she'd also be witty and wry. It's hard to be funny when you're explaining unrelenting pain, but she was. She talked about things that are difficult to put into words: how acupuncture has helped her, even though it didn't get rid of her pain; how acupuncturists can be supportive by reflecting back to her both how hard she works to manage her pain, and what an amazing job she's doing; and what constitutes hope. All 40 L.Acs were paying complete and total attention. After about 15 minutes she invited people to ask questions, and that's when I started noticing stuff.

Earlier in the day, John, one of our WCA punks, had commented how funny it was to watch all the people in the room go into acu-school mode. As soon as Teresa started teaching, they rummaged in their back packs, got out their Mason jars of filtered water and their containers of food, and settled in to take notes. That makes sense, of course, especially given how many new graduates there were in the room, but there was something about the way they settled in. I should say here that: 1) I didn't know most of them, 2) many of them were clearly very nice, 3) some of them had great observations about treating real patients that they clearly cared about. OK? All that was true. What was also true, at least from my perspective, was that there is a weird passivity that often emanates from acupuncturists when you get them together in a group, and I felt it then, when Ruby invited questions. It's not only passivity but reticence, a remove, a kind of social distance. It's what I've felt from the entire profession, forever, and it drives me crazy.

So one of the high points of the day for me was watching Whitsitt ask Ruby questions, and then watching him and the other community punks listen to her answers. Because they were into her. I could see them seeing her courage and her intelligence and her humility, and something beyond all that -- what a cool person she is, in the midst of all the awful stuff she's dealing with. Seeing that, seeing her, they lit up. This is what I always thought being a healer was about -- that it's a privilege, and you know it's a privilege, to be with your patients. That you light up in their presence, you can't help it. You want to be with them, you want to serve them, regardless of the results you might get. I looked at the community punks and I saw people -- FINALLY -- who feel the way I feel about my patients.

After Ruby left (to much deserved applause), we got into talking about how to treat chronic pain in a community clinic, and then the cultural differences between the community punks and the acupuncturists got even more obvious. Basically, it went like this: I said, this is what we do, and wrote it on the board; the other community punks started waving their hands and yelling, hey, you know what else works? This is what works! Or hey, I tried that, and it didn't work! And I'd write that on the board, or erase it, and they would interrupt each other and agree and disagree and tell touching stories about patients. And everyone else mostly quietly took notes. And yeah, you could say that makes sense, because the community punks are the ones with experience of treating pain in a community clinic, right? Of course they're going to dominate the conversation. But there was something about the difference between their rowdy enthusiasm and the restrained note-taking that was going on around them.  

It made me think back to the meeting on Wednesday night at St. Charles, and how tired I was when I left, because I'd just engaged with 25 other people who were also very engaged and who didn't necessarily agree with me. But they were RIGHT THERE, right on my working class wavelength. I could feel, viscerally, the exchange that we'd had.  This is also what I felt with the community punks, as we went back and forth about treating pain; they didn't necessarily agree with me, and they also were RIGHT THERE. And when they were lighting up as they were listening to Ruby, they were telegraphing a message that I, a working class person, can read. But the acupuncturists? I don't really know where they were. I couldn't feel them. Whatever their reticence is telegraphing, I can't read it. And it occurred to me that might have less to do with me personally and more to do with how working class people and lower middle class people communicate and connect, in general. There's a reason why I feel infinitely more at ease with any given white-haired lady from the Altar Society than I do with any given acupuncturist; I should have more in common with the acupuncturist, but somehow, I don't. I wonder how much this translates to patients, as a group, to acupuncturists, as a profession? How much does it have to do with our professional failure rates?

And then I finally watched this video, and I thought, Ohhh-- if that's what's going on under the reticence, if that's the message, that certainly explains a lot. It's a bitter rant disguised as a funny cartoon. And hey, nobody loves a bitter rant more than me -- but not when it's directed at PATIENTS, which this is. It also sounds like it was put together by the CCAOM to justify to new graduates why they're struggling in their practices; it's a succinct little expression of acu-school thinking.

It's also all about privilege. It's a kind of comic vignette of what happens to a white person when they briefly find themselves on the wrong side of white privilege. Oh, the indignation of being subjected to kung fu jokes! The humiliation of being asked if we eat a lot of Chinese food! Hello, fellow white acupuncturists? Some people have to deal with that kind of crap all the time, and not just in reference to a profession which they got to choose of their own free will. If the kung pao chicken schtick bothers you, consider doing something about racism. That would be better than boring the world by explaining how you are actually more educated than a lawyer.

I could go on and on, but the bottom line is, if someone says, can you take a look at my elbow, the correct answer is, sure.  That doesn't mean you have to treat them right there. All you have to do is gently touch their elbow and say, hmm. That popping noise sounds really uncomfortable. I can't guarantee that I can help you, but I'd like to try. That's a message that anyone, anywhere, can read.

You have to reach out. You have to extend yourself. People can't take you seriously if they can't feel that you are there. People aren't going to respond to you complaining about all the privilege you should have -- really, they're not, not even when the complaining is disguised as "educating" them. People do respond when they can feel that YOU feel that being able to help someone is -- as Albert Schweitzer said, and Teresa quoted -- a "great and ever new privilege".

This story was posted on December 9 2010 by Lisafer.

Comments

  • December 9 2010 at 8:19 PM
    suzzanne.lohr writes:

    Thank you, Lisa!

    Thank you so much for this blog.  I was so upset when I saw that video.  I can even begin to tell you how many classmates and even patients sent it to me and really it just pissed me off and made me sad. (Not that they sent it, just the contents.) Every point you just raised is exactly what made me uncomfortable.  It just got right under my skin.  Plus, who treats their patients or anyone like that?!  I might want to roll my eyes at someone for some weird comment, but usually they just need a little understanding and/or education and they aren’t so irritating anymore. Or maybe I need to get over myself and just chill out. Eek!

     And as for the CA Punks and Ruby- that is why I love CA.  Everyone really, really wants to see people. And that warms my heart.  (It also makes me more and more uncomfortable with other non-CA punks when they want to be aloof and cold.  Or when they tell me I care too much.  WTF?  Is that even possible?)

     Anyway, thanks so much Lisa!  As usual, you totally made my day.

     

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  • December 9 2010 at 8:40 PM
    mitylene writes:

    context

    I guess you have to give people a safe context to talk about racism. 

    I don’t really think about racism much, because it’s ever present for me. What is there to think about anyways? And I don’t talk about it with others, because unless there’s context other people just think it’s some rude interruption. 

    I audited a sociology of race class once, and I was one of the only 2-3 people in that class not cauasian.And there everyone asked me why I NEVER said anything before, as if it was my fault.

    And those Kung Fu jokes? Chinese food? I am sorry, but that’s my life really ...pre or post acupuncture. 

    I guess I chose somehow to embody those sterotypes oh no an Chinese woman who knows martial arts and acupuncture and drinks tea. And hide the non-stereotypical aspects of myself. 

    And I enjoy making smart aleck remarks like “Yes, I know how to paralyze people with pressure points like a Kung Fu Panda.” <i></i>

    Thanks for writing about this Lisa smile I really appreciate it!

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  • December 10 2010 at 12:22 AM
    Whitsitt writes:

    awesome class!

    That class was super inspiring for lots of reasons!  I’m glad we got to hear Teresa’s presentation, and Lisa’s.  It was especially cool getting to (re)connect with some other Cascadian acupunks, and really kinda funny seeing all the other acufolks too.  I think that was my first time since graduation hanging with a bunch of non-CA acupeople, and it was kinda like I remembered: lots of fancy boots, stories of foreign travel, and snacks.  Some of them seemed like decent folks, too (at least the ones I spoke with during lunch), though they mostly stayed real quiet during the discussion.

    Ruby has such a great sense of humor!  So dry and cutting, but also really sweet.  She was a treat to hear.  I thought it was interesting that the things she mentioned as being important to get from providers were things like: compassion, respect, kindness… as opposed to something like the perfect point prescription.  Goes back to that old advice about showing up and giving a fuck, eh?

    I didn’t really mean to ask so many questions and talk so much, but the whole thing was really inspiring.  This past week I’ve been trying out some of the things we talked about, especially around how to do intakes and manage expectations.  Lisa, you’ve probably shaved another 1:30 off my FOC time with your suggestion of talking about the treatment plan while pulling needles.  I had 5 new patients yesterday, one of whom didn’t speak English and was very nervous, and it ended up going really smoothly.  I feel like I’m getting even better at welcoming folks to acupuncture, and just able to pay more attention to the patients and get out of my head more.

    Yeah, I *love* my patients, so getting able to pay closer attention to them is good stuff.

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  • December 10 2010 at 1:23 AM
    MichelleRivers writes:

    People don"t care how much…

    This post reminds me of the saying “People don’t care how much you know until they know how much you care.” 

    My first response to that video was to laugh when the acupuncturist said it would be “giving away service” to look at the elbow. My service always involves needles. Every time. That’s what I get paid for.

    Looking at someone’s pain is not what we get paid for, it’s what we do because we’re human. And it’s definitely a critical first step in becoming a helpful ally for people managing their chronic pain.

    That first step may be where we get hung up, depending on our own relationship to pain, and to the specifics of any individual patient’s pain. So, when people, especially us punks, can’t connect - can’t empathize - can’t support our patients, I suspect there may be at least two things at play: 1. We may just simply not be comfortable enough to be present with suffering - our own, or that of our patients who may remind us that we have suffered/are suffering/will suffer. and 2. Our predominant professional culture, perpetuated by much of our training.

    I was also reminded of acu school as I sat among the note-takers, scribbling important things during Teresa’s talk. The difference in my notes, though (compared to what I would have written in acu school), is remarkable. In school, I wrote down symptoms, diagnoses, points, and herbs. During Teresa’s lecture, I wrote down quotes about how she talks to people, how she understands chronic pain, and how she thinks about patients as people. In case you didn’t make it to the class, here are three things I wrote on the first page of her handout:

    “You have to treat pain and suffering. And the way everyone suffers is unique.”

    “Those at the greatest risk for undertreated pain are those who have trouble communicating, because pain is measured by self-report.”

    “We want to get your pain as low as possible and improve your quality of life” (what she says early on in a new patient encounter)

    We didn’t get this kind of instruction in acu school, and only the very best clinical supervisors modeled it in clinic. It’s just not the culture. In acu school, other people’s pain is our puzzle. Again and again our task as students is to consider very difficult and painful theoretical conditions happening to theoretical patients and then deliver the Dx and Rx. I think our schooling could do a lot more to equip us to stand in the presence of suffering.

    The tone of Teresa’s talk was what I would call deeply respectful. At one point, she said that most people with chronic pain will be managing it for their entire lives. It’s not something we’re going to cure them of. And she is someone with vast experience and a huge catalog of modalities, from pharmaceuticals to meditation, at the ready. This was respect as lack-of-ego. Also, her respect was expressed in the way she acknowledged the patient’s pain as thier own. The came with it, they’ll leave with it, and they work with it every day. This was respectful of the patients own competence, at the patient’s being the #1 expert in their pain.

    And then we got to hear Ruby talk, and it all clicked. She talked about her daily task list of things to do to keep her pain level as low as possible. She has a full-time job just doing that. It’s a lot of work. She talked about what she gets from acupuncture, and that is a series of messages that’s summed up well by a quote I scribbled down during Lisa’s part of the class:

    “Don’t get discouraged, don’t panic, don’t give up.”

    We only gain authority to say those things if we’ve accepted the privilege of standing near enough to the patient’s suffering to see it almost as they do. We don’t get authority from the # of points we know, the # of formulas we’ve studied, or any of the other lists that our cartoon colleague enumerated.

    Michelle Faucher

    Chico Community Acupuncture

    http://www.ChicoCommunityAcupuncture.com

    530-564-1646

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  • December 10 2010 at 12:18 PM
    NancyS writes:

    You add a whole other level to think about, as usual

    I also noticed the difference in level of dialogue between the the community practitioners and the solo ones.  I didn’t make the connections you did.  I didn’t have much explanation for it at the time, but what you have said makes a lot of sense.

     

    Here’s what I did notice: Towards the beginning of the day, Teresa said a couple of things about how challenging pain is to treat.  She said something to the effect that there haven’t been great solutions to this point or implied that there were not approaches that were fully successful or something like that.  Then she went on to talk about how acupuncture can also be helpful but she didn’t paint acupuncture as THE solution.

     

    There were looks between a few of the acupuncturists in the second row.  Due to the timing, I sensed that they were annoyed/offended that she wasn’t giving their glorious profession it’s due.  I had the opportunity at the next break to check in with one of them (she didn’t know I had witnessed their displeasure).  She said “WE’VE been treating pain successfully for centuries” as if acupuncture was the golden key to pain management and Teresa’s expertise on the subject was certainly lacking in this regard.  As if all of us L.Ac.‘s in the room had personally been practicing for several hundred years.  Didn’t Teresa know how important we acupuncturists are?

     

    I found it fascinating that later in the day when Ruby was talking, neither she nor her friend said to Ruby that if she’d only come to their practice, she’d be cured.  In fact, neither of them seemed to notice that their previous defensiveness of acupuncture as the CURE for pain was in direct contrast to the reality we were all discussing—chronic pain is challenging and there is no one perfect approach.

     

    The hubris I witnessed had nothing to do with the daily pain and struggle patients have everyday and everything to do with the pride and arrogance we’re spoon-fed in school.  

     

    So I guess one additional difference I could see between at least some of the solo practitioners and those of us in community practice is that CA practitioners could not possibly deny the struggle our patients experience.  We don’t see a few chronic pain sufferers a week in our clinics.  We see 40 or 100 or 400.  And while we know acupuncture can be a wonderful addition to their toolbox for managing their condition, we also know acupuncture might not “fix” the source of the pain and maybe it won’t work for everyone.

    Nancy S. 

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  • December 10 2010 at 12:26 PM
    Pauline writes:

    Treating pain in BA

    There’s more I want to say about this  blog but I’m in a hurry now and will get back to it later. WHen I had a BA practice I saw very few people with chronic pain. Why? So many people with chronic pain are unable to work or work full-time. Many are on a disability pension. How many of those folks could affors $70 a tx. Almost none. Now, I see mostly pain pts. ANd if they need to come 3x a wk and can’t afford $15 a pop. I scale it down further. ANso so the love spreads. So It’s not surprising the BA folks had so little to say. They also had so little experience with chronic pain. Smae phenomenon when I was a psychotherapist threating abuse survivors. Most were working poor or just damn poor and too fucked over by life to work. How many of those people could afford to pay $90 a tx for therapy? None. So I did group therapy and charged $10 a week for a 3-hour group.

    You can always find a way to help those who most need it if you just think about and care a damn.

    Pauline

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  • December 10 2010 at 2:01 PM
    tessmcginn writes:

    First of all I want to express my horror

    at that cartoon.  What gets passed off as social satire these days is insulting to the whole genre of social satire.  I wish something in it could have made me laugh, instead it me feel yucky.  Oh where oh where is our zang fool?

    Lucky everyone who got to attend what from all descriptions sounded like a highly useful day at the chronic pain workshop.

    I think it is true as Nancy says that most acupuncturists do not get to see much in the way of chronic pain because of cost factors.  If they did, they would have a healthy respect for pain itself and from those who live with it on a daily basis.  It definitely has allowed me to see that I am in some cases just one tool in the toolbox of chronic pain sufferers. 

    Hats off to this great thread. 

    Tess Bois (formerly McGinn)

    One World Community Acupuncture

    Fitchburg, MA

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  • December 10 2010 at 2:07 PM
    Clayton Willoughby writes:

    Blocked for Canucks

    I’m missing a good chunk of the discussion since Comcast hates Canada - I have no idea what the video is about, so please forgive if I’m missing part of the point.

    One thing I liked though was mentioning good privilege; the good that we do through the service we provide. There’s so much anger here on this site about the negative privilege; the “white men are bad” point of view. OK, that’s a bit of hyperbole, but not by much; and it runs contrary to so much of my education within local first nation communities where the greater importance is on the individual rather than the group.

    Self esteem/confidence and strength have as an important role in privilege as ethnic background, age and gender and this is where we need to approach our patients. As individuals coming from their own place; which if they’re coming for treatment of pain & disease, might be pretty low. Being there feels good though.

    I will admit some envy though, hopefully these great events can be captured on film video for the eventual CAN online seminar package and we can all enjoy them at some point.

    Have a great one 

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  • December 10 2010 at 11:33 PM
    LarryG writes:

    Clayton-

    While we may be measured as individuals and that is fair, failing to point out group privilege based on sex, gender, race, class, etc allows for cycles of oppression not only to continue to operate, but to remain unseen to both individuals and groups hence perpetuating both subtle and gross privilege and oppression.  I do not see a “white men are bad” point of view” on CAN and I ask you to back up your claim with specific examples.  Does anyone else?  The arguments here are educated and nuanced by and large.  Again, examples please.  

    People demonstrate anger on CAN over “negative privilege” from time to time, no doubt.  However, I do not think it hyperbole to say that posters here maintain an overwhelmingly positive and supportive environment for fellow members and that the anger demonstrated here is both appropriate and well directed.  And by saying this, I do not mean to imply that getting angry is not a positive thing to do when undue privilege is being called out.  It is not only appropriate, it is productive.  As St. Augustine said, hope has two beautiful daughters, anger and courage.  Without anger, there is no hope, and CANners are courageous enough to act on it, whether in a post or in clinic.

    Insinuating that CAN is some sort of hotbed of anger over the relative privilege of white men, that you can hardly avoid it, just sounds like you are taking things way too personally as a self-identified white man, which I presume you are.  After all, if the greater importance is on the individual rather than the group, as you state, you shouldn’t be so sensitive to perceived anti-white man sentiment, which you apparently are. And white men are relatively privileged compared to other groups.  Is this even a question?  But even this is too generalized to talk about until we start pulling in other factors, such as age, ability, sexuality, class, etc.  

     

     

     

     

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  • December 11 2010 at 2:00 PM
    Ben writes:

    Are we not privileged?

    As stated above: “While we may be measured as individuals and that is fair, failing to point out group privilege based on sex, gender, race, class, etc allows for cycles of oppression not only to continue to operate, but to remain unseen to both individuals and groups hence perpetuating both subtle and gross privilege and oppression.” 

    As a membership driven organization, how is CAN different from the very points it strives to resolve?  For once we associate ourselves with anything, we’ve separated ourselves from the rest…

    Ben 

    The People’s Acupuncture Clinic

    “health for the people… by the people.”

    http://www.thepeoplesacupunctureclinic.com

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  • December 11 2010 at 5:08 PM
    cariadanam writes:

    Thank you so much for this

    Thank you so much for this post. 

    I am part of CAN, I run a CAP, I treat pain, have done so for years.  I have been a source for my patients to find some or a lot of relief.  A source for someone to talk to about their pain openly.  But this post made me realize that while I have been helping people with their pain for years and I am confident that I am making a difference, I still had much more to learn.

    I had two patients (well more but these are the extreme) with pain this morning.  One is a lady who fell off a roof, no health insurance, living with a shattered pelvis for a decade.  She is finally getting her surgery on Monday.  She laid there crying through her treatment.  The second lady had so much neck pain she was vomiting before her treatment. Pain to it’s extreme.

    And I felt their pain.  I felt it for the first time, obviously not to the degree they do, but rather than being here for them, I was *with* them.  I can let their pain go now, I can go home and play with my kids and not live in it, but for a moment we came to a deep understanding of each other.  What a gift for both of us.

    Thank you for this post and thank you for opening the door to humanity even further.  I am so blessed.

    ~Julie

    www.AuburnCommunityAcupuncture.com

    right next door to Sacramento

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  • December 11 2010 at 9:39 PM
    tatyana writes:

    great post

    i must join others here in my absolute disgust at that cartoon. i think the robotic and seemingly calm tone makes the “acupuncturist” character sound even more creepy.

    it also made me think of Dr.Tan, how he always tells people at his
    seminars to carry needles and treat folks anywhere they go - on planes,
    trains, in airports, etc. just needle people, help them feel better, and don’t talk too much. it’s pretty much the opposite of what that stupid cartoon advocates.

    i feel jealous of those that got to attend this very useful-sounding class and especially because Ruby sounds awesome.

    This - “There’s a reason why I
    feel infinitely more at ease with any given white-haired lady from the
    Altar Society than I do with any given acupuncturist; I should have more
    in common with the acupuncturist, but somehow, I don’t. I wonder how
    much this translates to patients, as a group, to acupuncturists, as a
    profession? How much does it have to do with our professional failure
    rates?”

    resonated
    for me a lot - over the years, i have spend countless seminars wanting
    to hide in the corner from all the other acupuncturists in the room
    because i could not relate to them.

    funny just today, i was trying to explain this thing to an acupuncturist friend of mine (who has a boutique practice) - about how patient education is futile unless we change how we communicate with people about what we do, unless we teach acupuncture students to actually connect with patients and their suffering. she was complaining about students she supervises in a school clinic and how so many of them are not motivated to treat patients at all. it made me think of Skip’s post and i said to her - sometimes people go to acupuncture school to feel better about themselves, they are not there to learn a skill so they can actually *work* at helping people. she nodded her head and agreed.

    -tatyana

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  • December 12 2010 at 12:56 AM
    Clayton Willoughby writes:

    R.I.P.

    The sense of humor.

    Born: the first fart

    Died: 2010 of shame through political correctness

     

    Although in your defence, cheek doesn’t translate well in written language unless I use those bloody smiley face things. Just take a deep breath and don’t get angry just because I said that people sometimes get angry (wink). 

    What you’ve missed entirely is the rest of the message; our patients are individuals and no matter how the political minded folk want to label them and vertically organise them, they feel how they feel. Individual privilege is more important than the broad strokes society paints because we deal with individuals as they come to us, which is usually feeling pretty rough. If we treat people as equal individuals aren’t we promoting the goal of equal rites?

    I just felt that Lisa touched upon a very valid point that isn’t often brought up of the individual, as well as our own positive privilege as practitioners being there in a position to help. I didn’t expect to set off a poop storm, way to make me feel valid and respected… sniff sniff.

    Again, not wanting to be a dick, but somehow pulling it off no matter how hard I try. For the record, since it’s so important, my family background is mostly European with Portuguese North African and First Nations.

    Peace! 

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  • December 12 2010 at 10:47 AM
    GAMB writes:

    Erin Brockovich

    Thanks for another great thoughtful post Lisa… 

    Being immersed in CA now for several years, something sticks out to me about a difference between CA punks and some other punks. Makes me think of the movie “Erin Brockovich”.  

    I am thinking of that scene when Julia Roberts (playing Erin Brockovich) is in the big time lawyer’s office and the other female lawyer, putting on airs, tells Julia Roberts that she needs the contact information for all the clients.  Julia responds with “okay which one do you want to know about?” and the other lawyer tells her that she can’t possibly know everything about all of the clients, then Julia starts spouting out all info about them, personal and contact info… Anyway….to me CA punks are like Erin Brockovich and some other punks are like the big time lawyers. The point being that Erin connects with those clients because she is one of them, the big time lawyer can’t make that connection because she is not.  Their motivations are also, a lot of times, different.   

    It’s about having a raw connection with your patient, and being present with them-even when you can’t necessarily take their pain away. It’s the difference between rolling up your sleeves and getting a little dirty, and standing on the sidelines wearing protective clothing.  I hope you can get my meaning here…personally, I love getting a little dirty. 

    Melonie (Sarasota CA) 

      0 likes
  • December 12 2010 at 11:30 AM
    LarryG writes:

    Clayton

    you pull it off (“being a dick”) because you seem less than authentic in your intentions for speaking. 

    I read your entire post and did not miss what you were getting after.  However, you set it up with something inaccurate and that is what my comment addressed.  If you would care to go and provide examples of the “white men are bad” sentiment on CAN, which you first called a bit of “hyperbole, but not by much” but is now being passed off as failed humor for the want of an emoticon, I’d appreciate that.  If not, maybe this thread is in danger of getting derailed as your individual privilege point has been made.  

     

     

     

     

      0 likes
  • December 12 2010 at 12:59 PM
    Nic writes:

    Shes from Lawrence!

    Kansas! 

      0 likes
  • December 12 2010 at 4:06 PM
    david villanueva writes:

    ...“students she supervises in a school clinic

      and how so many of them are not motivated to treat patients…”

    I think part of the reason for this is also what is taught in schools—herbal diagnosis while treating with acupuncture. Instead of (as Dr. Tan teaches) acupuncture diagnosis to treat w/ acupuncture. As a result, the treatment outcomes in school clinics are not as good as they could be. Because of this, some students may feel acupuncture is not really that effective. And if acup. does not seem to be  that effective, this lowers one’s motivation to treat people.

      0 likes
  • December 12 2010 at 5:56 PM
    Ben writes:

    hmm…

    I think the real reason that outcomes are not good is that the patients are being treated by STUDENTS!  That being said, observed outcome was good in my clinical education so I would suspect it so in others as well… why not? 

    Several of my supervisors pointed out some great ideas about difficult patients, and after following their advice, we often saw awesome changes.

    And I think it is a mistake to think that good acupuncture outcomes can not come from a Zang Fu DX.  If the patient has no pain then Zang Fu dx is very helpful… and most N. American patients have both channel problems as well as internal problems.  It may be short sighted to throw all the marbles in the channel dx box…

    all good medicine, 

    Ben 

    The People’s Acupuncture Clinic

    “health for the people… by the people.”

    http://www.thepeoplesacupunctureclinic.com

      0 likes
  • December 12 2010 at 6:28 PM
    Spartacus writes:

    It’s even worse when the

    It’s even worse when the pres. of one’s school, an acupuncturist himself, says repeatedly “acupuncture doesn’t really do anything” to all the students, weekly if not more often.

      0 likes
  • December 12 2010 at 10:01 PM
    Lisafer writes:

    you are very welcome

    glad you liked it.

      0 likes
  • December 12 2010 at 10:17 PM
    Lisafer writes:

    hey Jade

    you’re welcome. I appreciate you sharing your experiences. And I’m sorry that you have had them. :( I’m thinking about ways that we can do a better job of addressing racism. Creating safe spaces is not something I’m particularly good at—maybe there is someone in CAN who is? Meaning, somebody white—those of us who benefit from racism are the ones who need to take responsibility for dealing with it.

      0 likes
  • December 12 2010 at 10:20 PM
    Lisafer writes:

    Yay

    I’m glad it was a useful class. It was great to see you. Also, LOL “fancy boots, stories of foreign travel, and snacks”—that really sums it up.

      0 likes
  • December 12 2010 at 10:24 PM
    Lisafer writes:

    Thanks

    Michelle, for putting into words what I’ve been thinking about Teresa’s presentation and why it was so important. “her respect was expressed in the way she acknowledged the patient’s pain
    as thier own. They came with it, they’ll leave with it, and they work
    with it every day. This was respectful of the patients own competence,
    at the patient’s being the #1 expert in their pain.” This is such an important attitude to have towards community acupuncture patients,  period—and it’s so counter to the dominant culture of the acupuncture profession.

      0 likes
  • December 12 2010 at 10:26 PM
    jenniferwoolf writes:

    I second what Nancy and

    I second what Nancy and Pauline said.  When I started seeing 125 patients a week my ego about being able to fix pain permanently was crushed under the heels of all those chronic pain patients I saw.  It just was a whole different ball game.  Not to say that there weren’t lots of wonderful cases of dramatic pain reduction, or people for whom severe pain became a dim memory, but that there were still many, many patients for whom pain management was, as Lisa referred to Ruby, a full-time job.  My role is not that of hero.  And after a couple of years of CA I’m starting to be okay with that.

    The biggest challenge for me with chronic pain patients is talking to them in a supportive way and not misleading them or promising something I might not be able to provide.  ‘Cause I’m just so darn hopeful and perky.

    I need to remember that the BA acupuncturist down the street and I treat totally different people, generally.  There are so many reasons why I see many more chronic pain patients and patients on disability than she or he does.  For one thing, I saw more patients in the first two and a half months of this year than any acupuncturist in my town sees in an entire year.  That does *not* make me better than them! It just means pound for pound I’m going to see more of any disorder.  And the reasons go on at length from there.

    I dunno, I just wish the snickering in the second row, regardless of the seminar I’m at, would quit.  We’re worlds apart, in so many ways.  There’s got to be some commonality to be found or the arguing and sniping will never stop.  I don’t go to BA CEU events much any more because they don’t appeal to me at all.  I certainly wouldn’t go and snicker or roll my eyes.  There’s a place for everything and everything in its place.  No, I don’t need hair analysis in my clinic - but thanks, and how nice that someone else does that.  I’m beyond thrilled that I don’t even have to consider that kind of work any more, but you wanna do it? Fabulous.  Knock yourself out, and the very first person who asks me for a referral for hair analysis will be sent to your door ASAP.  No kidding.

    Sorry to veer wildly off topic, just had a rant building up in me that this post brought to the surface.

      0 likes
  • December 12 2010 at 10:29 PM
    Lisafer writes:

    thanks, Nancy

    your comment really helps me identify more of the disconnection between community acupuncture and the acupuncture professional culture. “The hubris I witnessed had nothing to do with the daily pain and
    struggle patients have everyday and everything to do with the pride and
    arrogance we’re spoon-fed in school. ” You’re exactly right, that hubris can only survive in the absence of contact with lots and lots of patients who are dealing with pain in real life. We have to do something about the spoon feeding thing, dammit.

      0 likes
  • December 12 2010 at 10:31 PM
    Lisafer writes:

    right

    we didn’t even get to that in the class, the part about how chronic pain = not having any money, in general.

      0 likes
  • December 12 2010 at 10:34 PM
    Lisafer writes:

    the only funny part of the video

    as Moses pointed out to me at work the other night, was how the video ended with the patient leaving to get acupuncture from his chiropractor—maybe the chiro actually had some social skills? Because who would ever want to be treated by the acupuncturist in the video?

      0 likes
  • December 12 2010 at 10:37 PM
    Lisafer writes:

    thanks, Julie

    that’s beautiful. That’s kind of what I felt after hearing Teresa’s presentation—OK, I get this at another level, and now I WANT to treat pain, because I don’t feel so overwhelmed by it anymore. I’m so happy that message came through in the post.

      0 likes
  • December 13 2010 at 12:12 AM
    david villanueva writes:

    Ben, I think you

    misread what I wrote, w/c was “As a result, the treatment outcomes in school clinics are not as good as they could be.”

    Acupuncture Dx isn’t taught in schools, at least not in the school I went to. It was always herbal Dx for EVERYTHING, w/c is not very effective when treating pain. This is what I was writing about. Oh, by the way, acup. Dx also works well for internal disorders. Zang-fu is preferable for this, but acup. dx also works.

      0 likes
  • December 13 2010 at 2:22 AM
    Lisafer writes:

    you’re welcome

    Mel, you raw, dirty punk (my favorite kind).

      0 likes
  • December 13 2010 at 2:33 AM
    Lisafer writes:

    white privilege

    If anybody is unclear on what the term means—and that we’re not talking about something abstract—please follow these links:

    http://www.scribd.com/doc/11917990/Racism-a-Gardeners-Tale

    and

    http://coalitioncommunitiescolor.org/—and then read the report. The whole report. We’re not talking about “voluntarily separating ourselves from the rest”, we’re talking about people of color being six times as likely to be killed by the police in friendly, progressive Portland, Oregon.

      0 likes
  • December 13 2010 at 3:38 AM
    Linda inDetroit writes:

    Seriously?

    The president of a school believes, and says to his students that “acupuncture doesn’t really do anything,“and he feels comfortable running a school where many students end up in 6 figure debt learning it? 

      0 likes
  • December 13 2010 at 8:40 AM
    Spartacus writes:

    Seriously.  If pressed he

    Seriously.  If pressed he might go so far as to acknowledge that it “improves awareness” or another similarly vague idea, but that’s about it.  He is much more about the idea that the future of medicine/healthcare in this country is “wellness coaching” - I just wonder how different the whole school might be if people were really excited about acupuncture (as I am, but hey I’m nearly free of it here shortly…) 

      0 likes
  • December 13 2010 at 9:29 PM
    tatyana writes:

    well…

    david and ben - i think you both kind of misundersood the point i was trying to make with my anecdote - i was thinking about the  context of priviledge - mostly  class (but also race as they often co-relate). many working class people do not really have the option of going to a really expensive school for 3 years in order to feel better about themselves, to feel like a “healer”. they have to roll up their sleeves and work. my observation of acupuncture students is that there are many (not all) who are not clear on exacty why they are in acupuncture school other than perhaps their own healing / self-improvement, maybe because Chinese medicine is pretty cool and interesting. the schools do not emphasize work ethic and ethics classes do not focus on the fact that it is our obligation to relieve suffering with what we learn and do it for many people, not just select few. clinical training in schools does not train students to connect with patients authentically without the “expert’s mask”. thus we have all these unmotivated acupuncture students sitting around twiddling their thumbs in empty student clincics, while the schools collect $ for every hour of thier thumb twiddling time. then they come out of school and come to classes like the one lisa describes and sit there taking notes, behaving like they are still in school.

    -tatyana

      0 likes
  • December 14 2010 at 9:17 AM
    Ben writes:

    I agree…

    that most who enter school are probably not there to help lots of people.  From my limited experience, it appears to be the same as those who enter the western medical profession as well.  Maybe it a human trait?

    thanks for your reply,

    Ben 

    The People’s Acupuncture Clinic

    “health for the people… by the people.”

    http://www.thepeoplesacupunctureclinic.com

      0 likes
  • December 14 2010 at 9:26 AM
    Ben writes:

    You’re right David.

    I misread what you wrote.

    But I think as a public organization that is getting more and more attention, we all need to more careful about generalization.

    Channel dx was taught in our curriculum at school.  It was not the Balance Method though.  It was standard TCM channel dx.  And looking through our vast medical history, both methods were often used together and by the experience of the physician.

    I do not disagree with you that channel dx works for Zang-Fu problems.  The meridians are connected to the organs are they not?  This is also the basis for Zang-Fu dx in the treatment of channel disorders.  Which you pick and how you treat is your choice… often based on experience and understanding of the patients disease mechanism and suffering.

    all good medicine,

    Ben 

    The People’s Acupuncture Clinic

    “health for the people… by the people.”

    http://www.thepeoplesacupunctureclinic.com

      0 likes
  • December 14 2010 at 12:41 PM
    suzzanne.lohr writes:

    that makes my head

    that makes my head explode.  why would you even bother to be the president of a school if you think it is bs?  so confused. 

     oh and congrats on nearly being free, kim!

      0 likes
  • December 14 2010 at 3:19 PM
    Spartacus writes:

    Thanks!  Oh, and your head

    Thanks!  Oh, and your head would explode again if I told you how much money he makes!  AND - I didn’t realize you opened the new CAP in Adams Morgan - I’m up near Catholic and I’ll be coming in to get poked by you soon!  Planning to open my clinic in Mt. Ranier sometime around early summer 2011!

      0 likes
  • December 14 2010 at 3:58 PM
    Ben writes:

    The Gardner’s Tale is interesting…

    and may be a representation of human behavior.  But I think the analogy to plants and soil is flawed.  For one, when someone reads this, they may unconsciously associate this type of behavior with nature.  That would be a huge mistake and lead us further down the path we are on.  Nature does not function as in the example of her understanding of why her old soil produced a ‘different’ result.  There is a reason why plants grow the way they do. And her boxes are not natural.   

    The beautiful planet we live on moves in a dynamic balance… not an equal one.  How we tend it though does produce different outcomes.  We can cultivate a re-generative environment where all the different species bring about a more resilient world, or we can rob and steal and violate natural law in hopes of survival.

    I think this is maybe what the author wants to address.  And a great idea for us to implement in our healthcare practices.  How can we make our work re-generative? 

    thanks for sharing,

    Ben 

     

    The People’s Acupuncture Clinic

    “health for the people… by the people.”

    http://www.thepeoplesacupunctureclinic.com

      0 likes
  • December 14 2010 at 7:12 PM
    Linda inDetroit writes:

    It’s sickening, but there’s

    It’s sickening, but there’s the answer to why he does it, MONEY!

      0 likes
  • December 14 2010 at 10:08 PM
    ewolfk writes:

    There’s a bit more to it than that

    I’m pretty sure I know the Pres. in question, and I don’t think he does what he does and says what he says for the money.  Bob (if I’m right) has done a huge amount for acupuncture in this country and, yes, now that he’s been doing acupuncture for over 30 years he’s come to believe that a lot of illness and suffering comes from people looking for experts to fix them, and that has developed into an emphasis on wellness and personal responsibility.

      0 likes
  • December 15 2010 at 12:26 AM
    Linda inDetroit writes:

    In many ways I agree with

    In many ways I agree with that philosophy, but I don’t understand why he is president of an acupuncture school. Why doesn’t he quit and start his own school or program?  I don’t know him, maybe his intentions are only good, but I question what he is doing in that job, call me cynical.

      0 likes
  • December 15 2010 at 9:32 AM
    ewolfk writes:

    If I’m correct about the identity of the person in question

    he is now the President Emeritus of the school, which he co-founded in the early 70’s.  He is not the President and he is not on the Board, and, I suspect, he’s not earning any income directly from the school at this time.  He has moved the school towards the vision of being a Wellness University over the past ten years.  This was his own school or program— and his vision and thoughts about acupuncture/wellness have been well known for decades.

    Original post-er, were you writing about Bob Duggan at Tai Sophia?

      0 likes
  • December 15 2010 at 10:43 AM
    Guest writes:

    Sounds to me like a group of

    Sounds to me like a group of people who know each other were more comfortable talking and sharing and the people who didn’t know each other were more quiet.  Sounds like a pretty typical human gathering to me.  I wouldn’t read too much into it.  As an outsider it’s interesting how many of these posts try to create an “us vs. them” dynamic.  It seems possible to be enthusiastic about what you’re doing without criticizing total strangers who you know nothing about.

      0 likes
  • December 15 2010 at 11:47 AM
    Spartacus writes:

    If I thought it was

    If I thought it was appropriate to name names I’d have done so at the outset.  My point doesn’t have much to do with who he is as a person, it is just what I said above - I just wonder how different the whole school (or more specifically, the central program of the school which is the acupuncture master’s program) might be if people (read: some of the powerful ones ie. its president) were really excited about acupuncture. This I believe would be true of any acupuncture school where the president routinely said such a thing - hence my decision not to specify identity when responding to a comment about people not being excited about what acupuncture can do and therefore being less motivated to treat.

    I offered the income comment as just another head-exploding factoid. 

      0 likes
  • December 15 2010 at 12:38 PM
    david villanueva writes:

    You make a good point,

    Guest.

      0 likes
  • December 15 2010 at 4:43 PM
    ewolfk writes:

    Into the very narrow boxes….

    I’m not wanting to belabor the point, so sorry if that is what this seems like.   I’m all for righteous indignation—it gets a lot done.  Misplaced indignation, though, does a lot of unnecessary damage—why have people’s head exploding if the thing that makes them explode is not what it seems?  I’m not sure why you don’t want to name names.  I don’t think this former pres. is the least bit shy about stating his beliefs.  The school I’m thinking of is certainly in transition—and, why not speak up about your experience to help potential students make the right choice?  Over the years I’d say some of the nations MOST enthusiastic practitioners graduated from this mystery program.  Also, over the years, the move to a “Wellness University” has not been hidden.  Speak up, but no one is helped by mysterious and perhaps inaccurate head-exploding statements

      0 likes
  • December 15 2010 at 5:07 PM
    Linda inDetroit writes:

    I respect KimDC’s decision

    I respect KimDC’s decision not to post a person’s name on this public blog without permission from the person, that is a common practice.  It was clear to me she was posting an opinion. If someone really wants to know names for whatever reason they can do some research and figure it out, or contact her privately.  

      0 likes
  • December 15 2010 at 5:31 PM
    Spartacus writes:

    If you are “not sure why” I

    If you are “not sure why” I don’t want to name names please consider re-reading my most recent comment before this one because I think I spell it out quite clearly.  I don’t know if you realize that you seem to really be lecturing about what comments are good and what ones are bad, as it pertains to mine in any case. I don’t usually get down with lecturing folks but since you opened the door please note that sycophantic knee-jerk responses don’t help too many folks either.  

     But hey, I’ll give you this: I didn’t think it was worth putting such a fine point on it to add “up until 2 months ago” and then go on and on and on about the minutiae of that whole scene. 

      0 likes
  • December 15 2010 at 6:50 PM
    david villanueva writes:

    Stop the harassment

    of KimDC. Let it go. No need to name names. No means no.

      0 likes
  • December 15 2010 at 8:00 PM
    cariadanam writes:

    I have a couple of

    I have a couple of thoughts.

    ~ I find it sad that the responses here have gotten off track from the original post which was about pain and our response to it as acupuncturists.  I took away something beautiful from it, it might benefit some here to look again at the intention of the post.

    ~I also kind of agree with the Guest, in that if it were me at the conference and I didn’t know anybody I would have been lumped into the category of those acupuncturists that were just coming to get CEU’s and eat.  I am introverted in a group setting and I like to eat, doesn’t mean I am not present and don’t learn from the presenters and those who are more outwardly expressive than I asking questions.

     ~Julie

    www.AuburnCommunityAcupuncture.com

    right next door to Sacramento

      0 likes
  • December 15 2010 at 8:43 PM
    Whitsitt writes:

    One of the interesting

    One of the interesting things was that a bunch of us CA folks actually met for the first time during the first break, so it was more like a bunch of folks with similar outlooks and, perhaps, experiences who were able to get down like we had already known each other for some time even though we hadn’t.

    Also, it’s not so much about trying to create an “us vs. them” dynamic as it is about acknowledging some very real differences between distinct groups of people and how those differences play out in our ability to help patients.  More of an “us and them” rather than a “vs.”, though I can see how one would assume otherwise.

      0 likes
  • December 15 2010 at 10:52 PM
    David Lesseps writes:

    Stay on point

    As one of the moderators of the CAN forum, I am asking everyone to keep the discussion on point and related to the posted topic.

    Please never badger someone to “name names” in a public forum.

    David
    The Punk from SF

      0 likes
  • December 16 2010 at 1:16 PM
    Lisafer writes:

    that’s a good perspective

    if you want to avoid reflecting on, and addressing, the problematic aspects of acupuncture professional culture. I suggest that people think of this post as a companion post to this one and this one.  Community acupunks who want to be successful need to figure out how to stop acting like acupuncturists. It’s not about judging individuals, it’s about being honest about how acupuncturist culture comes across to the rest of the world.

    This thread is now officially unwieldy, so I’m closing comments;  if  any CAN members want to discuss it further, please start a thread inside the forums.

      0 likes

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