Re-inventing general practice in our community acupuncture clinics

I'm a community acupuncturist. I work in a clinic in the neighborhood next to mine, and so I walk to work, through a park, for about 25 minutes there and 25 back, five days a week. I work four days treating people, and one day doing office work, and give about 90-100 treatments every week.

Because I live in a densely populated city, most of my patients are within walking distance of the clinic. That means that I see my patients all of the time. At the grocery store, at the library, in the corner coffee shop. At my husband's pub (he's a local small-business owner as well), on the path in the park, dropping our kids off at school in the morning. They wave at me while sitting at stop lights, riding by on their bikes, watching their toddlers climb the play structure in the park. And I treat my patients for just about anything they might be dealing with at any given time. I see them when they have head colds, get bad blood test results, collide with errant drivers, and discover they're pregnant.

Basically, despite living in a city of 800,000 people in twenty-first-century America, I'm an old-school, small-town general practitioner. Punks like me run clinics that are open every day, for regular hours, and employ several people so that we don't have to close if we catch that cold that's making the rounds, or take a week off for a family vacation or a conference. In this era of procedural reimbursement, medical specialization, and general practitioner shortages (see "Nation Faces Shortage of 150,000 Doctors"), I have doubts that most medical professionals are providing the kind of whole-life, full-time care we associate with traditional general practice- except for community acupuncturists like myself.

So it was with some snorting disbelief that I read Peter Deadman's uninformed and belittling comments (see link in previous blog) concerning the practice of community acupuncture. "When community acupuncture offers three-minute consultations and tacitly or overtly expects ‘the needles to do all the work’ I think this is a betrayal of acupuncture as medicine," he declared. "After all, much dismay accompanied the transition from the old-style GP who lived in a community, knew their patients and their lives, relationships, strengths and weaknesses, to the modern rushed GP whose main preoccupation is to find a way to stop their patient talking so as not to exceed the few minutes allotted to each consultation. Yet even they spend considerably longer than three minutes."

Snorting disbelief, because Deadman obviously hasn't spent time in a busy community acupuncture clinic, or he would never have made such an erroneous statement. As Lisa points out in her excellent blog, plenty of information can be gleaned in three minutes of conversation with a person who knows you well, and when a person has seen you three days a week for the past four weeks and watched over you while you rest for an hour or two each time, believe me, they know you well. I think Deadman’s critique of the 3-minute intake is seriously lacking because it is ignorant of the continued intake that goes on during and after the treatment. Our knowledge of our patients becomes much more sophisticated than questioning because we rely on observation rather than discussion. Human language originated in gesture, signs, expressions- we all use those tools throughout our shifts to gather information about our patients as individuals and the group energy as a whole. Rather than asking questions and taking our eyes off of our patients repeatedly to take extensive notes, we become that much more aware by relying on our visual monitoring to follow the course of the treatments time after time.

But even more to the point, it's not like Deadman or any private-room practitioner with an hour-long intake is somehow going to get to know his patients better, or provide more comprehensive care, than a community acupuncturist. Because as Deadman says himself, "So many new practitioners never get a practice off the ground – at least one that can give them a decent living." And how could they? Private-room acupuncture is simply not a sustainable option for ongoing treatment in any community. A practitioner might cover every possible detail of a person's health history in an hour, but the vast majority of patients won't be able to afford to come in more than once, if they come at all. Community acupuncture clinics that are open full-time, providing affordable continuous care to thousands of people in their communities, are the places where thriving, holistic care is being re-invented. 

To my mind, the brilliance of our community acupuncture practices is that they treat SO MUCH MORE than the chief complaint. Can I quantify that? No, it defies definition. But anyone who regularly spends time in a big room filled with lots of napping people will know exactly what I mean. There is something happening there that is unbelievably Whole, that makes everyone in the room glow with some kind of brilliance that has absolutely nothing to do with point selection. It’s way bigger than the practitioner. It’s the Whole that is so much bigger than the sum of its parts. It’s the technique of getting people together, often, in a quiet place, where they can rest with acupuncture needles in, and heal, together.

We community acupuncturists are filling a huge hole in our communities, a hole created by managed, for-profit healthcare. For Peter Deadman to act as if what is happening in our treatment rooms even exists in the same realm as the HMO three-minute doctor visit only reveals his total ignorance about our collective practices. Certainly, the imperative is on those of us who are creating this new tradition to define it for the world at large. 

So let's tell this story of community acupuncture to the world in a thousand ways: to practitioners who want meaningful work; to patients who want an effective means to cope with pain and stress; to policy wonks who want an affordable solution to the insane cost of insurance-based medical systems. But let's NOT allow ignorant critics to define us out of spite. The reality is that community acupuncture is affordable, accessible, and effective. If you want to find out more about it, go to your nearest POCA clinic and start getting treatments. We'd love to get to know you.

This story was posted on May 20 2012 by Demetra.

Comments

  • May 20 2012 at 8:22 PM
    Wadelp writes:

    Beautiful post DDM.

      1 likes
    • Nora
  • May 20 2012 at 10:53 PM
    CamRN writes:

    I completely agree with you about the huge differences in knowing pt’s when you have many frequent visits/ contacts vs lengthy infrequent contacts, and then doing your pre-tx assessment. 
    While I am just an acu-punk right now, I also have 20+ years experience as an RN in a conventional medical setting so very much like CA: hemodialysis.  I saw my pt’s at least 3x/ wk for tx’s that lasted 2-4hrs over the course of years, met their wives/ children/ friends/ neighbors, even if it was those years I worked 35 miles from where I lived (and even still, I run into them at Costco!). 
    They could walk in saying nothing with a fake smile, but I’d know it was a rough weekend.  It didn’t take hardly 3 minutes for a good assessment.  Deadman is dead wrong about this point.
    Thanks for reminding me that much of human communication (I’ve heard maybe 90%) is non-verbal.

      10 likes
  • May 21 2012 at 6:51 PM
    mitylene writes:

    awesome!

      0 likes
  • May 23 2012 at 11:34 AM
    spitfire writes:

    Great post!

      0 likes
  • May 23 2012 at 9:25 PM
    urbanapuncture writes:

    BAM!

      1 likes
  • May 26 2012 at 4:12 PM
    Chris P writes:

    Good blog. Totally agree. I run a community acupuncture clinic in the UK and Peter Deadman has been supportive of this model up to now. He runs JCM - The Journal of Chinese Medicine and sells books and acupuncture supplies. He currently gives a discount to clinic members of ACMAC in order to support community clinics, so why this sudden about face? He clearly has a deep appreciation of the rich history and complexity of TCM, which is fine. But the people I treat are not particularly interested in it’s nuances. They just want something to make them feel better. I didn’t go into acupuncture just to treat wealthy people. That’s not how acupuncture works best and it’s not how it is practised in China. Surely “best practice” is to use treatments that you know work, and use them regularly, to help as many people as possible with the common ailments that affect them most. You can’t do that if people can’t afford to come!

     

      4 likes
  • June 9 2012 at 11:57 AM
    bellottojr writes:

    Results is our goal, the patient too.
    Treat everybody like you would like treat you.

      0 likes

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