Slowing Down To Speed Up

My road towards becoming a full-time CA practitioner has been long and bumpy, but here I am, and as a few posts have indicated, lots of people are in a place I can definitely relate to.

First off, I think people need to not be so hard on themselves, this is really difficult to get, it seems to me, especially if you haven't been in practice a long time, or even if you have and just haven't been that busy. There are a couple of different obstacles to overcome before you're really comfortable with seeing 40+ patients a week. One of them is timing.

What helped me, and still does if I find I am getting bogged down, is a "self-indulgence" rule: I would look at the clock and give myself 5 minutes, in that time, I could indulge in question asking, palpating, theorizing, etc. All of the mental noise we tend to generate as acupuncturists, but when that time was up, I had to put in needles and walk away. Whatever treatment plan I had devised up to then was what they were gonna get, if some inspiration moved me to a particular point that was not in the plan, sure I'd needle it, but I wouldn't start second guessing or reformulating the basic strategy. Conversely, even if there were a dozen more points I wanted to do, when the 10 minute mark rolled around, that would be time to wrap it up, put in your last two needles and again, walk away. You only spend the time you actually have, and let go of the outcome. Eventually your thinking becomes limited to conclusions you can make with a modicum of information, and the time limit sets the pace for the level of theoretical complexity you can achieve. By slowing down and then completely minimizing the mental process, you actually become faster. I still don't live up to this, but I try.

This brings us to the next, and probably the biggest, obstacle: confidence. There are three aspects of this, the confidence we have that our treatments work, the confidence that patients have in our treatments, and finally confidence that 90% of the time, 10 minutes is more than enough time.

Confidence in my treatments was easy. I was fortunate enough to barely pay attention in class and instead listened to my wonderful mentors and studied things that are actually expedient to practice (as well as a heapin' helpin' o' big league theory and classics) while in school. I never took anything at face value, if it didn't work, and for me in most cases that meant immediately, it got discarded. Consequently, I studied the meridian therapists, whether they be Japanese, French-Vietnamese or good ol' Dr. Tung (or his theoretical disciple Dr. Tan), and I suggest to anyone looking to build their confidence to start here.

This isn't some anti-TCM screed, just that Meridian Therapy lends itself to a more exploratory approach and all major teachers from these schools believe in instantaneous results--maybe not cure, but some sort of change. When we see these changes manifest right then and there we begin to truly gain confidence that what we are doing is real, concrete and effective. I think many practitioners have rather unhealthy levels of doubt, there will always be some doubt and this medicine has its limitations, but I'm just talking about change--if you felt it, if they felt it, you both know something is happening, this is good, end of story.

I personally used to do A LOT of palpation and interaction with my patients, asking for feedback about points, the effected area (in cases of pain), etc. I still probably do more than the other practitioners here at WCA, but it's part of my style and not necessarily a liability in the timing department. If you work within the limitations (time or otherwise) of this system, there's really no limit to the different styles you can practice.

The real obstacle is letting go of your patient's confidence in your treatments. Here's where the lion's share of doubt creeps in. It used to drive me absolutely crazy when I'd have a patient's neck pain reduced to almost nothing in the chair, and the next week they'd say the treatment didn't change anything. WHAT? You came in here with a 6-7/10, it went down to 1/10 for a couple of hours and you can't see the progress in that!?! Here's the thing: they came back, and most people will come back even if you do absolutely NOTHING to change their condition. You don't have to cure something in one shot, even if you do, it's not required that the patient even realize it. As long as they are coming back, some part of them knows this is a good thing to be doing.

At a certain point I realized almost all of my palpating for ashi points was really to show THEM there was something there, and almost all of my asking for feedback was either trying to get THEM to acknowledge a change, or to try and make the treatment perfect. Patients that expect miracle cures as a matter of course are not the right kind of patients for acupuncture in general, and especially not for community style acupuncture. Treatments don't have to be perfect, now instead of asking for feedback until I run out of time or the symptom disappears, I ask until they feel significantly better, then I do what I'm gonna do, if it has a better effect or not, who cares? Reducing symptoms 50% for any amount of time is plenty for most people to understand that something more than placebo is happening.

Things get ugly when you start assuming that your patients are displeased that you didn't cure them in one treatment, you start to loose ground in your confidence, don't let this happen! YOU are the acupuncturist, managing expectations is not about telling them it won't work like they think it should, it's letting them discover how acupuncture does works. People have all sorts of different preconceptions, let them have them and let them play-out naturally, most people simply "get it" after a few treatments. If a patient makes an issue out of how on treatment 3 they aren't able to throw away their crutches, then it's time to simply explain that acupuncture doesn't work that way. They'll usually decide to listen to the expert (you) or they're probably in that "miracle cure" group, and your time and energy are not used wisely in trying to live up to that. It's actually a very small group of patients, and choosing not to play that game is better for BOTH of you in the end.

The last obstacle is The Perfect Treatment. Oh! If only I had more time, I could whip-up The Perfect Treatment. Not to beat a dead horse, but any treatment that can be done in 10 minutes and still effects some sort of change IS the perfect treatment. This is very closely related to all or nothing thinking. When patients question the process it's usually either/or thinking at work, ie "either acupuncture works or it doesn't" and consequently we get into the old "either I'm good at acupuncture or I'm not".

Here's where the "frequency of treatments" aspect comes in. It takes time. All healing takes time. If you have a miracle treatment, it's very likely that the patient has already done the majority of the healing before even coming to you. Sometimes they aren't ready and you keep treating them--with absolutely no effect--until they are, then they have that miracle break through. Mostly, though, people get better step by step. Most people have been through enough in their lives to understand what it is to heal without any help and therefore instantly recognize how acupuncture facilitates it. Even the most radical healing, surgery, takes time. The recovery from the trauma, that's part and parcel of the process, it's as much of the healing as the cutting. Even "faith" healing requires that the patient be ready for it, and I'll wager even that takes time. So, The Perfect Treatment is really a myth, you just happened to be the right thing at the right time. Recognizing this will set you free in your practice. Every damn treatment where a patient shows up is the perfect treatment.


--Matthew

This story was posted on February 16 2008 by MattGulbransen.

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