The Art of Practicing Acupuncture or Why the FPD won’t save us

I think it was the last chapter in the "Web That Has No Weaver". It was called the "Art of Chinese Medicine" or something of that sort.  When I read it, I loved it. I made a ton of copies (even though I owned the book), so I could read it everywhere, anytime and could pass it along to other people.

I happened to sit through the debates on the FPD at the CCAOM meeting a few years back and open public discussions on the FPD, so I learned a little about it. What was it. Why they wanted it, etc. etc.

Some people want the FPD, they say it will provide a better education. There is so much to Chinese Medicine.  Students aren't given enough time to learn enough. They aren't prepared for the "real" world of practice.etc.etc. The 3-4 years it takes now is too rushed, too shallow. 

  • Honestly....

A practice of acupuncture (or Chinese Medicine) is both a science and an art.

What is the role of education?

Ask any HR person at any company. (Especially small business owners) (Especially people that specialize in hiring people right out of school)

Our education gives us the fundamentals, the building blocks from which to understand the system of Chinese Medicine. Right out of a phD program a person could probably be a teacher (with no clinical experience or case studies)

But how does a person practice acupuncture right out of school?

  • People think back to the first 6 months of practice.

.....

Well right after I graduated I thought I was going to be like superman (superwoman to be exact). In the Maciocia book, it listed about every possible diseases and protocols for everything. So I was going to "cure" all those impossible diseases that plagued the everyday lives of common men and women (i.e. infertility, mania, stroke, paralysis, anxiety, depression, menopause, plum pit qi, running piglet syndrome, borborygmos.etc.etc.) (don't laugh too hard wink

right....

  • Then you actually try to treat "real" people in the "real" world.

...

Then I am just scared. "Real" people aren't like textbooks and don't respond as well as cases in text books (and even if they did you would have to convince them that they needed to come in for the THREE MONTHS that it took to cure the case in the textbook). RIGHT.  

They ask you questions you can't answer. You break out in cold sweats every time you're treating someone because let's face it. You've NEVER seen this before and have NO IDEA what you're doing. You try to find new ways to acupuncture yourself for sweaty palms so you don't drop your needles wink

Let's not talk about the "business" part of the practice... wink 

...

  • So what do we do?
  • A) Let's get another degree. Having a few more letters after my name always makes me feel more confident and less of a hack.                                                                                                                                                                                          (In case you're wondering my parents tried to convince me to get a phD while I was "interning" in China. I told them that killing and torturing cute fluffy bunnies with acupuncture needles is bad for my karma)
  • B) Grit your teeth and just hack it. Yes, you have no idea what you're doing. You have no idea why some people are getting better and some people aren't. And you've long given up writing pretty Maciocia style TCM diagnosis on patient charts (i.e. phelgm fire rising, with damp cold in the lower jiao) or you just kind of make them up as you go. 

Eventually, you develop some semblance of you own style of "healing" (big needles? little needles? few needles? lots of needles? auricular? scalp? intent? how intent?). As you're acupuncturing a pastor you wonder if it's more appropriate for their healing process to be drawing energy from the universal qi chanting enya like chants of Amen instead of your usual buddhist ones.   

And people get better. Some don't, but a lot do. And you think the world is just crazy.  

Let's face it.

The Practice of Acupuncture or any sort of medicine really is both an art and a science. You're not going to learn how to "practice" from school.

-Jade

  • P.S. I was studying with one of those old old old old chinese medicine doctors in China. He had one of those "Zan Zao" patients menapause, just crazy. She came to see him like once a week for like the last 2 years. He whisper one day that he adds and subtracts things from her herbal formula every time she comes, because THAT makes her feel better. Not the added herbs you know. Just the process of adding and subtracting semi-random things.  
This story was posted on November 30 2009 by mitylene.
Tags: fpd

Comments

  • November 30 2009 at 9:58 AM
    ellengrover writes:

    what do you mean

    you don’t write your diagnosis in the chart anymore?  grin  loved your post!!  

      0 likes
  • November 30 2009 at 12:43 PM
    River Jordan writes:

    expensive sham

    I too loved Mr. Maciocia and his textbooks - the elaborate outlines appealed to my sense of order. Study and memorize enough, they seemed to promise, and the world of acupuncture doctoring can be yours. Of course, we all know it’s not so simple.

    I don’t mean to disparage anyone who wants to pursue a PhD in acupuncture as an elective, but to require everyone to do it so that we can all add and subtract semi random things from our formulas or point combinations (and other intellectual chirades) - is a very expensive sham.

    Okay, back to silently chanting my incantations and mantras now….

      0 likes
  • November 30 2009 at 3:58 PM
    JuliaC writes:

    Amen

    You really nailed it, Mitylene!  There is so much art to what we are doing and after learning the fundamentals, we don’t actually start healing until we are in clinic, no matter how much education we have under our belts.

     

    Here’s my conundrum: I really like some of the people who are crazy in love with the idea of this FPD.  Benjamin D is one of my friends and he helped me so much while I was negotiating my crazy life while at AIMC.  I truly believe that he truly believes that the FPD will be good for us as a profession and therefore as individual acupuncturists.  He’s not just in it for the money.  There may be others up high in the land of lots of letters from the alphabet who are lobbying for bucks, but some of these people are working for this from the bottom of their hearts.  Personally, I have never agreed that more education is the answer to our woes and no matter how much I LIKE somebody, I still have to hold my ground about my beliefs.

     

    There was a time, not so long ago, when I was convinced that if only I had enough degrees, I would be happy/successful/smarter/respected.  For years, I went through my life without a BA and always hit some ceiling at whatever job I was doing bc I didn’t have a BA.  So in my mid-30s as a single mom, I went back to school and got one.  It was fabulous.  I learned so much.  Pre-socratic, continental, and post-structuralist feminist philosophy with a bent towards science & technology studies, queer theory and religion.  Fabulously usefull stuff for getting a job somewhere, right?  That’s the funny part.  I DID learn so much, and everything I learned enriched my life in so many ways, and I did feel good about myself, etc., etc.  But what in the world was I going to do with it?  So I applied to graduate school AND I applied to acupuncture school and I waited to see where I would get in (not knowing that every acu school would take me just bc I was breathing and had student loan money still available).  I went to an astrologer to talk about my struggle in making such a lifepath choice, and he rightly alerted me that no matter what, I was destined to pick the more difficult path given any choice in my life.

    I got into some very competitive grad programs and felt all proud and righteous and was sure that getting a PhD was the absolute pinnacle of who I could choose to be in my life (esp since I really bombed out of all 3 high schools I went to when I was younger - I’ll show them!!!).

     

    Spending 5 years at Stanford in an interdisciplinary PhD program taught me a LOT about disciplines and their turf wars and validation and notions of legitimacy and notions of truth and notions of facts and made me really face my motivations and my insecurities and ultimately, I saw that it wasn’t nurturing my soul to be pursuing such a thing as a PhD (plus it was ruining my marriage and I was constantly stressed, and we were beyond broke and my friends out there in job land were having to move to places I didn’t want to live to work 80 hours a week in jobs that were paying them $60k a year and they weren’t happy!).

     

    So one day while I was unhappily writing my dissertation, I called up some acupuncture schools again and decided to go to AIMC (and then I laughed when I realized that the astrologer’s vision of my choosing the hardest path meant doing BOTH the PhD AND going to acupuncture school!).  At AIMC, I heard all this talk of how we needed to be integrated with the western medical world in order to gain legitimacy.  And I realized that such a notion comes from a deep insecurity.  I’m absolutely convinced that if we as a profession are to blend what we do with the allopathic world, we will be totally subsumed and subjegated by them. We will be allowed into hospitals so that we can twirl P6 as patients come out of their general anethesia for whatever surgery they are having.  We will have a little booth in the PT’s office to poke Yao Tong Xue before they get a massage for their acute lumbar sprain. 

     

    THE MDs WILL NOT GIVE UP THEIR TURF!  EVER.

     

    Sure, there are exceptions.  I have a fabulous orthopedic surgeon who sends people to me to try 8 or 10 treatments before they decide whether or not to have knee or shoulder surgery.  He trusts our medicine and encourages his patients to give it a try before he cuts into them (and after the surgery, he sends them, too).  But I don’t want to read their xrays or look at their MRIs bc I don’t want to be an orthopedic surgeon.  I want to be an acupuncturist and it doesn’t matter what I would see on those films when I’m putting needles in somebody to help them out of pain.

     

    My patients don’t give a hoot about what degrees I have after my name (or, in my case, what degrees I almost had behind my name).  I held onto the fantasy of someday going back and finishing my PhD so that I could use those letters as some form of cultural capital (it looks good on a business card, my mother told me), and, hey, I did 5 years of it - shouldn’t I have something to show for it??!!, but it’s so obvious that it doesn’t matter.

     

    I have a lot to learn as an acupunk.  And I am learning it by doing it.  Since we’ve opened the clinic, I’ve poked more people and learned more about what works for what and for whom bc I am actually doing it.

     

    If somebody wants to go back to school and study more theory and case studies and Chinese language and xrays and lab reports and physiology, then by all means, there should be a path available to them to pursue that.  But please, please don’t be fooled that such a degree is going to get you a seat at the table (and let’s not even talk about how messy that table is and why do you want to sit at it anyway???).  And please, please don’t force me to go back to school!  I’m so done with school (plus, I think it would mean an automatic divorce at this point!).  Besides, I’m at my lifetime aggregate maximum limit in student loans.  Lifetime.

     

    whew.  Sorry.  

     

    Thanks for all that you are doing to gather a force to be reckoned with.  I’m there with you.  with deep appreciation. and with deep, deep compassion for those who are feeling so insecure that they are convinced another degree is going to validate them.

     

    Julia in Berkeley

     

      0 likes
  • November 30 2009 at 7:10 PM
    tessmcginn writes:

    So Mytilene you really get it…

    and not so long out of school even! 

    I was reading in on some posts on the AIMC forum (I graduated from Meiji) and one of the arguments was about what patients respect.  And one of the folks arguing had some background in evidence based medicine and research.  She argued that studies point again and again to the fact that patients like white lab coats and the term M.D. behind their name.

    And I have to say I sometimes meet those people in my practice.  They can’t afford to see the “doctor” acupuncturist down the street but decide to give me a try because I’m cheaper.  And if I help them -and they really like it when I do- they give me plenty of respect and send me patient referrals too.  And I wear casual attire and laugh alot, my office is “homey” not professional.  

    I don’t sweat anymore because I know that results can never be predicted so I just say that in advance…patients understand, they know I’m not super human. And now I’m sure I’m not either.

    But I have to say, treating lots of people in rapid succession has made me a better practitioner.  A higher academic degree would not have done that, nor would a doctorate made my palms sweat less when asked questions I couldn’t answer in my own little practice.

    I think academics is great.  It really is and sometimes I wish that I could hide there forever, thinking great thoughts and writing them down, researching them, read, read, read.  It’s really exciting and challenging. 

    Working everyday?  Crap, it’s, well, it’s work. 

    With patients!  Real patients!  All messy and imperfect and fun, and drudgery and well…work that mostly makes people feel good…but sometimes not.  My favorite reality check, “so how are you doing today?”  Patient response, “How am i supposed to feel?” uuhhh…

    And worry…did I give the right treatment?  Should I add herbs?  Why isn’t she getting better?  How come his diabetes is getting worse?  He’s better but will it last?  How do I increase patient volume?  Will I ever find someone to work here that I can work with who doesn’t mind my messy writing? 

    And sometimes I worry in this rapid succession with no breathing space, no periods between sentences.  Only my husband knows about that…well and now you.

    And I respectfully disagree with Julie from Berkeley.  Doctors are giving up their turf everyday.  There is a primary care doctor flight in my area that is frightening.  The good ones can’t operate in this current system because they have no freedom to make any independent decisions. It is all insurance driven.  How can we as a profession want that? 

    Maybe a few  individuals in our profession will benefit. 

    A good dose of primary care doctors are studying their 500 hours (or something like that) of acupuncture training at Harvard (thanks Kiiko and Ted!) or UCLA medical school and drop the testing, primary care etc. and get loads of referrals from doctors in the area who send them CASH paying patients!  No insurance!  And here we are chasing the dragon’s tail.

    Love, tess

     

     

     

      0 likes
  • November 30 2009 at 10:31 PM
    jazzyblues writes:

    Jade
    Thanks for this post…

    Jade

    Thanks for this post… it was great.  What you say is so correct… acupuncture is an art and science and how does an artist or muscician or scientist get better… by doing the work and practicing over and over again; working and “perfecting” their craft.

    Already, the cost of schools and the prospects for acupuncturists at this time are prohibitive to alot of people. However as Lisa mentioned in a previous post, some are comfortable with this - it doesn’t really bother them.

    Some seem mainly to be focused on ingratiating themselves within the existing broken health care system, instead of advocating by their practice to ensure acupuncture is accessible to many more people instead of alot less.

    But the winds of change and time is on our side…

    Brian

      0 likes
  • November 30 2009 at 11:10 PM
    JuliaC writes:

    subjugate

    not “subjegate”.  don’t think my fancy education was for nothing…

     

    j in b

     

      0 likes
  • December 6 2009 at 3:53 AM
    mitylene writes:

    Your comments are great!I

    Your comments are great!

    I LOVED my BA degree and education. I really do love learning and books TONS. I went to a crazy liberal arts school and it enriched my life and opened my world. It gave me words for my real life experiences of power and oppression.

    It’s funny that I always thought the people wayyy on the right of things could be just the same wayyy on the left if they realized the left also had words that spoke to their experiences. A lot of immigrant women are that way. They think the left is a place for bored middle and upper class white kids until they learn the words that speak to their experiences.  

    OMG a phD and acu school at the same time, you are completely crazy.

    I totally agree the MDs will not give up their turf. They pay lots of due and stuff to AMA and the schools to fight for their turf. A lot more than our acu organizations are going to have to fight for turf.

    Some people love school. But it’s not right to force EVERYONE to go to school just because the people who do are high up in the schools and other organizations. School is not for everyone especially when the school is for something that is very dependent on everyday experiences accumulated over time. 

    -Jade 

    Jade Community Acupuncture, Winona, MN

    acupuncturewinona.com

      0 likes
  • December 6 2009 at 3:57 AM
    mitylene writes:

    Yeah the MDs as individuals

    Yeah the MDs as individuals are running away from the “benefits” of their profession and we’re running towards it. It’s crazy

    I had a retired MD in my acu school class and his daughter an MD graduated from my acu school a few classes before him.

    Guess what they both only practice acupuncture now at cash only practices. (these are MDs that can bill insurance for their acu treatments. and they won’t)

    He always told me to ever get involved with insurance and sign my name up to be their covered groups and plans. And he’s right!

    -Jade 

    Jade Community Acupuncture, Winona, MN

    acupuncturewinona.com

      0 likes
  • December 6 2009 at 11:10 AM
    Nora writes:

    “School is not for everyone

    “School is not for everyone especially when the school is for something
    that is very dependent on everyday experiences accumulated over time.”  YES!  Especially when the cumulative experiences that are supposed to be part of the schooling, e.g. clinic shifts in this case, are so deficient (see David V’s post). 

    Also, this is a little off-topic, but I keep thinking about the activism in/around college campuses right now about tuition hikes, etc. (the UCs got shut down right around the time that the FPD re-reared its ugly head), and your comment “They think the left is a place for bored middle and upper class white
    kids until they learn the words that speak to their experiences” made me think of this blog post about that (and also Lisa’s post about “inessential weirdness”): http://sdswomynscaucus.wordpress.com/2009/11/20/why-im-more-inspired-by-uc-student-actions-than-i-am-by-nyc-student-actions/

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