July, 2007

Just back from a week off, five weeks into the opening of the Manchester, NH CAP (genius job scheduling that vacation, I know). A few observations after evening #1 back in clinic...

- Any worrying about taking a week off was foolish, on a few different levels. First, I needed the time away. Second, nobody suffered unduly from a lack of treatment (as patients were given local practitioner contact info, if they felt the need/desire to get treated in my absence) Third, I am booked solid upon my return this week. Any fears of 'losing my practice' seem to be wholly unwarranted...

- Those patients whom I saw tonight that have been coming in 2-3x/week as part of their treatment plan, sustained their gains over the week without treatment, despite being at varying points along Recovery Road.

A couple of comments in the blogs and forums have gotten me to thinking of fees again and how to present them to patients. It seems that more than a few acupuncturists who practice in the Boutique style and some who practice in the Hybrid style have a certain rationale to their fee structure:

A certain fairly high fee, say $50+ a visit, but will go lower than that if the patient can’t/won’t pay that amount. I say “can’t/won’t” because it seems like there is some negotiating taking place, some haggling if you will. Sometimes this is justified as an act of compassion to lower the price; sometimes this is attributed to good business sense ($20 is at least better than having the patient walk out.)

I see a problem with this. This is bad business.

The reason that it is a bad business practice is that in part comes from a lack of understanding of how acupuncture works and in part not realizing that negotiating prices actually turn away customers.

Dear Fellow L.Ac..,

Last Wednesday I had a very interesting day at work. The first part of my interesting day had to do with the fact that WCA is getting our floors re-done (I’ll get back to that part later) and the second part had to do with my business partner, Lupine, being in a really bad mood.

Most of our conventionally practicing colleagues are a little shocked and perhaps put off to hear their practices described as boutique acupuncture. Many probably believe their patients are from a variety of economic classes, some high, some lower, but most in the middle. If they're like I was, they may think it is mostly a mind set that allows one group to pay for medical care out of pocket, while another group rejects anything that isn't covered by insurance. And their experiences may strengthen all these opinions. Most acupuncturists have treated many clients for whom $60-$70 a treatment is a real stretch, but they do it anyway. But they probably haven't treated most of them for very long, or very often. And less acupuncture often equals poorer results.

Lofty title for a blog post, eh? Well, I’m just lifting it from Chapter 9 of the Ling Shu. A little, well, rather large bird, recently told me to give that chapter a read as I try to understand how to use Jingie as a diagnostic tool.

Now, I am not sure if any of you have read this chapter, let alone understood it, but I have quite a few questions about it that I would like to explore. This is really my first crack at the classics so if I say anything too far off base, I’m just taking a novice stab so forgive and correct me. Also, I am more interested in discussing what I don’t understand rather than what is clear to me. Which leaves me a lot to discuss.

The premise of the Ling Shu seems to be creating a document that will communicate the theory of Chinese medicine for posterity. Chapter 9 appears to be one of the meatiest chapters in the whole book in regard to diagnosis and treatment.

Is there a mechanism to evaluate who all is reading these posts?

Is there a way to do outreach on other acupuncture sites refering back to this blog

to cause problems or disturb normal acu channels

or simply kindly inform?

Please discuss

...is pretty much how these last couple of weeks before we open are feeling right about now. But I just feel so damned lucky that the 3rd floor of the firehouse my husband is transforming was already in a relatively renovated state compared to that money pit we almost tried to turn into our workhome. The last minute detail kinds of questions about it that sometimes keep me up at night are only along the lines of:

Do we need a cash register? A safe?
What about a paper towel dispenser?
Where are we going to keep the mop?

Stuff like that. Nothing that we can’t handle by ourselves or by posting questions on the CAN forum. Which brings me to my next topic: the shameless promotion of the Community Acupuncture Network.

When I was in school I was taught that people would only value acupuncture if it were expensive. We were told to charge more than the going rate; so all the patients would think we were exclusive and special. Does that business concept actually work? I was raised in a working/lower middle class neighborhood and I don’t know anybody who would buy into that. Charging prices that most people couldn’t afford didn’t sit well with me.

My blog this month is about Dr. Wei-Chieh Young, from whom I just received a weekend seminar which consisted of many hours of lectures in Chinese (translated by Dr. Christine Chun of Emperor’s College) and a day of clinic divided into two parts. The first part was Clinic Theater, in which four patients were presented to the class with their medical history and current complaints. The second part was set up so that we could treat various patients and receive counsel and supervision from Dr. Young.

Clinic theater was very relevant to our movement, as I noticed that he intake was similar to ours. He sometimes seemed to be asking the Ten Questions, but only if his broad experience was leading him down a particular path, and he was closing in on a pattern. Otherwise he didn’t conduct as extensive an intake as previous Chinese medical teachers. He used three to five needles, left them in at least 30 minutes (as per Master Tung’s technique) and got great results.

OK, I just have to say this is one of those moments when I feel disparate parts of my life magically coming together. In a previous incarnation I was a Greek major (no, NOT the kind that anyone still speaks) and spent many hours poring over arcane texts. (If anyone is wondering, Homer in the original is lots of fun, while Aristotle is sheerest hell. But I have a feeling nobody was actually wondering, so I’ll shut up about all that now.) Anyway, in the margins of those arcane texts were often lengthy apocryphal comments, also in Greek, by some guy who found the original text a few centuries later and felt compelled to scribble around the edges. Often the later guy had no idea who the earlier author was -- but had plenty of opinions -- and modern day scholars made a living making guesses about all of it -- the original author, the later scribbler, what it was all about anyway. Now here I am, almost two decades later, creating my very own commentary on an anonymous manuscript.

For my blog entry this week, I wanted to share two letters that I’ve received recently, because both of them have to do with the public aspects of CAN, and I figure that’s your business, all of you, as much as it is mine, and that they belong here, because this is CAN’s public blog. Here is Part Two.

I have a question that has needled me for some time.

during the rest period of a treatment
we have all gone places

...and sometimes seemingly not at all and of course the healing takes place there my question
do our texts or masters give commentary on this place or travelling?

follow up question:

where do we go together as it relates to the the community setting?

Please excuse my lack of blog dexterity or blog-a-propriateness

thanks

For my blog entry this week, I wanted to share two letters that I’ve received recently, because both of them have to do with the public aspects of CAN, and I figure that’s your business, all of you, as much as it is mine, and that they belong here, because this is CAN’s public blog.

Part One is the following letter, which was not anonymous. I responded, and asked the sender for permission to also respond publicly here. I never heard back, so I’m not going to share the sender’s name, but I am going to share the letter itself, because I think it raises some important issues:

[i]Hello:

I am a huge advocate of what has been labeled "Community Acupuncture" but feel that there is a need to honestly acknowledge its origins. Those of us

Like Lisa's paper about loving one's micro-business, I'm running what I would call a micro-csa and I hope this post is helpful for those of you who are in similar circumstances.

I have a great office space that I share with 3 others (Shiatsu; Ortho-Bionomy; Intuitive Reader). We're all independent yet often refer to one another. We share a common waiting area and a kitchenette w/ laundry!

When was the last time that you found that the simpler an object was the more beautiful it was?

In acupuncture school, students spend hours upon end learning how to decipher complex case studies. We search for the exact diagnosis that our teacher has come upon only to find that our teacher actually changed how they decipher cases since yesterdays class. And though I must admit that it feels good, and I feel rather smart for 30 seconds when I get the correct diagnosis–overall these intricate case studies are not what acupuncture is all about. Acupuncture is much simpler then most of the schools want to admit. And overall, admitting this would require a change in curriculum and a substantial decrease in tuition (which is not happening anytime soon).

Is it a bad sign that on my 3-week summer vacation after my first 3 terms of my very 1st year of acupuncture school, I didn’t think about Chinese medicine for even a second?

I am an acupuncturist.

I am not a receptionist. Nor am I a bookkeeper. Or a human resources director. Or a publicist. Or an administrator. Not me at all. Clinic manager? Ha. Good one. No.

Are we clear yet? I am like most of you. I needle people for a living. I went to school because I wanted to learn to be an acupuncturist and ever since I graduated that's what I wanted to do.

When I was about to graduate last summer, one of my classmates told me that I should check out Lisa’s articles in Acupuncture Today because if he knew anyone that should be doing a community acupuncture clinic, it would be me.

I hail from Youngstown OH. If you know anything about the steel industry, blue collar, union organizing, massive strikes & lay-offs and the first community buy-out of a steel mill…then you should know Youngstown. It is WAH-HUR-KIN CLASS!!!!

Many lifetimes ago, I lived as a squatter-ex- patriot on Flower Island in remote British Columbia. A friend of mine named A (pronounced "eh!"), a Canadian immigrant with a real sense of humor, befriended me and taught me a few things about czars, dictators, secret police, corrupt societies, and the wisdom of blending in with the crowd. He had escaped from Czechoslovakia in 1968 before Russian tanks rolled into Prague.

A was a bard, gypsy, hobo, chess fanatic, clown, comic, Tai Chi practitioner, vegetarian gardener of remote sea bluffs. A taught me that living simply, with dignity, joy, and integrity, had not much to do with money, which was a good thing, because both of us rarely had any.

If you’re like me, you wait and wait and wait and wait for your Community acupuncture practice to grow, and really get busy. You are beside yourself with excitement, it can’t happen quick enough for you.

Then all of a sudden, it’s here, and it’s kickin’ your butt.

Kinda like wanting to be all grown up…. First you’re a teen, then you’re in college, then, boom, you’re 40, and somehow in spite of all that waiting time, you are unprepared.

For the last six months or so I’ve been suspecting that CAN has a disproportionate share of good writers, sharp thinkers, and generous communicators. Two weeks’ worth of collective blogging has more than convinced me that I was right. In this post, I want to comment on parts of the discussion so far, and also reflect on why this discussion is more than the sum of its parts.

Ok, at this point I have either completely lost your attention or you are watering at the mouth. Herbs have that effect on people--you love them, you hate them, mostly though, people just hate loving them. There are problems with the community acupuncture model. There, I said it, and I mean it, so deal. It's a much better solution than the conventional private practice model (but that's really not saying a whole lot, now is it). I'm not going to say much more than that, except to point out that the biggest deficiency in the CA model--for me--is how to fit (real) herbal medicine into 10-15 minute time slots.

One thing that has really impressed and surprised me since starting up our community practice is the generosity we have seen from our clients. This outpouring takes shape sometimes as stuff, sometimes as service, sometimes as good feedback. Getting stuff has also become an experience of being supported.

When someone can see what you need, or could use, and can offer it, there is some deep acknowledgement there. Without blurring the lines of client/practitioner relationships, there is just this sort of kindness that permeates interactions. This feeling of being supported is immensely valuable to me especially when I consider that 8 months ago we didn't know a single person here in Boise, ID.

Taking a break from an incomprehensible packing job to chatter at you. How do you pack lightly when going to a place where the weather may as likely be 85/sunny or 55/thunderstorms! Whew, you can see why I would rather type....

I am heading home (Maine) for my mom's 65th+1/2 B-day. Her birthday was in January and I was knee-deep in creating Communichi so she graciously let us postpone the festivities 6months till now.

The ol' Ball and Chain (that's Lisa Rohleder) pointed out that [url=http://www.tcmstudent.com/main/Hinchey%20Bill%20Moving%20Forward%20for%20the%20First%20Time.html]TCM Student[/url] posted about the improved prospects for the Hinchey bill in Congress with a gratuitous snark at Community Acupuncture (CA), to boot, back on May 25. My apologies for not keeping up with the latest in what TCM Student has to say!

Anyway, that got me to thinking about the Hinchey bill and does it really mean potential doom for CA as we know it as Mr. Student hopes? Honestly, after getting over my laughing spasm, I can't say that it will affect CA even if it does pass. Why?