The Re-Localization of Medicine, or Why I Love This Blog

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.

My friend Dr. Horowitz, whom lots of people met at the October WCA conference, likes to describe what he is doing as “the relocalization of medicine”. What he is doing is running a sliding-scale primary care clinic for patients who don’t have insurance and who are not poor enough to qualify for free clinics. He’s doing this partly because WCA begged him to (we had too many patients who needed to see an allopathic doctor that we didn’t want to send to emergency rooms) but also because he has been a doctor all his life, he had a small-town practice before the advent of managed care, and he remembers what the practice of medicine used to be -- and is disgusted by what it has become. He loathes the interference of third-party payers in his relationship with his patients. He distrusts big corporations because he thinks they have no souls. He believes that you can’t practice medicine without including the soul -- yours the practitioner’s, your patient’s, and the soul of medicine itself.

Souls, while not physical, are still somehow local. We acupuncturists believe that the Shen, or spirit, is housed in the Heart (and the corporeal soul, or Po, is housed in the Lungs --but that’s another story). Pondering the verb, “to localize”, my friendly Roget’s Thesaurus lists as synonyms “to center”, “to embody”, “to strengthen” and “to unify”; and as antonyms “to disperse”, “to dissipate” and “to scatter”. Clinically speaking, dispersing, dissipating, and scattering is exactly what you do NOT want to have happen to your patient’s Shen -- or yours, for that matter. That is exactly what shock does -- it scatters the Shen. One of the lovely qualities of acupuncture is that it can help patients re-gather their Shen after a trauma -- or, as one of my patients said after an acupuncture treatment following a car accident, “Ahh -- I finally feel like I’m back in one piece.”

Every post on the CAN blog has felt like a gift to me, every one like a really big deal. (I bet no one, as they posted , necessarily thought that just by clicking their mouse they were going to make somebody somewhere all emotional -- but take my word for it, you have.) I was thinking about why that was, and I realized that in reading this blog, I feel that I know where people’s hearts are. I can feel what matters to you, and how much it matters. It’s like Frannie’s post about patients giving eggs, and carrots, and handmade kaleidoscopes; something gets mobilized when people give something in a heartfelt way, whether it’s a tangible something like an egg or an intangible something like a sincere reflection on their experience. And when the Heart gets involved, everything changes.

So, okay, that’s lovely, but still, why am I getting all worked up about it? Why am I reading your posts and feeling like a parched plant soaking up rain? It’s not like I didn’t know how committed you all are. Every week I get news and dispatches from people all over the country pouring themselves into the creation of new clinics. What is it about this blog thing? I realized that it has to do with the public discussion of where our hearts are, and it’s a big deal to me because, since the beginning of my involvement with the acupuncture profession, back when I started school in 1991, I have never felt that I knew where its heart was.

Yesterday I went into work early for a meeting, and Sandy, our receptionist, grabbed me and said, “Oh good, there’s somebody here who was really hoping to meet you, and we didn’t think you’d be in until later. Do you have a minute?” The somebody was a very kind practitioner from California who happened to be visiting Portland, and wanted to see WCA. She told me that she has been practicing a variation of community acupuncture for a long time, in that she accepts Medical, which will pay $17 twice a month for a patient to get acupuncture. She teaches at an acupuncture school, and encourages her students to take Medical patients as well. “Oh, good,” I said, “do you teach practice management?” She looked awkward, and explained that she used to teach practice management, but the powers that be replaced her with a teacher who is known far and wide for encouraging students to charge high rates. This teacher actively discourages taking Medical patients. My visitor further explained that she used to teach an ethics class as well, but was removed from that position because she insisted on bringing up as an ethical issue the need to treat patients who couldn’t afford market rates.

I thought about this conversation as I read the discussion of the Hinchey Bill below. If that bill passes, how likely is it that the reimbursement rates for acupuncture will be low, comparable to the Medical reimbursement of $17, twice a month? Pretty likely, I’d say, and let’s leave aside for now the relative futility of treating anybody for anything serious at the rate of twice a month. What is the likelihood then that if the Hinchey Bill does pass, it will be hailed far and wide in the acupuncture world as proof that we deserve inclusion in the healthcare system -- while the vast majority of acupuncturists refuse to accept patients covered by it, because the reimbursement rates are so low?

What do you think?

I’m not a fan of cynicism, and I try to avoid it. One thing I’ve learned as a practitioner, though, is to factor in my own reactions to a patient into that patient’s diagnosis. If I get annoyed with someone, it generally means that something is going on that I need to pay attention to. Patients who don’t interact easily with me often don’t interact easily with anybody else in their lives, either, and that is often both a cause and an effect of the imbalance I’m supposed to be treating. So I’m going to extend this analogy to the acupuncture profession as a whole, and say that I think I’ve never known where its Heart is because it can’t find It either, because it has a problem with its Heart. This is America, after all, where heart disease is a major killer. I would call being chronically angry that we are not included in the healthcare system as a whole, while simultaneously refusing to include the majority of American patients in our care, a major problem for our collective Heart. The acupuncture profession has a problem with embodying sincerity, it has a problem with embodying selflessness, and it has a huge problem with seeing the big picture. All Heart functions, so -- big Heart problem.

The argument is, of course, that the whole inclusion/exclusion thing isn’t our fault. The responsibility lies with the BIG systems -- government, insurance companies, etc, etc.I think that argument de-localizes our medicine and dissipates our Shen. Top-down solutions, like the Hinchey Bill, don’t demand anything from our Hearts. It’s hard for me to trust anymore anything that acupuncturists say that has to do with what we’re entitled to, when it leaves out what we are responsible for, and capable of, regarding our patients and potential patients. As Tatyana posted, according to Trogyam Chungpa Rinpoche, “Dignity comes from using your inherent human resources, by doing things with your own bare hands – on the spot, properly and beautifully”.

And as Blythe posted, “Critical thinking and open frequent communication is essential for making decisions about how best to serve everyone.” Thought and speech are both functions of the Heart. The solution to the problem is us -- sharing experiences, creating metaphors, communicating sincerely, using our collective imagination, and making clinics. The effort that everyone is putting forth in writing, reading, and commenting on this blog is what opens the door for acupuncture in America to re-locate its Heart. Thank you all.