A Glimpse of CA In Action

Here is a glimpse of what a typical acupuncture shift is like at the working class acupuncture clinic.

It’s Tuesday morning at 8:00 AM and I have just arrived at the clinic. My shift is from 8:30 to 12:30 and I hope to see around twenty patients this morning. There are 18 people scheduled in ten minute increments and that leaves room for about 4 more call-ins (new patients get two appointment spaces and I have two new patients today).

Sandy arrived a few minutes ago and put out the front door mat and brought last evenings cups into the kitchen. While she unloads the clean cups for the day and re-loads the dishwasher I walk through the clinic and check that all lights, heaters, and fountains are turned on. Once the gas ceiling heater is humming above me I make the rounds and visit each recliner and table to fluff the fleece cover and change out those that need to be changed.

It is now 8:10, I have finished preparing the treatment room and am off to look through my charts for the day. Sandy has photocopied my schedule and put it on my desk and I feel a sense of appreciation to all of our receptionists for all that they do to make my acupuncture work easier. I highlight the new patients on my schedule and then fold it so it fits neatly in my back pocket. With my treatment schedule in my pocket I start to skim through all of my patient charts for the day, noting patients that I am familiar with and patients I will be meeting for the first time. I place my stack of charts on my desk and file through the top layer, taking a moment to memorize the names and chief concerns of the first five patients of the morning.

As I do this the copper bell tied to the front door chimes and I hear the voice of my first patient, who takes a seat at the front desk and begins chatting with Sandy. By 8:25 the first patient has paid and gone back into the treatment room to settle into a reclining chair. I am ready to begin treatments and take a moment to stretch while I let my first patient get settled. As I enter the treatment room I notice that the overhead heater has been on high long enough and I turned it down to keep the treatment room at a comfortable temperature.

I then roll a stool over to my patient’s chair, open a new package of needles, and rub my hands with sanitizer gel. I say hello to my patient, and ask how her hip is doing today. She replies that the pain is around five out of ten (1 is low intensity and 10 is high intensity) but that the location is more generally in the low back since last treatment four days ago and she feels less shooting pain in the hip and down the back of the leg now. I nod and say that I am pleased with the progress thus far. I check her wrist and neck pulses to determine the Jingei ratio and I come up with 2:1, arm, indicating small intestine as the main channel to focus on. Since her pain has moved from specifically sciatic type pain to more generalized low back pain I revise the treatment from last session by a few points and yet maintain a strong focus on treating the Taiyang channels and specifically the low back area.

As I place the needles she inquires about treatment frequency and I tell her that two times per week is still recommended right now since her pain level is over five out of ten. I remark that once the pain has subjectively dropped to a four out of ten for a whole week I would recommend her shifting to one treatment per week. She says that sounds reasonable and as I place the last needle I wish her a good rest. The heat is at a comfortable level now and I move on to the next patient.

I notice two more patients have entered the room and have started to settle into their recliners. As I think back to my list I note that one is the patient I haven’t met yet but who has been regularly seeing another acupuncturist at the clinic and the other across the room is someone I know. Everyone is slightly early this morning and I like that. I greet the next patient by introducing myself and making sure to note his name to be sure it is the patient on my list. I have already read through his chart and ask him what he would like to focus on today. He says that his headaches are back and he has a mild one right now, but his left ankle is feeling much better, so could we do a little bit of both. This patient has lifelong migraine headaches on the right side behind his eye. After weekly treatments for three months the headaches have gone from daily to about once per week if at all, and the intensity of pain has gone from around six to eight out of ten consistently to around two to four out of ten if they come up at all. This patient is very easygoing and I find a quick connection and trust developing as I place the needles. I say nice to meet you and ask him if he wants a blanket before moving to my third patient of the day.

My third patient is a regular that comes in to counter the exhaustion that comes with radiation therapy. She has been working through cancer and the treatment effects are promising, yet each bout of radiation leaves her feeling drained and vulnerable to colds. Today she has a productive cough, clear and thin sputum, and is very tired. She finds that acupuncture helps her make it through each week. She comes twice a week and it is clear that the acupuncture is keeping her going. I know this patient well and as we exchange greetings she is already settling into a restful state. I cover my third patient with a blanket even though the room is warm. Her body needs all the external warmth it can get right now. Once the first three patients are relaxing peacefully, I glance around the room taking in all that is going on. Everyone is resting comfortably so I start toward the charting room in the front of the clinic. I notice my fourth patient is calmly sipping tea and my fifth has just walked through the front entry, sounding the chime of our door bell. I greet them both, glance at the schedule on the front desk and make my way to the back room to chart.

As I think through my first treatment of the morning I jot down “low back pain” under subjective, “2:1, arm channel and wiry” under objective, “focus on small intestine channel” under assessment, and under plan I write: “repeat treatment 11/03/07”, and note the 3 points that were added today and the 4 points that were left out based on the changing location of the pain. For my second patient I put “mild right sided headache behind eye and ankle pain improving, still lateral GB 40 area (Shaoyang)”. Under objective I note “1.5:1, leg channel and slightly rapid pulse”. Assessment is “focus on the gall bladder channel”. For the treatment plan I draw a cross on the page and note the acupoint numbers under each of the four quadrants of the body. At the end of each charted entry I draw a line to the edge of the page and sign my name. It has been about five minutes since my fifth patient came in the door so instead of looking at my third chart I memorize the names and chief complaints of my next 5 patients and leave the charting room to treat my fourth and fifth patients of the day.

As I make my way through the work day in the clinic I develop a rhythm to how I think and move. I am always keeping an eye on the treatment room as a whole while moving from patient to patient. When I notice one of my patients has started to stir from their slumber I prioritize unpinning before starting my next treatment.

Tending to a room full of patients becomes an opportunity to learn how to stay in a flow state while simultaneously developing technical and interpersonal skills as an acupuncturist. When six to ten patients are resting in treatment at one time it creates a palpable restful energy, and I use this environmental influence to stay relaxed and move smoothly through the treatment processes. Clinically speaking, community acupuncture is a mix of making specific health assessments quickly coupled with observing the group of patients as a whole. My day is made up of a series of small moments that when looked at in sequence seem very busy, yet in real time each moment is given careful attention.

I make an effort to talk as little as possible in the treatment room, I remember Lisa referring to this as an economy of dialogue, where you concisely discuss the main points of health issues with your patients on follow up visits. I also make an effort to finish with my current patient within about five minutes when I see that another patient is waiting for me. This awareness of timing maintains the flow, and encourages a smooth pace during the treatment process.

This, in a nut shell, is a typical clinic shift at WCA. Greet patients new and returning, unpin patients when they are rested and ready to move again, allow time for patients to settle into their treatment environment, check in with and needle patients once they are ready for treatment, and chart a little bit here and there as time permits.

This is one example of community acupuncture in practice. I helped 21 patients this shift. Sometimes you start slow and get busier as the day goes on, other times you start with a full schedule and have cancellations. It is a living breathing healing environment that allows people time to rest and heal from so many different stressors that come up in life. This is a busy and dynamic workplace that gives back in many ways both to the individual acupuncturist, in seeing patients get well and express their appreciation, and to the greater community through providing much needed access to healthcare.

- Moses