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Musings From a Senior Practitioner

By Felice Dunas, PhD

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Building Relationships and Referral Networks with Allopathic Practitioners

Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM. He couldn't give a recommendation based on anything other than hearsay from patients and was not comfortable referring to acupuncture. But he was curious.

Sophia had been a chronic pain patient in Dr. Doug's practice for more than a year. She asked him to help her avoid surgery for spinal disc compression related pain, if at all possible. He had her working with multiple modalities to delay, in his mind, the inevitable. Last week, she scheduled an appointment to ask if she could lower her pain medication dosages because she was feeling better. After working with me for a few months, she had a broader range of motion, slept better and had less pain in her lower back, a problem area for years. She also asked if Dr. Doug would be willing to speak to me. She wanted her doctors to be aware of each other's work, to be a team. While it is still not the majority of physicians who are willing to do this, some will avail themselves of, at least, a phone conversation.

Many of us encounter medical doctors this way. Once a patient signs the relevant forms such that you and your patient's MD can speak to one another, you have been given a green light. See how far you can go with it. Doctors know little of what we do, but word has gotten around that we may have something of value to offer their patients and some of them welcome an exchange.

These pivotally important conversations with medical doctors could determine the way they view your work and if they choose to refer patients to you. You may also have opportunity to meet with other practitioners of allopathic medicine including physical therapists, occupational therapists, podiatrists, doctors of osteopathy, psychologists, and many others. The following information is also relevant for meetings with these professionals and potential referral network sources.

The outcome you want

When you have the opportunity to interact with an MD, your goal should be to introduce TCM simply and with researched data. You want them to leave the conversation interested in learning more and comfortable with how medically knowledgeable you are about the patient you are sharing. (This knowledge must be shared in their language, not yours!)

You want your questions answered and a "yes" at the end of each interaction, even if the yes is a five minute follow-up call in a few months as the patient progresses or a "yes" to sending a packet of studies on TCM efficacy relevant to the case you share. You want the door unlocked for more dialogue and information exchange. Don't plan on kicking it wide open in a few conversations or becoming an MD's teacher. Pacing is important. It could take years of demonstrating your ability, asking relevant questions and providing education in very short conversations before an MD feels comfortable or has time to consider referring to you.

You want professional respect, which you can gain by properly presenting yourself, and you may have some specific questions for the MD that you want addressed. To get the answers you want, you must ask questions in a simple and concise manner.

The outcome the MD wants

  1. The goal of every MD is to provide patients with the best care possible. They are legitimately protective of their patients and of the legal responsibility they bear by referring patients to anyone, especially an acupuncturist whose field they do not fully understand.
  2. Doctors want to see that you have the experience, credentials, professionalism, intelligence and language skills to have constructive conversations with them. They want to know you can provide answers and ask astute questions. To provide these things you must show that you:
  3. Respect their time and do not need to take up more than they have to offer.
  4. Are well educated about and respectful of their system of medicine.
  5. Are able to listen to their concerns and respond to their questions thoughtfully, seriously and quickly.
  6. Ask questions that are within the confines of their medical expertise.
  7. Communicate in a language they understand and are familiar with.
  8. Have evidence (they find convincing) that would make your participation a legitimate possibility for addressing certain conditions in their practice. You can't fix everyone of everything. Even if you think you can, don't present yourself or TCM this way. They want specifics.
  9. Are not desperate for their business, are not hard "selling" or trying to convince them of your or TCM's legitimacy. You are merely presenting information and offering them an opportunity to consider it's viability.
  10. Are mature in your perspective and do not put your modality on a pedestal.
  11. Can improve patient results.

Time Sensitivity

Doctors run hard every day and are super busy. They have little time and bandwidth to learn about what you do. They are often in crisis management mode and the bottom line, simple approach is all they have time to hear. The only question they need answered is: "How is your care improving my patient?" They need that answer in a few sentences. In Dr. Doug's case, I had just enough time to say, "several studies have shown that acupuncture helps lower inflammation and increase blood flow in the body. This can lower pain and is, I believe, playing a role in why Sophia's lower back is feeling better. If you would like, I can send you some studies documenting acupuncture's benefits for lower back pain. I am glad I had a chance to introduce myself."  That was almost the whole conversation.

Everything I say must be approached with this understanding. Less is more. The person on the other side of the table or the other end of the phone is time crunched and stretched to the max so make your conversations friendly, much shorter than you would like, and productive.

Do your homework

Research who you are speaking to. As with any business meeting, you should know something of the person on the other end of the phone. There are websites to help you gain information about physicians. These may be related to their individual or group practices, the medical schools or hospitals with which they are associated, peer review sites, etc. I recently shared a patient with an orthopedist who had never teamed up with an acupuncturist on a patient. We worked successfully on a complex shoulder reconstruction patient who was also dealing with autoimmune problems. I administered care before and after the surgery. Having proven myself, as he noted by the patient's surprising speed of recovery, he agreed to coffee. In our 20-minute meeting, I brought up his history as a band drummer. He was delighted I had taken the time to learn about him. How did I know he played the drums? A bio online. It took me only a few minutes of research and one sentence of conversation to break the ice and leave a positive impression. Mentioning his or her papers or unique professional achievements demonstrates your thoroughness as well.

Research how their field of medicine has been addressed by TCM research studies. Find studies that are relevant to any patients you share or to the specialty of that physician's practice. Please note that many doctors do not consider studies from China relevant because some are constructed with the presupposition that acupuncture works. These studies may focus on how well it works in a particular situation or how much better results are if a specific set of points are included. Be careful in choosing your studies. If no studies have been done that fit exactly, present those that are more general, pain control, for example, or post surgical healing time.

Prepare a packet of material/studies for the MD's reference. This may be overkill for a busy MD. But having something like this prepared can help move an already established relationship forward efficiently and impressively. Never push information on anyone unless they welcome it. You can also send bits and pieces of the following:

  1. Your bio, (which you may wish to redo such that is more appealing to an MD).
  2. References/testimonials from other MD's or allopathic medicine practitioners like DOs, physical therapists, occupational therapists, etc., that you have worked with.
  3. Some simple, explanatory paragraphs about how TCM has been used historically to address the kinds of problems an MD with their specialty has seen in practice.
  4. Relevant studies on acupuncture efficacy in similar situations to the patient you are sharing or to their medical specialty.
  5. A brochure. If you are using language that would not enhance your image to a medical doctor, do not include it. You may wish to prepare a brochure specifically for MDs.
  6. Business cards. Many report folders have slots on each side for business cards. If you make a hard copy of these documents, include your card on both the front and back covers. This packet extends your conversation in that the physician has all this info readily available for perusal following a call or in person meeting. If an email is also requested during your meeting, you can send links.

The first meeting

Your first opportunity may be by phone. Ask how much time they have for the call at the outset and make sure you respect their time limit. Say something like, "Well, we have about five minutes left before you need to go. Are their any last questions or concerns I can address for you?" Or, "I have one more question I think you can respond to quickly."

Begin with yin - Listen

You must know whom you are speaking to, what they want to know and how they will best hear you. Asking questions provides you with two valuable tools for a constructive outcome. First, it teaches you what the MD wants to know and what they hope to get from the conversation. Second, it gives you a chance to hear the language with which this person speaks. If you wish to converse well and get information across, it is always best to speak in a similar style to the one with which they approach you. Sample questions include:

  1. What specific questions can I answer for you about this case?
  2. What have you heard about acupuncture from our shared patient/your other patients?
  3. Do you know about some of the excellent studies that have been done regarding acupuncture relevance to your field, this patient's specific problem, etc.? Be sure you have those studies available for reference if you ask this.
  4. Is acupuncture something you have persinally tried or would be interested in experiencing?
  5. May I ask you a few questions about this case?
  6. What  expectations do you have for this patient's improvement?
  7. What do you see as their prognosis?
  8. What are your greatest concerns for this patient?
  9. Is there a message you consider important and that I can support in my conversations with the patient?

Their previous history determines their opinions of TCM, their degree of open-mindedness and how best to approach them. Knowing this gives you a starting place for conversation. If they are less knowledgeable, start with studies that reflect the kinds of patients they have and pepper in a few patient anecdotes that are relevant to the studies.  Anecdotes do not convince MDs as much as studies do. But they must be relevant.

Meeting Follow Up

If the MD says they have an interest in learning more about acupuncture, ask if they would like a brief, in-person meeting. Offer to buy coffee and make it ideally convenient for them. Meet them in their hospital cafeteria, the coffee house in their office building, etc. It may take a year or two or three for this meeting to happen. Don't push it.

Offer to send your packet by mail to extend the benefit of the few minutes you spent together. And if you send an email of your packet or studies during  a phone conversation, be sure to mail a packet anyway. Repetition of exposure is a key element in relationship building, even if they don't read what you send.

Plan  what the follow-up will be during your first meeting by saying something like, "Would you like to touch base again in a few months?" Even if the meeting date and time is not set, this can be helpful in creating a longer term conversation.

Language and Appearance

The concepts behind what we do are not easy to explain or understand. It took you years and you can anticipate that it will take at least that long for someone trained as a physician to "get" TCM concepts. This is why you must use vernacular that is something an MD can be comfortable with. Be able to discuss the anatomy and physiology of the area you will be discussing, be it a joint, a system, as in vasculature, or a gland. Be able to explain how acupuncture works in scientific terms. This kind of explanation can be found on many websites. You will see examples of good and bad descriptions. The important thing is to take the time to see what is out there and use it to put together wording that will be most effective given the circumstances. Your aim is to have TCM make sense to someone who is highly intelligent and doesn't think as you do. That's not an easy accomplishment. The goal of each conversation is to keep the door open for the next conversation. If more gets done, that's great. If not, there is no need to preach your gospel or get every question answered. Less is more.

Social science research documents that people more readily form positive opinions of those who dress and speak as they do. If you meet in person, dress professionally and conservatively. It will make your appearance a non-issue, which is what it should be. You aren't trying to prove a point with your attire. You are transmitting information about your competence, professionalism, personal hygiene, manners, etc. Your appearance is your brand at an in-person meeting.

We have multiple responsibilities when speaking to medical doctors and other allopathic medical professionals about our patients and about TCM. We are the face of our profession. The better we do in representing our work to medical doctors, the more truly integrated medicine will become.

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