How Much is Enough?
One of the primary arguments used against acupuncture care is the overuse of treatment. Some people say, "once you go, you have to go forever." I have been in practice long enough to have encountered many patients who say this more than once and understanding the issue must be met with a balanced perspective. After all, the world has changed. Don't get me wrong, I still think that what we offer is fantastic, but the way society as a whole views healthcare is different. We must recognize this issue and approach it accordingly.
I have a good friend that practiced for many years in China. She was paid by the community to help keep them well – if someone got ill, they didn't pay because she had failed to keep them well. How's that for a paradigm shift to modern America? I clearly remember being treated by the same pediatrician who took care of my mom – he was a stately old gentleman who looked a lot like Col. Sanders. He did everything – blood pressure, exam, shots - he even made his own medications there in the office. He was the one my family considered responsible for my healthcare and my family followed his advice. Hey, this was the same guy that took care of my mom 25 years before I was born!
Sadly, that kind of healthcare is dead and gone. If you see the family doctor or pediatrician now, you go through the front desk, then the nurse, then somebody else, then maybe the doc stops in to say "hello," then the nurse comes back in to finish up and direct you to the front counter for payment. Not quite the old school, personal touch of the "good old days."
As much as I miss that level of personalized care, that level of interaction with every aspect of the office encounter is not really possible in today's world. The rules, regulations and requirements have changed greatly. Maybe not as bad in some states, but the requirements to provide patient care have risen across the board. I cannot see my patients, do my exams and notes, render my care – and at the same time handle the front desk schedule, negotiate insurance calls and supervise three other patients doing active rehab. I just can't. That era of healthcare has passed. Notice, I did not suggest that what we do has changed or that our philosophy needs to change – I just have to recognize that the medical, legal and social elements of healthcare in the modern world are vastly different from even 25 short years ago.
People expect a quick fix now. The focus of healthcare is on symptom relief, not necessarily wellness. As acupuncturists, we need to recognize this difference in our patients and when dealing with insurance companies and attorneys. Again, I have not said anything about compromising philosophy or principles – I said recognize the change. There is great value to acupuncture care as healthcare. It is up to us to make that presentation in such a way that patients "get it." When a patient comes in with a specific complaint, I will tell them I recognize that we are going to deal with their specific issue, but also looking forward there is more I can do to help them feel better and prevent those problems from recurring.
Many folks are used to taking their "normal" medications for their "normal" headaches, back pain, etc. Why should acupuncture care be any different – or, even better, why should acupuncture care not be a normal replacement for those other options? What is the problem? What is the pattern interrupt? Simply put, it is us – we as a profession are the problem. To a large extent, many in our profession have so alienated themselves from the mainstream that we become an irrelevant distraction.
Remember Dale Carnegie? He said to approach people in such a way that you bring them around to your way of thinking, but don't berate them and scold them about how they are wrong, no one likes to be told that and more often than not, they will walk away. Again, recognize that I did not suggest to ever compromise acupuncture principles or philosophy. I did suggest that we present the message in such a way that it will be heard, digested, and accepted.
So how much is enough? When it comes to what we do the answer is obvious – we want everyone to embrace the logic of a lifetime of acupuncture as part of their health care. It is our responsibility to recognize where people are in their personal philosophy and to then engage them and explain to them the wisdom of a health-oriented lifestyle. Yes, this does imply ongoing care, but hopefully they recognize that it is reasonable. How often do you see your dentist? Most people see their dentist once every six months. That's ongoing! How often do you take your car in for a lube-oil-filter? Every 3,000 miles. That's ongoing! There is nothing wrong with ongoing care if it has a clear value. Keeping your teeth clean prevents cavities and saves a lot of pain and expense on dental work. tune-up every so often is a lot cheaper than waiting until the transmission falls out and you need a new engine. There is value to care, we just need to show it.
One of the most vocal groups I have encountered about ongoing care is defense attorneys – they expect us to over treat. In reality they should be our biggest ally. When someone is injured, we should be able to clearly define that and provide them a good course of care to get them back to pre-injury status, then release them from that care. (Yes, some people have chronic issues – that is the exception, not the norm.)
Now, one more time, I am not abandoning my philosophy or principles here – release them from care in relation to the injury case, not from care. There is a point where you have reached maximal improvement with the care provided in relation to an injury. At some point, it is expected that the cast comes off, the crutches get put away and the patient goes back to normal life. That does not mean that care stops, but the patient should recognize the value of taking care of their health.
It is not reasonable that a defined injury claim suddenly is on the hook for a lifetime of palliative support. There should come a time when they have reached "pre-injury" and get back to normal health care. If we can't get them better from an injury and back to pre-injury, then what good is the care we provide? The patients can't understand that until we do and it is up to us to clearly explain that. If the patient doesn't see the value in care and doesn't want to pursue care on their own, then we have lost the fight to present ourselves as a good option for health care.
As I shared before, what we do has value, but only as much as we give it. You need to be engaged in your practice every day to promote the services you provide – there is more to acupuncture than just poking holes in the skin or providing the patient with weird smelling herbs. Know the value of the care you provide and promote it. Provide the highest quality services you are able. If we do not promote the value of our profession, someone else will step up to take our place. Be the goldfish in the bowl – set yourself apart as unique and valuable. Don't settle for anything less.