The Spongebob Paradigm

If you have watched anything on TV in the last 10 years, you have probably encountered Spongebob Squarepants at some point in time. A ridiculous, irascible sponge who lives in a pineapple under the sea in the town of Bikini Bottom. He is joined by his buddy Patrick the Starfish, Sandy the Squirrel, his boss Mr. Crabbs, and of course the evil Plankton. The foil to Spongebob's effervescence is his neighbor Squidward – a moody, unfulfilled octopus. At best the show is just plain ridiculous, but I have to admit that sometimes it is a great brain purge. After all, laughter is good medicine.

While walking through our family room a few days ago, my son had Spongebob on. Spongebob and Patrick were upset because their TV was broken and they were going to miss the new episode of their favorite TV super heroes, Mermaid Man and Barnacle Boy. They ran over to Squidward's house and begged to use his TV. Of course Squidward denied their request because he didn't want to watch "some men in silly costumes prancing around, he would rather watch more meaningful programs." He then sat back and turned on a show of men in tutus dancing ballet.

I hope you get the irony of the above story. Arguably, both shows were pretty ridiculous, but the importance was clearly in the opinion of the individual. So what does this story have to do with acupuncture? Quite simply, it has everything to do with our profession.

We have many in our profession who are passionate and enthusiastic about the care we provide, but many on the other side – medical doctors, attorneys, politicians, and patients – don't understand our perspective. We represent a philosophical ideology that does not fit their way of thinking. How can we present our profession in a way that protects our philosophical underpinnings, yet reaches out to those who "just don't know." I don't think there is an easy answer to that question, but I do think the future of our profession depends on how we answer it.

First, I think we have to recognize that many of the medical definitions have been written for us. As acupuncturists, we have our own set of words we like to use, but the reality is that the medico-legal profession has set the standards and alternate vocabulary is not relevant in the big picture. Perhaps the best example of this would be the general term "drug." Typically we thing of drugs as pharmacologics, but in the big picture, a drug can be defined as any substance you provide to a patient to change their health, mitigate a symptom, or promote healing. This definition can very quickly move to include herbals, teas, homeopathics, etc.

I will be the first to say that I am not a fan of pharmacologics. I have seen both my grandmothers pass at the hands of irresponsible medical care. I dealt with serious gastric issues for years as fallout from allergy shots my parents were told I "had to have" in my youth. But in light of the real-world, medico-legal definition, we need to be very clear in how we define what we do.

Another topic that I have written extensively on is documentation. With the impending requirements for medical records, we must make sure that we fully document all aspects of our care: presenting complaints, objective findings, relevant medical information, treatments rendered, care plan, and objective improvement with care. For a long time, relief of symptoms was an adequate patient response, but now the goal posts have moved – we must be able to objectively show how our care provided benefit. That might be a decrease in medications, improved ROM, or increased functional strength – but you must be able to state how your patient benefitted from care beyond just "feeling good."

Finally, I believe that philosophy is vital to our profession. But philosophy is only of value when applied to the real world. I had an experience in a deposition where I had treated a patient for a neck strain injury. I had treated several points along the Bladder meridian, including down in his lower back and legs. Opposing counsel pounced on that as showing my care was irrelevant and not for body areas related to the injury. This had nothing to do with meridian dynamics or flow of qi – but simply body location. The question posed was: "This patient hurt the neck, wouldn't you agree that the leg is not part of the neck . . ." Will you be able to defend what you do in medical terms when that time comes?

Realize that I am not advocating for medical documentation, these are the rules for healthcare in general. We cannot fully participate in the healthcare realm if we do not step up to the plate and play by the rules that every other healthcare discipline does. Regardless of your practice style, personal beliefs, or business arrangement, there is no philosophical compromise to working within the established medico-legal rules.

I love what I do, and I cannot see myself doing anything else, but the reality is that there are a lot of "Squidwards" out there. We need to show that we can step up and fill the void – we are more than just goofy practitioners dancing around. The world needs good healthcare, and acupuncture needs to be a part of that care. The responsibility falls on all of us to meet and exceed the medico-legal norms.

We do not have to sacrifice the history or philosophy of our profession to function within the established healthcare system, but the Squidwards won't hear our message if we don't phrase it in a way they can digest. To meet this end, we need to demonstrate good care with good outcomes, validated by clear documentation, we must show that we are not just "fringe" but a relevant and vital health discipline.