Current news topics point to the difficulty in ethical leadership. Facebook is criticized after the Pandora Papers leak1 alleged leaders have allowed business policies that may harm users. As acupuncturists and Chinese medicine practitioners, we may not face the same billion-dollar consequences of questionable ethics in our daily business practices, but we face challenges of how to act ethically and survive financially.
We are faced with patients who don't like our treatments, don't get better, don't want to pay us, and are fundamentally in pain. We have staff members who make errors, need corrective feedback and sometimes aren't a good fit for their positions. We must generate enough money to keep our doors open, pay our staff, pay the overhead, and compensate ourselves in a manner that is just as a highly trained professional.
As acupuncturists and Chinese medicine practitioners, I suggest that the "Three Gates" could guide on our ethical practice. The Three Gates have been attributed to Rumi, Buddha, and other spiritual and philosophical leaders. The axiom states that every word we speak should pass through Three Gates: Is it true? Is it kind? Is it necessary?
Applying the Three Gates
Let's look at a small application of this axiom. A staff member needed feedback on safety issues associated with use of electroacupuncture equipment. It was my job to provide this feedback.
Is it true? I formulated the words and asked myself, Is what I am going to say true? We have to make certain that electroacupuncture equipment is turned off whenever there is oxygen in use. The veracity of the words was clear; no argument in the facts of the safety requirements.
"Is it kind?" Now our ethics are somewhat stretched. Kindness isn't just about the words we are saying, but also when we are saying them and how we say them. Would it be kind to give the staff member feedback in front of the patient? No. It was kind to the staff member to pull them aside and provide the feedback privately.
It wouldn't have been kind to say, "You have been trained on this and you are doing it wrong." This is blaming and is unlikely to be well-received by the staff member. Northouse2 supports direct, descriptive feedback and encourages leaders to avoid blame and "you statements."
"Is it necessary?" has even more nuance. In my experience with the staff member, the answer to the question seems clear. Because of safety concerns, the information was necessary for the staff member, the patient and the continuation of my practice. The nuance of the third gate is important to consider when thinking more deeply about ethics.
"Is it necessary?" is a nuanced question because ethical professionals have to think about "necessary for whom / what?" In my example, the words were necessary to address the safety issues. If a patient wanted to discuss that treatment wasn't giving the desired results, the third gate becomes more complex. Perhaps the truthful and kind statement(s) are "You are right, the treatment hasn't yielded the results we were hoping for."
The ethical dilemma in this instance could revolve around the necessity to be honest, but knowing your practice will lose revenue. Losing patients is almost always tantamount to loss of revenue, then a subsequent threat of diminished treatment hours, and diminished hours for employees.
Practice Pearls
It is unarguably ethical to be honest with the patient, and as ethical practitioners, ethical leaders, we must face the discomfort of the "necessity" of being honest, even when it threatens our practice, our revenue and our staff. If the allegations against Facebook leaders are true, it seems that the only necessity they considered was, "Is it necessary for my continued success?"
By sharing these thoughts on ethics and the framework of the Three Gates, I hope acupuncturists and Chinese medicine practitioners can delve deeper into how and why to practice ethically. The Three Gates provides a way to examine our clinical and leadership practice through a deeper lens, considering the meaning of why we do things. How we act as professionals determines how we are perceived by patients and other professionals. Ethical practice can be professionally satisfying when we use the Three Gates.
References
Structured water (H3O2) can be considered a fourth state of water between liquid and solid. It has the hexagonal structure of ice; however, missing a critical bond, it behaves more like a gel than a solid, but retains some of its crystalline structure.
In the past five years of my clinical practice, I have seen an astonishing upsurge in the chronic use of proton-pump inhibitor (PPI) medications for the gastrointestinal issue diagnosed by allopathic medicine as GERD. It is not uncommon to encounter patients taking these prescriptions for five-plus years.
Working with chronically ill patients entails acknowledging the reality that not all patients will survive their diagnosis. Chinese medicine and acupuncture play a crucial role in palliative and end-of-life care, addressing medication and disease side effects, alleviating pain associated with death, reducing anxiety and stress, and helping patients find peace during the dying process.
