One of the questions I always ask new patients is, “Have you ever had acupuncture before?“ On many occasions, the response can be smug: “Yeah, I tried acupuncture ... once. It didn’t work.”
As acupuncturists, we are well-aware of the transformational possibilities through a well-structured treatment plan. But how do we ensure that a patient continues with that treatment plan so the patient is medically stable?
There is a danger of “magical thinking” that is more and more common in the medical world and in our profession. Patients are inundated with advertising that implies all of their problems will go away with just one pill. Most health care providers know there are risks with the proverbial “a pill for an ill” treatment method.
Not only that, but it’s easy as an acupuncturist to fall into the expectation we are supposed to provide immediate results that last forever. How do we support our patients to reach their health goals and become medically stable?
One of my favorite questions to ask every acupuncturist is: “What’s the single most important thing to ensure your patient gets better?” Most acupuncturists I have spoken with have tried to dream up different acupuncture treatments, special points, cupping, herbal therapies, nutritional advice, etc.
The key is patient education and scheduling appropriately. But how do you do that in a clinically relevant way that is representative of a medical professional? The answer lies in the most fundamental aspect of our intakes: OPQRST(L).
Creating a foundational understanding of a patient’s chief complaint is not only the essence of creating a successful treatment plan, but also a process of helping our patients understand our services.
OPQRST(L) is how we open the door to patient education while gathering clinically relevant information regarding their chief complaint. It is how we show progress and results to the patient, insurance companies, and other providers, and also ensure we are providing appropriate care. OPQRST(L) is the baseline from which we can navigate. This will also help you communicate with patients who might minimize their results.
What Is OPQRST(L)? Active and Engaged Listening
In doing so, we are asking relevant questions, following up with clarifying questions, palpating as the patient shows us areas of pain, and completing objective measures that include range of motion and orthopedic tests.
It is important to get up out of your chair and explore what the patient is trying to show you. Repeat what they say; not only for your clarification, but also so they can hear their problem.
- O: Onset. When did they first notice these symptoms? What were the circumstances?
- P: Provocative factors, Palliative factors, Prescriptions/OTC medications and supplements, and Providers. What have they been doing about this situation? Who has been on their health care team? What results have they been getting? This is also an opportunity to write a medical report to those providers.
- Q: Quality. What is the quality of symptoms of the patient’s chief complaint(s)? What does it feel like? Also “Quality of Life”: how is this impacting their quality of life? Is it better with acupuncture?
- R: Radiation. Does the pain travel? Where? How does it feel?
- S: Severity/frequency/duration. On a scale of 1-10, what is the severity of pain/symptoms? Ask when the symptoms are at the worst, average, best, and as treatments go on. Always ask about severity/frequency/duration after acupuncture treatments. I recommend keeping a visual analogue scale (VAS) handy in all treatment rooms.
- T: Timing. When do symptoms occur? During what activities or time(s) of the day or night?
- L: Limitations. This is a crucial question that can be overlooked. How is this affecting their life and in what ways? This is an opportunity for patients to realize how their chief complaint is impacting their life.
Always follow up with objective measures. We know our pulse, tongue, and abdominal palpation, but understand there is so much more that needs to be charted and communicated. Review your orthopedic exams. Go through the range of motion for relevant pathologies. Practice using a goniometer. Palpate areas of reported pain, and the associated meridians and muscle groups. Blood pressure can also indicate how pain conditions are impacting their heart health.
At the end of your initial intake, the next stages are going to be helping your patients become “solution aware.” Provided they do not have any red flags that require a referral, you have now created the foundation for a transformational health care experience. Finish up with a treatment plan. Create a short form that includes clear instructions of how to schedule and what tools you’ll be using to help them reach their goals.
Solicit Questions
Remember, you are an expert who has completed a rigorous medical school program. Your job is to offer them your best advice. Be clear how often they need to reschedule and ask them, “Are you ready to get started?”
Give Yourself a Break
Escape from the magical medical mindset trap. There is powerful transformation in the simple act of patient education and appropriate scheduling. We all want to help people quickly, but not at the expense of creating an actual physiologic change that lasts.
Do you know anyone who learned to play a sport or musical instrument in a single sitting? We are creating new muscle and neurologic “memories,” and this can require repetition.
Remember, less than 2% of Americans currently utilize acupuncture per year. We have so much more room to make an impact and help people. Keep working on your communication skills as much as your clinical skills.
