I have written in past columns on the importance of listening in clinical encounters with patients. Most often we tend to consider the skill of listening to be focused on the intake of subjective and objective signs / symptoms the respective patient is experiencing and manifesting. This aspect is of course foundational.
The majority of my patients consistently express gratitude and appreciation for my offering of ample time each appointment to allow the patient to explain their suffering, which goes unheard during a typical hurried medical appointment. This month, let’s focus on other areas of listening that are extremely important to allow acupuncture therapy to reach deeper levels of patient satisfaction and clinical efficacy.
Listening to the Point
I touched upon this idea in my previous column discussing the use of intention while needling acupuncture points. I always encourage students and practitioners to not robotically use the same points, but rather “listen” to the unique description and actions of each point and choose accordingly. Acupuncture point prescriptions are skeletons which are to be creatively and intelligently fleshed out for each unique patient.
Take the time to listen to each specific action attributed to an acupuncture point and the point’s meridian influences. There are differences between Sp 3, Sp 4 and Sp 6, for example.
Sp 3 is the shu-stream point of the Spleen channel and tends to focus on deficiency patterns, as well as eliminating pathological issues related to a weak spleen. Shu-stream points are often used to alleviate heaviness and pain in the joints due to dampness. On Yin channels, shu-stream points are connected to the actions of yuan source points and directly treat zang organ disorders; on Yang channels, shu-stream points tend to clear wind and heat. All of these nuances make Sp 3 a unique point.
Sp 4 has a connection to the Penetrating vessel and disorders of qi flow, making its use more common in patterns of excess – quite different than Sp 3.
Take the time to listen to the unique personality of each specific acupuncture point; it’s as important as listening to the unique needs of each patient.
Listening to the Needle
After choosing a specific point, take the time to focus on each point during needling. Notice how the needle reacts to your insertion and how the “arrival of qi” occurs. Does the patient have an instant response or a slow / delayed response? Is this due to the lack of intention in the needle technique or a specific state of the patient’s qi? These are important questions to ponder. The response can reveal something very important if you are listening.
A local physical therapist refers a large number of patients to my practice (which is extremely interesting, as he teaches and uses “dry needling” in his practice). I once asked him why he frequently sends patients to me; his response was: “You seem to be doing something different when you use your needles; and you use less needles.”
He asked if he could discuss my needle technique, During our discussion he said, “I just don’t have the time to take this much time with each needle.” It was a fascinating discussion, as the concept of the “arrival of qi” was not accepted in his clinical mindset.
Each time we needle, we have the opportunity to listen to the whispers of the patient’s body.
Listening to the Patient (During Needle Retention)
Although discussed last in this article’s “sequence of listening,” in reality the patient always comes first – we listen intently and compassionately at the very beginning of the clinical encounter. However, in this particular sequence of listening, “listening to the patient” refers to taking note of how the patient feels during the retention of needles.
I encourage students and clinicians not to simply insert needles and abandon the patient for 30 minutes to “relax.” Ask the patient how they feel after the acupuncture points are inserted. Does any area feel odd or heavy? I always ask after five minutes: “Does anything feel stuck?”
Is there a certain point more reactive than other points? This can be an important clinical clue. Ask the patient and listen to the feedback they offer. This feedback is important and can determine if acupuncture should re-stimulated or removed, or if another point should be added.
I typically monitor my patient every five to 10 minutes over a 30-minute session and adjust frequently based upon the patient’s feedback, as well as the pulse changes.
The many levels of listening that occur during the clinical encounter can significantly impact the efficacy of the acupuncture session and the overall well-being of the patient. Take the time to listen!
