I have developed a kind of calming routine as soon as I experience the tension of not knowing which element to concentrate upon. If I am unable to home in on any particular dominant sensory or emotional signal coming from one element above all the others, I will experience that all-too familiar feeling of slight panic at not knowing what to do next, which all five element acupuncturists will, if they are honest, often feel. I then move into a routine which I have devised for myself in which I slow down what I am doing, and try to put myself back in the position I was in when I first met the patient. In other words I try to see the patient with completely fresh eyes once again. To do this I may concentrate on one of the sensory signals, voice, for example, and just engage in some conversation, not primarily to hear what the patient is saying, but how they are saying it. Or I may make a deliberate effort to smell, maybe by moving the blanket away to get closer to the body. I may also take this as an opportunity to look again at my notes. Doing this helps to insert a pause in what I am doing, since I have to page through the file and there has to be silence whilst I am reading. The patient, lying quietly there, is not aware of any hesitation in me, seeing only that I am absorbed in reading my notes and therefore is more likely than not to be pleased that I am taking so much time and care over them rather than, as I might worry, becoming impatient.
In fact the cultivation of periods of silence when nothing is happening except in the practitioner’s mind is a good practice to follow. It allows the patient to relax and the practitioner to think unhurriedly. One of the problems we may all have is in believing that we must always be doing something in the practice room, as though action is always a sign that we know what we are doing. If we don’t know what to do, because we are not reading the signals coming from the patient clearly enough to work out what treatment we need to do, we must give ourselves time to think, without feeling that our silence will be interpreted as incompetence by the patient.
I have always been quite happy, too, with admitting to a patient whose treatment appears not to be progressing that, as I have learnt to put it, “there is something here which I don’t understand”, and asking them whether they are happy to give me the time to work this out. No patient has ever been anything but delighted that I am prepared to give them so much of my time, and all have been happy to agree to coming more frequently for treatment if I think this is necessary, until I have worked out the direction I want treatment to take. For it is unprofessional if, knowing that we are unsure where treatment is going, we then agree not to see the patient for quite a long time, say a month ahead. This only delays the time we will take to get our treatment focused properly, and does nothing but increase the level of our uncertainty, since we have too much time to worry over our patient, with no feedback from seeing them to help us.
We should instead openly discuss our uncertainty to the patient, and ask them to give us the time to work out what we need to do. In such a situation it is essential that we see the patient as frequently as possible, because this gives us the opportunity of looking at them afresh and with these new eyes seeing the elements within them more clearly. Nor should we worry, as some of us do, about our patient’s finances here. We should leave it to them to say whether what may be an unexpected return to frequent treatments is making things financially difficult for them and, if so, perhaps we should consider reducing our fees for a short time. In the long run this saves patients both time and ultimately money since the frequency of treatment now will reduce the overall time the patient needs to come for treatment.