Tuesday, August 8, 2017

How do we judge whether treatment is a success or a failure

I think most of us assume that a successful course of treatment should result in the patient feeling better in some way.  But in what way?  And who decides what feeling better actually represents?  In Western medical terms the successful outcome of any treatment can probably be judged as being whether the physical symptoms have improved or disappeared.  But when we view things from a less physically oriented point of view, as a five element acupuncturist or a psychotherapist would do, the role physical symptoms play in assessing the success of treatment is much less clear-cut.   

We take it for granted that we are offering treatment for soul as well as for body, and are therefore viewing things holistically, so how do we gauge how successful our treatment has been in helping our patient at the deeper level?  This is a much more difficult question to answer than merely noting that a patient is suffering from less headaches or is sleeping better, and the outcome of treatment may therefore be much more difficult to assess.  We then have to consider more complex questions, such as a patient’s own assessment of how far treatment may have helped them in changing some more intangible aspect of their life.  This could involve something like coming to terms with a past emotional trauma or having the courage to confront an unresolved issue with a partner.  Improvements in these areas of life are difficult to quantify, because they are based on much more subjective criteria, and may often at first hardly be perceived by the patient and only by a practitioner trained to notice what are often very subtle changes..

I learnt a very important lesson not long ago, which has given me a different perspective on the whole issue of what can be considered a failure of treatment.  A patient told me that he had been given my name “by a friend of mine who said you had transformed her life.”  I was puzzled, because I could hardly remember who this former patient was.  Looking up my notes afterwards, I found that she had come for just two treatments and then disappeared.  At the time I had assumed that she had not been happy with treatment, and I therefore listed her amongst those I thought I had not managed to help.  Obviously, though, this was not how the patient herself had viewed things. This taught me that we can never really know how far what we have done for our patients has helped them or not, or indeed what they themselves want from treatment.  It is therefore likely that patients and practitioners will have different criteria by which to judge the success or failure of treatment.  It also helped me understand the importance of not becoming too self-critical, a tendency I think we all have, particularly when we start in practice, because we may not be aware that our expectations are not matching those of our patient.

We must always ask ourselves whether what we assume our patient wants from treatment is actually what they are coming to us for.  Perhaps the few treatments I gave my former patient was all she felt she needed to set her life on the right path again, whilst I might have been considering a different outcome for her.  The very simple but profound treatments of the Aggressive Energy drain and an element’s source points which we start our treatments with can by themselves give a strong boost to the elements and help them regain balance.  An AE drain, for example, is a way of asking the elements whether they have been invaded by harmful negative energy, and, if so, clearing it from the body.  Addressing an element’s source points is one of the deepest and safest ways of stimulating that element’s energy.  These first treatments therefore set the tone for all subsequent treatments, and act as their firm foundation.

Perhaps for some patients, as with my former patient, this simple treatment is all they need.  Others, though, come for more than this, and may be uneasy about being left to sort out their life by themselves without ongoing support from their practitioner.  If this is so, it is a clear reminder that each of us is likely to want something uniquely different from treatment, often related to the specific needs of our element, and that it is the acupuncturist’s task to gauge these needs sensitively and try to satisfy them in the best way possible.

We can also waste a lot of time analysing each treatment in too much detail to see whether we could have done better.  Some good advice I was given early on, which I have found increasingly easy to follow the older I get, is to stop thinking about our patients the moment they leave the practice room at the end of treatment, and not continue to clutter our minds up by taking thoughts about the first patient with us into the next patient’s treatment, or home with us at the end of the day to preoccupy us later on.  Originally I thought that switching off from a patient too quickly at the end of treatment might be doing them a disservice, but I now realise that the opposite is true.  Before the start of each treatment, it is useful to give ourselves time to empty our minds of what has gone before so that our next patient receives the full attention from us that he/she needs, not the half-distracted attention somebody still preoccupied with thinking about the last patient will bring them.  And then when the patient comes back next time we are fully able to concentrate on them once again. 

It is of course natural to continue to think through the events of our day when we have finished practising, but we should try to do this at quiet times and not during the hurly-burly of the day’s activities.  Only then can we clear our minds sufficiently to help us sort out any problems we need to deal with.  All this is easier said than done, but if we are aware of some of the issues which make practising problematic for us, we are half-way to solving them.


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