Never let a patient take control in the practice room

It is interesting how often somebody asks me a question or tells me about something which has happened in their practice which illustrates something I have just written or am thinking about.

I just received the following email from Hongmei, a five element acupuncturist in Singapore:

“Last Thursday I had a small issue. One of my patients has been doing the 5 Element treatments for nearly 5 months. I strictly followed the procedure.  But last Thursday she urged me to squeeze her in (that day I was fully booked). I agreed to let her come to see me after my normal work hours. She was very bothered by her sleepless night, and asked me to do the CV GV for her. She had it first time in mid April , and then another time in mid May. Two weeks later I did some other treatment (clearing a different Entry/Exit block, CV14 and Earth source points). She said after this treatment she did not feel well, could not sleep and easily got upset. She asked why and wanted only the CV GV. I explained to her again how 5 Element acupuncture worked. I refused to do the CV GV for her again after I took her pulse , and suggested another treatment. She got very upset and refused to do what I suggested. I let her sleep in my clinic for a while. She then decided to do nothing. I let her go. But I felt awful. I was very tired. My energy was not good. I did not handle it beautifully. But it’s a good lesson. I am learning.”

In reply to this email, I just sent Hongmei the following extract of something I had just written, with the title “Never let a patient take control in the practice room”, a particularly appropriate piece to help Hongmei at the moment, I feel.

A further lesson which I learnt early on from JR Worsley was a very important one that we often don’t confront in our attempts to make the practice room a welcoming place, and that is ensuring that a practitioner must never allow a patient to take control of what goes on in the practice room.  For once we have lost control, it is very difficult to regain it.  Control can relate to many areas of our practice.  It can cover whether we allow a patient to dictate to us which points they will allow us to needle, at what intervals treatments should be spaced, whether or not we need to answer their questions about the treatment we are giving, and whether they choose not to answer our questions.  If we allow the patient to decide how the treatment will proceed, each of these situations is potentially one where we are assuming that they are the ones who know what needs to be done.  This is of course never the case, and is particularly true in the always tricky case of treating a fellow practitioner or somebody with some knowledge of acupuncture.”

Reading through what she has written carefully, I see that there are a few things that I would like to point out which might help in future, apart from the obvious fact that she seemed to allow her patient to interfere in the treatment more than is wise. 

1. We shouldn’t need to explain our selection of treatments to our patients, because this is to draw them into the practitioner role, something which it is always unwise for us to do. 

2. Then there is rarely, if ever, a need to clear a CV/GV (Ren Mai/Du Mai) block more than once, provided we are sure we got the points the first time.
3. There are many reasons why patient say that they don’t feel good after a treatment.  It’s unusual, because all the elements like being helped, but often it is a way of a patient trying to control the treatment, and should not be regarded as evidence that we have given the wrong treatment.  Patients have all sorts of different motives for not wanting to acknowledge the success of treatment.
4. “She refused to do what I suggested.”  As soon as a patient refuses to allow us to do the treatment we think is necessary, we must immediately stop treatment (after all they are in effect withdrawing their consent to any further treatment).  At this point, Hongmei should have told the patient she could not help her any further.  She should certainly not have let her “sleep in (her) clinic for a while”. Allowing the patient to sleep in the clinic sounds as if Hongmei was worried by her patient’s reaction, and was trying to placate her – never a good idea

What I admire about Hongmei’s account of this interaction with her patient is her honesty in seeing that she did not handle the situation well.  When she reads the remainder of my blog from which the extract above is taken (see my next blog), she will see that I give my own examples of how I, too, have often lost control in the practice room, and therefore failed to help my patients.  We all live and learn, as I do after all these years in practice.