Tuesday, July 25, 2017

What to charge patients

Since my formative years coincided with the birth of the NHS and free medical care for all, I feel deep in my bones that at some level all medical care, including what I offer my patients, should be free.  This has always made me feel uneasy about charging my patients, making it all the more difficult for me throughout my long practice life to know at what level to pitch my fees.  I am, after all, a freelance acupuncturist dependent on my practice income for my financial survival, unlike those working in the NHS who are employed by the state, so charge I must, but how much?  Do I add into this figure the number of years I have been treating, and do I have a standard rate for everybody? But what about those people who can quite understandably not afford the weekly fee needed for treatment?  Hidden within this, to me, vexed question of the level of fees to charge, too, is the conviction that it would be wrong to deny treatment to somebody I could help simply because they cannot afford it.

This problem has bedevilled all the years of my practice, and seems to have grown if anything more acute since my move first from my home practice to the SOFEA clinic in Camden Town, and finally on to Harley Street, of all places, to what is considered to be the pinnacle of medical practice, where I now work amongst those who are happy to charge the most exorbitant fees that I would be ashamed to charge anybody.

My arrival in Harley Street was the result of one of those chance encounters which seem to punctuate my life, and had nothing to do with a desire to work from the very heart of London’s private medical world.  If anything, I would have preferred to move my practice somewhere else, but this clinic just fell into my lap, a chance too good to miss.  I was walking along Harley Street and passed a handwritten notice in a window saying that there was a clinic room for hire.  It turned out to be an ideal place for me and for others from SOFEA, its greatest advantage being our freedom to use moxibustion without other practitioners complaining of the smell, and access to surprisingly large storage areas for the many SOFEA files which needed to be kept for the requisite minimum of seven years.  It also happened, luckily, to be only a few minutes’ walk from my new home.  But as I walk to Harley Street each day, I am aware that I am walking past many medical practices where what I have decided to charge my patients would be viewed as ridiculously low.  What would those working in these very luxurious clinics say, I think, were they to know that I continue to charge some of my longstanding patients the very reduced rates I have offered them over the years, with the occasional free treatment thrown in for good measure?

One of the reasons why the whole issue of fees has proved such a problem for me is because it has a lot to do with my assessment of my own worth, something I am unclear about.  How do I value what I do, and do I put a monetary value on this, and, if so, at what level?  What fee to charge therefore still remains a sensitive subject for me, particularly as a few days ago I happened to note from the web that a former student of mine is charging three times the rate I now charge.  Is she right to do this, and am I therefore being unprofessional not to do the same?  Or is there still some value in retaining the idea that the vocation I have chosen represents my desire to help others, rather than doing it for financial reward?

I realise I have ended up after all these years doing what a tutor during my original training told us not to do, which was to charge different levels of fees for different patients.  He said that this only led to confusion, and he was right.  “Stick to one fee and let the patients decide whether they can afford to pay it.  Don’t make their financial circumstances your concern,” he told us.  And this is what I have always found difficult.   

I have come to the conclusion that my problem with working out how much to charge touches on my dislike of meanness, and its counterweight, my desire to be generous.  I regard treating as a gift I am offering my patients.  To ask them to pay for this is in some senses much like giving somebody a present and then holding out my hand for them to pay for it.  Even though I recognise the need to make a living, to charge the high fees which some would definitely consider appropriate for my many years of practice and my level of expertise represents not the gift I would like to bestow on my patients, but smacks of meanness.  For somebody who would always prefer to give than to receive, this inevitably causes problems, still unresolved within me to this day, after so many years of practice.


Tuesday, July 18, 2017

Not yet finding the right element does not mean that the treatment you give is wrong

I was walking along thinking about the blog I have just posted Nobody likes getting things wrong (13 July), when I realised that I needed to add something to it.  If we are treating a “wrong” element, we may assume that we are doing something wrong.  But that is not what I believe.  We should not condemn any treatment we give as being wrong provided that we follow one of the basic rules of five element practice, and that is to ensure that we are not going against nature by taking more energy away from an already depleted element, or adding energy to an element already with an excess of energy. 

Our pulse-readings should tell us what to do, for they will help us assess the relative level of energy in the different pulses.  Any treatment we then give on whatever element we choose will not only not harm, but will be beneficial, because it will help balance out the different levels of energy between the five elements.  And anything which brings greater balance is to be recommended.

To all five element acupuncturists out there reading this I would therefore say “take heart”.  You can never harm a patient if you let the pulses guide you in this way even if you are unsure which element you should be concentrating your treatment upon.  Pulses alone are unlikely to pinpoint the patient’s element for you, (but you may like to take note here of Peter Eckman’s comments on my blog on Facebook about this). Using your reading of the pulses to help balance the relative strengths of the different elements one to another can help you lose some of your worry about whether the element you have chosen to treat is the “right” one or not.

Finally, in all my years of practice, no patient of mine has ever, I repeat ever, told me that any treatment I had given them had made them feel worse, except when it has temporarily exposed an underlying block, such as Husband/Wife or Entry/Exit, which the appropriate follow-up treatment successfully clears. 

I think nature is very kind.  The elements help themselves by disliking the states of imbalance which lead one element to have too much energy and another too little.  It seems that they try everything to even out any discrepancy in energy between them, which is why the treatment using energy transfers between elements is greeted with such a huge sigh of relief by all the elements.

Thursday, July 13, 2017

Nobody likes getting things wrong

One of the most difficult lessons for a five element acupuncturist is learning to train themselves not to mind when their choice of element eventually turns out not to be the “right” one. I can still remember my feeling of embarrassment when the whole of my Leamington class except for me thought a patient was quite clearly Earth, when I was sure she was Metal.  I remember cringing inside when I realised that there was something in the patient which I had not before then associated with Earth, but everybody else had, and my shame at having to admit this in front of the 20 or so of my fellow students.

I have often baulked at using the words “right” and “wrong” when talking about the elements, because these terms hide within them just this feeling I had in the class of not being good enough, or at least of not being as good as other people.  But there is definitely a “right” element, which is the patient’s element, and eventually “wrong” elements, which are the four other elements which are not this patient’s element.  We have to learn to accept, though, that discovering the right element always takes a lot of time and a lot of experience, but does not come as a result of a flash of insight in a few moments.  It helps, though, to know that the cumulative experience of years of practice undoubtedly speeds this process up.

 I have tried to think of better ways of describing an element as being either the “right” or the ”wrong” one, but have not yet come up with any satisfactory alternative.  So these descriptions may have to stay, despite making us feel just as inadequate as we felt at school when we got an answer in class wrong.  “Not yet the right element” is the nearest I have come to a possible solution, but, although it is an accurate description of the step-by-step process of diagnosis, it does not slip easily from the tongue.  Perhaps with more frequent use, though, it will gradually start to supersede the phrase “the wrong element” with all its unhappy associations.

I have often thought that this is one of the reasons why people hesitate to venture into five element acupuncture.  Other branches of acupuncture seem to display their diagnostic choices in less black and white terms, and can therefore seem to expose their practitioners less to public displays of what they may wrongly feel as their ignorance.

Significantly, though, this, to me, embarrassing lesson in not recognizing the Earth element taught me the most about Earth in the shortest time that I have ever learnt.  As JR would tell us: “You don’t learn anything if you get the element right.  It’s when you get it wrong that you learn the most.”