Daring to think our own thoughts

However much we owe to those from whom we have learnt the most, it is one of the fundamental qualities of being a human being that each of us has the right, and I like to think also the duty, to develop our own understanding, and in so doing perhaps move what we have learnt in new directions.  This prevents us from simply repeating robot-like what we have been taught, and gives us space to develop fresh approaches.  It is natural that we will all feel daunted by the expertise of others, particularly those with many more years’ experience than we have, and this may make us believe that we have nothing original to add to what has gone before, but we each have our own particular perspective on our work.

I am thinking about this today, because of an email I received this morning.  It always amazes me how things occur very unexpectedly to move my thoughts in a new direction, this email being one of them.  It was from my lovely young Indian friend, Sujata, who lives in Bangalore.  Sujata is a keen reader of my blogs, and is herself a serious yoga practitioner, always looking for an inspiring yoga teacher to replace the one who unfortunately moved to another town and has left her somewhat bereft.

She told me about an interesting book she had just read in which the author described developments in his yoga practice.  This is what she said about his book:  

“(The writer) outlined his frustrated attempts, what the teachers had said, what he could implement or learn, what he refused to do, and how all this shaped his philosophy and knowledge.  It came at a time (a few weeks ago) when I (Sujata, that is) felt there were no more teachers here whom I could contact (after meeting a highly unsuitable teacher!) and I would just have to proceed by myself, by re-reading the old texts and practising.  It motivated me to think about things I had not thought of for a long time.”   

 

Sujata finished by writing:  “….It was the book about an apprentice that gave me the final push to go ahead, not the books written by masters.”

As I read this, a light went on suddenly in my mind.  I am very preoccupied at the moment in describing the many lessons I have learned over the years which have contributed to help me develop my five element practice.  What I had not until now thought of doing was to include in this writing more about the often difficult personal obstacles I have had to overcome in my practice to reach the point where I am today.  Sujata’s email has provided me with another slant on how I should pass on my experiences.  This should not just describe the valuable lessons I have learnt from others, but also the difficulties I made for myself.  In past writings I have tended to omit these, or have only briefly mentioned problems I encountered in my practice.  Perhaps the time has come, stimulated by what Sujata has written, to describe the five element journey to where I am now in more candid, honest terms than I have done so far.

 

This may well be a help to any reader now struggling with the inevitable confusions and puzzling situations confronting anyone starting out on the hard, but ultimately supremely satisfying road to becoming a competent five element acupuncturist.

Difficulties of dealing with our own element

How does the Fire element make me feel?  This is a more difficult question than when I ask myself how the other elements make me feel, because here I am confronting my own element, and dealing with one’s own element presents challenges and risks all of their own.  One would think that its very familiarity to me would make me feel far more at ease, but oddly this is at the same time both a true and a false assumption. 

In a way I am very easy in the presence of Fire because I can relax and express my enjoyment of life with those who enjoy similar things.  But I find that I am also irritated by just those familiar qualities in other Fire people that irritate me in myself.  So my contacts with Fire are not always the unalloyed delight one might expect them to be.

In looking at the elements over the years I have often learnt a great deal from studying them in those closest to me, my family and friends, as many of us do.  We cannot choose our families, but we do of course definitely choose our partners, and thereby hangs many a tale about our relationship to the other elements.  We also choose our friends.  Unless we have moved from partner to many other partners over the years, our choice of friends will provide us with the largest selection of those we like to be with.  We are likely to have accumulated more friends than partners, and thus have a larger choice from which to learn more about the elements at close hand, and more specifically, to explore what it is about particular elements that has attracted us sufficiently to select them as people whose companionship we enjoy.  For me it has been a fascinating exploration which has yielded surprising results, all of which has taught me a lot about particular elements in general and about my own element in particular. 

I have therefore used myself as a productive tool of learning, which we should all do if we are to deepen our understanding of what distinguishes one element from another.

Never ask a patient how they feel after treatment

It is never good to ask a patient to tell you how they feel at the end of a treatment.  A question such as this is usually a sign that we are looking to the patient to reassure us that we are on the right track.  Patients are not there to reassure us;  we are there to reassure them that we know what we are doing.  What a practitioner is really hoping with a question like this is that the patient will tell them that they are feeling marvellous.

In any case how can any of us put into words how we feel if we are asked?  There is so much involved in our feeling anything, particularly something like the result of an acupuncture treatment, when we are not sure what we are supposed to be feeling.  Being asked is therefore also likely to worry us to different degrees depending on the kind of person we are.  I know that when I have been asked this by some of the several practitioners who have treated me over the years, the question has always thrown me.  Being the person I am, I try to be helpful to whoever is trying to help me, and therefore I will think that I ought to say something complimentary as a way of thanking them for their help, however untrue this may be.  Other patients may think they ought to be feeling something, but cannot detect any change at all, and therefore leave the practice room disappointed.

A practitioner is the one who at the end of a treatment should be observing their patient so closely that they will be able to judge if the elements have responded in some way, always a sign of a good treatment (see my last blog about this).

We are there to help our patients, not puzzle or worry them.

Feeling our way towards a patient’s element

I always say that the work of a five element acupuncturist starts within themselves.  We should always ask ourselves “How does this patient make me feel?”  This feeling must then be linked to all the many other feelings our patients have given us over the years, and which, particularly in the cases of those patients we know we have treated successfully, have added to the pointers to the different elements we have gradually accumulated.

I have had a good example of this from a day I have just spent in Switzerland looking at six patients with two five element practitioners.  It was a productive day, as these days usually are.  I am with people who are keen to learn as much as they can from me, and I have to offer them as much of my expertise in diagnosing the elements and working out a treatment schedule as I can.  So days such as these are always challenging for me, because, unlike when I am in my own practice, I feel compelled to get my diagnoses right in such a short space of time, otherwise I will feel that I am wasting my host practitioners’ time (and money!).  In that sense, a day like this, as with any seminars I have run, has its own particular stress.   

It is by close observation of any changes at the end of each treatment that I receive some confirmation that we are on the right elemental path.  Changes can range from being quite obvious to being so subtle that I am sure that I would not have seen them in years gone by. Yesterday, for example, I observed two quite clear colour changes, one in a Wood and the other in an Earth patient, and a third patient looked much more relaxed and was communicating more easily with us.  There were also marked changes to how I felt about the fourth and fifth patients, as though I sensed that my relationship to them had shifted as their elements responded to treatment. 

Finally, the sixth patient blessed our day by putting the change he felt into words, such a rarity, and valued all the more for that.  This was a young man I diagnosed as Water, who was coming for his first treatment.  After his AE drain and his Kidney and Bladder source points, he stood up and said, with great surprise in his voice, “My feet feel as though they are touching the ground quite differently.”  I love the thought of the Water element sending good energy to connect him with the earth beneath his feet in this way.

This reminded me of what two of my Water patients told me after I had needled IV(Ki)1 on the sole of the foot.  Both said that they felt a rush of energy like a fountain pouring up their body. I remember thinking what an appropriate name for a point this was, Bubbling Spring, confirmation that the ancient Chinese really did understand the actions of the points they named.

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.

 

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.”

 

 

Being incurably curious

I have just passed a lovely sign on the outside of the Wellcome Collection in the Marylebone Road here in London.  Appropriately for its name and for what the Wellcome Collection does, which is focused on medicine and helping the ill, it says in bold letters “Welcome to the Incurably Curious”.  On the bus ride back home I decided that it would be good to adopt this as my own catchphrase, but with a slight modification.  I would amend it slightly to read “Welcome to the Curably Curious”, in honour of my calling as an acupuncturist, because it is our curiosity, in five element terms, which, far from “killing the cat” as the saying goes, helps us to cure.

And curiosity is what we need, an infinite dose of it throughout every minute of our working lives to help us understand our patients better and through this understanding restore them to good health.

I have always been incurably curious, from childhood onwards, staring unashamedly at people to try and fathom what makes them tick and how they relate to others.  I think people have always at some level puzzled me, challenging my Small Intestine to understand what is going on in another person at every new encounter.  I suppose it was therefore only natural that I would eventually gravitate towards a calling which feeds my desire to explore the intricacies of human relationships, however late in my life this was, for I only started practising acupuncture in my mid-40’s, exactly at the midpoint of my life when viewed from my present standpoint.  I am a living example of the dictum that it is never too late to change the direction of one’s life, and that it is often only by passing through the dark days that light begins to shine through.

For I came across acupuncture, or as I like to think somewhat fancifully, acupuncture found me, at a crossroads in my life, with the early part of my adult life, that of being wife and mother, almost behind me, and the next part hidden behind what seemed to me to be an impenetrable fog.  So the moment when I encountered acupuncture for the first time surprised me with its rightness;  it opened a door wide on to a completely new vision of life which has fascinated me, occupied me and preoccupied me ever since.

As a coda to this blog, I have just read the following passage in a book by Barney Norris called Five Rivers meet on a Wooded Plain (a lovely title in itself). This seems to me to describe very acutely what intrigues me so much about encountering other people:

“So I love watching the way another person holds themselves when they are alone and thinking.  Their actions and postures are windows into the vast and secret worlds below the surface of the day around me, the lives of others.” 

I love the thought of those “vast and secret worlds” which surround me.

 

The filter our element lays between us and the world

The more I try to teach people about the elements, the more I realize that over the years I have worked out my own personal, possibly rather idiosyncratic way of interpreting the signals a patient’s elements are sending me, and using these as pointers to a particular element.  I imagine that all experienced five element acupuncturists must do the same.  None of these pointers will be exactly those other practitioners have discovered, because everything we experience has to pass through the filter with which our guardian element envelops us.  Even though some of the impressions we receive from a patient may have some similarity with those which others will experience, we will each put our own interpretation upon them.

I was reminded of this a few days ago when I ran a seminar with Guy Caplan.  He is Metal and I am Fire, so inevitably we see life through two very different filters.  This was emphasized for me when both of us were interacting with a very lively Fire patient.  As usual, whenever I am in the presence of Fire in another person I relax because I can feel that I am on familiar ground.  So this particular patient, though very much out of control Fire, did not prove a problem for me to treat.  On the contrary, I felt I knew exactly how she needed to be treated, which was in a robust, quite challenging way, my Fire, as it were, blazing away to control her overheated Fire.  Guy, on the other hand, told me that he found her exaggerated gaiety uncomfortable to deal with, and would have taken longer to work out how to react to it and contain it.  We can interpret this as hot Fire threatening to melt Metal, whilst hot Fire just makes me feel, not perhaps always completely comfortable to be with, but certainly not difficult to deal with.

This is why as practitioners we should do all that we can to find out what our particular element is, recognize its qualities, make allowances for its weaknesses, and take all these factors into account when dealing with our patients.  This is not an easy task, because we all have a tendency to think that when we have an uneasy relationship with our patient the fault lies in them not in us.  It is good to remind ourselves at intervals that this is not so.  Often it is the balance of the elements within us, particularly that of our guardian element, which is shaping our relationship to our patient, and perhaps distorting it in some way which we fail to recognize.

 

 

Our responses to the different elements

At different times we all display the whole range of emotions associated with the five elements.  One way of helping ourselves become more alive to the differences between these emotions is therefore to think back to any situations which have led us to experience them ourselves. 

I am sure we have all at different points in our lives felt ourselves in the grip of fear (Water), longed for some understanding of what we are going through (Earth), become irritated by somebody (Wood), wanted to share our happiness with others (Fire) or retreated into ourselves to deal with some loss (Metal).  At different times we will express each of these emotions reflecting reactions to the different stresses each element is being subjected to, irrespective of what our dominant element is.  We will therefore have at least some inkling of the effects within us of these different emotions.  If we extend this understanding to what we feel a patient of a particular element may experience as their dominant emotion, this will go some way to feeling ourselves into elements which are not our own.  It requires some persistent work to do this in such a way as to give us accurate feedback, but once we recognize how much our work is enhanced by an ability to understand within ourselves the emotional responses of patients of other elements, this will be an enormous help in pinpointing the right element and therefore responding appropriately to its needs.  For each element demands responses which will reassure it that we recognize what these needs are.

It is not only that we all feel more at ease in the familiar company created by our element, and therefore tend to think other people will be as well, we also like to spread our particular emotional sphere around us by trying to draw other people into it on the assumption that this is what these other people want as much as we do.  We therefore live our lives enveloped within a kind of cocoon which our particular element spreads around us, and in which we inevitably seek to draw those who approach us, since this is the emotional atmosphere we are familiar with. 

It is a useful experiment for us as five element acupuncturists to observe our own interactions with others very closely to see what kind of an emotional net we spread around those we meet.  We may be surprised to note, as I was, how often what we are offering others in these interactions is not in fact what they want.  In normal social situations this will not matter too much as we have all become used to accommodating ourselves to whatever the people around us demand of us, and usually manage to shrug off what we find irritating.  In a clinical situation, however, things are very different.  We are not there to demand of our patients that they cope with approaches which disturb them, but to adapt ourselves through our knowledge of the elements to what will make them feel sufficiently comfortable to relax and be themselves.  This is often the opposite of what happens in the world outside the practice room, and unfamiliar as this will be initially as we learn our craft, how successfully we manage to do this will depend upon some persistent work on our part.

Curiosity – a five element acupuncturist’s most important quality

I have always maintained that one of the qualities we must develop in ourselves as five element acupuncturists is being curious about other people (and about ourselves).  Without this, we will never be able to help our patients.  A lack of curiosity is evidence that we are not really looking at them with the depth of interest we need to have to see them as they are.

I was glad to have my belief in the importance of this quality confirmed by something I read in the newspaper today.  A reader wrote the following:  “There are many reasons why we should cherish Albert Einstein.  What a pity then that biographer Steven Gimbel (about whose book there was a review in the Guardian on 13 June) omitted one of the greatest: curiosity.  Einstein is quoted as referring to this important disposition on several occasions, asserting:  “I have no special talent.  I am only passionately curious.”  Perhaps it was curiosity that led this patent clerk to become such a great physicist, and perhaps it is curiosity that our schools should cherish, rather than testing and league tables.”  (Quoted from the Guardian readers’ letter page today, 19 June).

Oh, how I agree with that!  Perhaps I, too, have “no special talent”.  But I am certainly “passionately curious.”  And it is this curiosity which leads me to explore every more deeply the world of the elements within each of us.

Beware of becoming too comfortable in our work

All therapist can fall into bad habits over the years, risking becoming careless in what we do.  One such pitfall is that we may become a little bit too comfortable in our work, not challenging ourselves as much as should do.  We may start to forget that each time we see our patient we see a slightly different person who is altered by the passage of time.  The patient before us is not the same person we saw at the last treatment.  We have to understand the need to see them with fresh eyes, requiring possibly a different approach from us.

It is indeed very difficult to retain a freshness of approach to our patients if they have been coming to us for a long time.   Often we are only too pleased to welcome patients we think are doing well, because we feel they are unlikely to challenge us by presenting us with new problems.  These are patients whose treatment we assume to know in advance.  Here we can be at risk of falling into rather too well-worn a rut if we are not careful, thinking that our patients will be as they were before.  Perhaps unconsciously we ignore the possibility that they may have changed in some way, since changes require us to make more effort.  It is much easier, we may think, to continue doing what we have done so apparently satisfactorily before.

And then we may not see, or choose not to see, something in our patient which should be pointing us in a new direction.  A long- term patient of mine, whose treatment I regarded as being simple to plan ahead for, turned up for one appointment not as I expected her to be.  If I had not been alert, I could easily have overlooked the slight change I perceived in her.  She herself volunteered nothing until I probed a little more and discovered that quite a disturbing event had happened to her, which totally changed the direction of the treatment I was intending to give.  Looking back on this afterwards I realized that I had been in danger of assuming in advance that I would find her as I had done before, and might perhaps have ignored the pointer alerting me to a need to re-evaluate the treatment I was intending to give her, which was now no longer appropriate.  We must never assume that we know our patient’s needs of today, since yesterday may have changed them

 

 

The qualities of a good physician

Heiner Fruehauf has translated part of a very interesting passage from a 1000-year old text about the qualities of a good physician.  To see the whole text, look at his website: www.ClassicalChineseMedicine.org.    

…Every physician should be warm and dignified by nature, humble and respectful by disposition; polite in actions; soft and flexible in behaviour; devoid of self-aggrandizing attitude and without indulgence in pride and extravagance.

…Wealthy and poor patients should be treated with the same level of attention, and those with rank and those without social status should receive the same type of medicine.   

…Nobody should ever be treated the same way – this principle was most important to the wise physicians of old”

These extracts are taken from his translation of A Guide to Children’s Health:  Theoretical Discussions and Treatment Plans, 1156 AD.

I have chosen a few passages which are particularly dear to my heart, the most important to me by far being the last, a precept, I notice, which is closest to the anonymous author’s heart, too.  “Nobody should ever be treated the same way.”

This is one of the reasons why I love being a five element acupuncturist, and why some people find this too challenging a discipline.  No five element acupuncturist can look up in a book to find a prescribed set of points for a set condition.  Each person presents a unique challenge to the practitioner, a unique puzzle, a conundrum which needs to be solved anew at each treatment.  The question each time must be, “What treatment should I give today which meets my patient’s needs of today?”  And, I emphasize, “of today”, because today’s needs always differ from yesterday’s, and differ even more widely from those I diagnosed when first I encountered my patient.  Our anonymous author says, “Nobody should ever be treated the same way”, and I would add, “nor the same way as they were treated when we last saw them.” 

We may be delighted to see how the previous treatments have helped our patient, but we cannot then rest on our laurels and simply repeat what we have done so far.  The patient coming to see us today is different from the one who came yesterday, or last week or last month.  He or she has lived another cycle of minutes, days or weeks, and is thus a different person from the person to whom we bade farewell last time.

And I have often experienced a slight shock when the patient coming into my practice room today appears so different from the one who left me after the last treatment.  Life has added another layer to them, and may either have further burdened them or lifted some of that burden, but will have altered, however slightly or radically, the interplay of the elements within them.  Since time never stands still, the elements which reflect time’s pressure upon us can in their turn never stand still.  And thus our treatments, directed at these elements, have to adapt themselves to take account of these changes.

 

 

 

Treating the whole person

I’ve just read a very interesting article in the Observer with the title “Over-treatment is the greatest threat to western health”.  It ends with a quote from a “visionary American physician and social activist Hunter Adams”, who said “When you treat a disease, sometimes you win and sometimes you lose.  But I guarantee you, when you treat a person, whatever the outcome, you always win.”  The article finishes with the words “It’s time for real “whole person” care.”


This is a subject very dear to my heart, as somebody who regards “whole person” care as the main factor in helping our patients regain their health and balance.  Having myself recently emerged successfully from a life-threatening condition (a subdural haematoma of the brain), with all that it has entailed of Western medical care, by far the most important aspect of the care I received was its “whole person” aspect, the love of family and friends, and the caring attention of the medical staff. 


But I remember thinking to myself when I returned back to normal life that what I had most wanted to be asked by the numerous medical personnel who surrounded me was the simple question, “How are you coping with this?”.  I was constantly asked about my physical well-being, but not about how my spirit was responding to the situation I found myself in.  And, for me, this was what was troubling me most. 


The best example I have ever encountered of the kind of question I would have responded eagerly to was that of a very junior nurse at some hospital visit a few years ago who said at the end of a diagnostic procedure I had undergone, “You hate this, don’t you?”  And I certainly did.  She had paid me the kind of close attention we should all pay our patients, and had made what in five element terms would have been considered to be an excellent diagnosis, saying just the right thing I wanted to hear.  My immediate response was relief that here was somebody who saw me and understood my needs.


This remains for me an illustration of what each of our patients would like from us.  Each must hope their practitioner will have sufficient insight to see their unique needs and have the ability to respond appropriately to these needs, as this young nurse did to mine.

 

Giving advice to patients

I have just received an email from a Chinese acupuncturist asking how she can improve the skills needed to help her patients cope with their problems. She writes, “How to interact with our patients is very subtle and skilful, and a very challenging task for us practitioners.  I really wish I could do better on this, but I don’t know how I could improve… (Their) problems are so tricky that I always have no suggestion to give.  I even sometimes don’t know how to comfort them when they are sad.  I wish I could say something to make them feel better!”


I am sure that every practitioner can relate to what she says, for these are issues we have all struggled with in our practices, and no doubt continue to struggle with.  There is no one approach that will suit all practitioners, because we will each have worked out our own way of dealing with our patients.  As with everything we do, our own guardian element will shape our interactions with our patients and determine the nature of these interactions.  Some practitioners will be much more hands-on in their approach than others (perhaps those with Fire as their element), whilst others will be much less so, giving their patients more room to breathe as it were (perhaps those with Metal as their element).  No particular approach is better than any other, provided that the practitioner is aware at all times of how far what they are doing and saying matches their patient’s needs.


Of course this is where experience comes to our aid.  If I think back on the years of my practice, I realise that there were many occasions when my own very hands-on approach disturbed some of my patients, where allowing a little more space between us would have given them the time they needed to work out their own solutions to their problems.  As with any profession, we can only learn by hit and miss, and only experience will teach us how much advice it is helpful to give our patients, and what kind of advice this should be.  As I mentioned in my previous blog of 2 July (Never assume that we know how others feel), we have to be careful not to assume anything about our patients.


Finally, it is helpful to remember that we are not there to solve our patients’ problems;  only they can do that.  Our help must focus on offering treatments which bring greater balance to their elements, and then allow these to do the work.

 

   

We all want to be heard

I am off to China again with Mei and Guy in a week.  And as usual before I go, I like to think of what stage I have reached in my own approach to my practice, and what will be the main theme around which we will build the two weeks of our seminar over there.  The title which came to my mind this morning was: “We all want to be heard”.


It sounds so simple, put in that way, but actually it is one of the most difficult things of all for us to feel secure enough in our relationship to our hearer to have the courage to open up sufficiently so that what we say reflects truly what we feel, and therefore what is heard by our hearers is truly what we would like them to hear.  What is so important for a good five element practice is that a patient must feel they can reveal what they are really feeling whilst knowing that what they reveal  is being heard and understood properly.  All too often, even in the caring professions, patients’ words become distorted by hearers’ preconceptions. 


So my two weeks with my Chinese students will centre around the importance of allowing a patient sufficient space and time to feel emotionally safe with us, and ensuring that for our part we do not cast our own shadows over our patients so that what we hear is a distortion of the reality.  When a patient feels that what they are telling us is being heard as they want us to hear it, this allows the elements within them to express themselves freely. When we cloud a patient’s elements through incomprehension, we will not perceive them as they truly are, and will therefore be unable to respond to their needs.  Elements can so easily disguise themselves, and, like snails under attack, draw back into their shells when they feel misunderstood.  And this inevitably distorts our diagnosis.


I will use these thoughts as the foundation for our two weeks in Nanning.  This is all the more important because Chinese culture places no emphasis on the importance of allowing patients to open up emotionally, and Chinese practitioners have to be encouraged to dare take their first tentative steps in this direction.  I well remember an incident from a previous visit to China, when an acupuncturist asked me, “But how do I learn to talk to my patients about their emotions?” 


I hope that after a further seminar with us she will be given some more help on how to do this.

 

How much do we owe our patients?

I asked this question of myself just before Christmas when a long-term patient of mine unexpectedly appeared after quite a long absence abroad and expected a treatment at the start of my Christmas holiday period, almost, I felt, as though by right.  In the past I think I would have felt compelled to make every effort to fit him in, even though I was officially already on holiday, and I did a lot of heart-searching along the lines of, “Why did he not have the good sense (and courtesy) to get in touch beforehand to check whether I would be available?”

At the start of his treatment, many years ago, we had done a lot of good work together, and he attributed the regaining of his good health entirely to his acupuncture treatment.  This long and successful association made me feel very close to him, and has in the past persuaded me to make every effort to fit him in on his infrequent and very brief visits to London from abroad.  But when I heard his voice on the answering machine I realised that, with my new-found aim of looking after myself a little more and not placing myself under too much stress, a good Christmas break was more important for my well-being, rather than re-adjusting my schedule to fit  him in at the last minute, as I used to do.  So I didn’t treat him, but suggested he contact a colleague of mine, which he decided not to do.

Each practitioner has to work out the parameters within which he/she works.  Mine, I realise, have not been as rigid and as carefully delineated as I have told my students they should be.  In other words, I am often a bit of a push-over for patients in need.

Perhaps this recent example is a sign that I am at last learning to harden my heart a little more than I have done in the past.

 

The importance of getting feedback from other practitioners

Because it is so difficult to pinpoint one element out of the five which stamps a person’s life with their individuality, we can be guilty of trying to simplify things by sticking to rather rigid guidelines by which we judge the elements. This can become a kind of false short-cut without our being aware of this, and we can then refuse to deviate from these whatever the evidence which should be persuading us to modify our understanding.  We should never say things like, “Oh, this is obviously Wood, “ or, “It can only be Earth”.  We should always say, “I think this is….”, and wait for time and good treatment to confirm or alter our opinion.  

I can still remember my amazement that a patient I was absolutely sure was Fire turned out instead to be Metal when this was pointed out by a tutor.  And I only really began to understand the Earth element’s need to turn thoughts over and over in their mind, when a patient of mine I was sure was Fire proved instead to be an excellent example of Earth.  In both cases, I had to stop myself from expressing my initial reaction, which was “Oh, no, I think you’re wrong”, forcing myself instead to face the fact that I still had so much to learn.

So any five element acupuncturist reading this should take what I am writing to heart.  We always need those with more experience than we have to open our eyes (and ears and noses!) to deeper levels of understanding.  Even now, after more than 30 years of studying the elements, they continue to surprise me with some unexpected display of an aspect I did not associate with them.  Good five element acupuncturists must never mind stumbling around for a time in the unknown, because every new person we meet is an unknown.   

It’s what makes our work so exciting.  That is, of course, one of the delights, to me, of my practice.  Thank goodness it will always be challenging, never boring.

Don't ask our patients to reassure us!

We can so easily fall into the habit of asking for confirmation from our patients that our treatment is helping them.  It is not our patients’ job to make us feel better; it is ours to make them feel better.  So we should avoid asking a question like, “How are you feeling now?” at the end of treatment, because this is usually our way of asking for reassurance.

This is why it is important to remember the following:

1. It takes times for treatment to percolate through, so we should not expect patients to feel an immediate effect. It may takes some days before patients are aware things are beginning to change.
2. Some people are not sufficiently self-aware to register that things have actually improved.  This may be for several reasons.  They may be reluctant to trust that things can get better, or uncertain whether things won’t just go back to being how they were.  They may also be unwilling to admit to any improvement for fear that we may start losing interest in continuing to see them.
3. “Feeling better” is a very subjective assessment of how we feel.  As energy starts to return to greater balance, there may be all kinds of reactions as patients get used to adjusting to the changes inside them.  There is often an unsettling time as patients have to learn to cope with what may be strange new feelings.

The only things we as practitioners should learn to rely upon are our own observations of change (or no change).  We should look carefully at our patients as they leave at the end of treatment to see whether they look any different.  And these changes will always be very subtle, a slightly brighter look in the eye, a brisker way of walking, a slightly warmer smile.

 

I was reminded of this yesterday after I had treated an Earth patient of mine, who came in looking worried and rather depressed, and left looking as if his spirit had received a welcome uplift.  I felt that the person walking out of the door was quite different to the one who came in.  He himself said as he left, without any prompting from me, “I feel much better now”.  This was an unexpected bonus for me, and left me feeling, yet again, what a lovely, yet profoundly simple calling is five element acupuncture.

 

                                                        

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For those interested to know what treatment I gave, it was: GV14 (Great Hammer) (5 moxas), AEPs (back shu points) of Stomach and Spleen, III (Bl) 20, 21, (7 moxas), followed by the source points of Stomach and Spleen, XI (St) 42, XII (Sp) 3, (3 moxas).  When he came in, he looked so resigned in a passive kind of a way that I thought his Earth element could benefit from being given a boost from GV 14, Great Hammer, before I did the AEPs.

Trying not to cast our own shadows over our patients

Yesterday I caught myself talking to a patient about something personal to me, prompted by what the patient was telling me.  As I said it, I realised that I had made a mistake, for I could feel that my remark had slightly changed the direction of what the patient wanted to tell me.  It was as if I had interposed my shadow between the patient and me.

I have often said that we should try to cast as few of our own shadows over those we encounter, because these distort our relationships with them.  This is particularly true of our encounters with our patients, where the need for maturity on the practitioner’s part is at its greatest.  For if we utter an unwise remark or react clumsily, our patient will feel constrained to adapt his/her behaviour, however slightly, to take account of what appears to be a problematic area they perceive in us, and may well hesitate to open themselves up further.  Then the chance for them to feel free to explain themselves without inhibition may be lost, and our relationship with them may descend into the kind of superficial encounter which characterizes much of everyday life.

The practice room should not reflect such superficialities.  It should be the place where the patient feels free not to have to adapt their behaviour to take their practitioner’s personal needs into account. As practitioners we have to learn to remain true to ourselves, whilst assessing with each patient how far it is appropriate to share some of our personal views, but never to burden them with our problems.


 

Latest update from the practitioner treating the patient with lung cancer

See my blogs of 27 February and 7 March 2013

I have just received this heartening email from the practitioner:

“Just thought I'd update you briefly - I have continued to visit my patient twice weekly in the Hospice and he is going from strength to strength, despite a major setback a couple of weeks ago. At that time, he had been doing very well indeed - he was no longer reliant upon oxygen, his breathing was normal, he had good pain control and had regained his appetite. In acupuncture terms, H/W had cleared and I was treating him very minimally, purely on command points. However, things went pear-shaped a couple of days later when his bowels appeared to be blocked - he was eating an enormous amount of food (2500 calories per day) but his bowels had stopped working (probably due to the morphine and other drugs) and nothing was getting through. He was once again in tremendous pain, had a stomach drain in situ, was nil by mouth and was scheduled to have ileostomy surgery. H/W had returned with a vengeance, he was in very low spirits and did not feel up to any needling, so I treated the H/W with acupressure instead.

 

A few days later, I received a message that his bowels had started to work again and that he had a reprieve from surgery - and when could I come to give him another treatment!  At my next visit, once again I was amazed at the difference in him - H/W had disappeared again, and the pulses were the most even to date. This time I cleared AE and finished on source points.

 

I am due to see him again today and he is due to go home on Wednesday all being well, though he will be continuing with his chemotherapy as an outpatient. He feels that the work we are doing together is extremely worthwhile and really looks forward to his treatments, as he says he feels very focussed and strong afterwards, and also relaxed and rested, but energised. Above all, he says I'm probably his only visitor who comes without making any demands, physically or emotionally - for which he is immensely grateful.

 

This experience brings home to me how important it is to be aware of our own emotions and to maintain a balance, especially through difficult times, where words can be superfluous - a mere presence is enough.”

 

I cannot praise this practitioner enough for her courage in keeping things simple and refusing to panic.  As I wrote to her in reply to this email:

 

“It is never easy to treat somebody who is so ill. There will always be times when their health deteriorates suddenly, as their body struggles to cope both with the disease and with the side-effects of the drastic treatment they are getting. But you seem really to be helping him.

 

I love what the patient said about you being “probably the only visitor who comes without making any demands, physically or emotionally”. You can’t have a better compliment!”

 

Nor can we have a better illustration of the rare quality we all need to nurture in ourselves as practitioners and as human beings, too, not to make demands, either physical or emotional, upon those around us which they are unable to meet.