It's never a good idea to try to persuade a patient to continue treatment

I never think it is right for me to answer questions from practitioners who ask me for help in trying to diagnose a patient’s element or what specific treatment to give.  I can only do this when I am actually there with the patient in the practice room.  On the other hand, there are general questions about five element practice which I find useful to answer, and which often stimulate me into writing a blog.  Into this category falls something which a practitioner, Caline Chew from Singapore, has just emailed me about.  I cannot help her with specific questions about the treatment of her patients, but she finished her email as follows:  “…..I don’t know how I can convince (my patient) to stay on the treatment.”

I always say that treatment can only be successful when both patient and practitioner are equally involved, 50% the patient and 50% the practitioner.  It is therefore good to remember that we can never help a patient who is reluctant to receive treatment.  As soon as we sense this, we need to stop what we are doing and address the issue.  Dealing with a patient who openly doubts the effectiveness of our treatment is always disturbing for any practitioner, nor can we do good work if we are not sure what is going on in the practice room.

One of the tips I learnt many years ago from JR Worsley, which I have followed successfully ever since in all cases where my relationship to my patient is under some strain, is always to be honest with the patient, and tell them as soon as I sense that there is a problem.  You need to be brave enough to ask them whether they, too, feel that this is so.  I always preface what I say with the words, “I feel that ….”  Saying this removes any risk of the patient feeling that we are blaming them for what is not right, and gives them the courage to be open with us.  I am then often surprised by my patients’ answers, which may be quite different from what I have imagined.  This frankness between us goes a long way to solve some of the tricky patient/practitioner issues which complicate our work.

So this is the advice I am going to give Caline, with the hope that it will help restore a good relationship with her patient.  I hope, too, that this will clear up some of her own doubts about what she is doing.

 

We should never rely too much on our pulse-taking

An Israeli practitioner, Anton, who is making every effort to deepen his understanding of five element acupuncture, has recently sent me the following interesting question:

I have a question about the husband/wife block. Today I treated a patient and found this block on her. And this is the third time in four months that I make this treatment for her. Well, maybe I am missing something, am I? Does it seem ok to you to have this block back almost every month?

 

This patient delivered a baby four months ago, and the baby has a heart problem from birth. He needs to undergo a surgery on the next week. I explain to myself that all the worry about new born baby makes the block to come back every time, but is it really so? Do you think it is possible, or maybe I need to pay attention to something else?

 

This was my reply to him:

It is very rare for blocks to come back more than once in a short time.  It is most likely that this patient’s pulses are always a little stronger on the right hand than the left hand, so that it isn’t a H/W block.  Just assume that that is what is the case, and don’t treat the block again.

I mulled over his question and my reply for a time afterwards, and realised that I should have added something important.  I myself never rely only on my pulse-taking to help me diagnose a block of any kind. As I have said on many occasions, pulse-taking is a very complex art, much more complex than I think we like to admit to ourselves.  In effect we are attempting to read the state of the five different elements and their 12 officials with what I always like to think of as the rather blunt instruments of our finger-tips.  Of course we get more adept at doing this as the years pass, but I have never forgotten the lessons I learned comparing JR Worsley’s pulse-readings with my own, even after I had been more than 3 years in practice (plus 3 years training myself to read pulses). 

He would tell me one of my patients had an Entry/Exit block or a Husband/Wife block when I simply could not feel this.  Conversely, what I rather simplistically thought to be some kind of a block would turn out not to be that.  In other words the delicate art of accurate pulse-reading was something I realised would take me many years to learn.  And in the meantime I realised, too, that I had to look for other indications in patients which should be helping me suspect the presence of a block.  In the case of a Husband/Wife block, we must never forget that this is the indication of a deep attack on the Heart, and a patient must be showing signs of some desperation, of almost wanting to give up.  They may not articulate this in words, and some may like to hide their despair, but as good five element acupuncturists we should always be looking below the surface to see what is really going on deep inside a patient.

Anton’s patient is dealing with the serious condition of her baby, but not everybody facing something like this would necessarily feel like giving up.  It may not be causing a Husband/Wife block, though it is always worth considering this, and carrying out the treatment procedure for a block even if we are not sure of the pulse picture.  Remember that it never matters if we try to clear a block of any kind, from Possession to a simple Entry/Exit block, if the block is not there.  It is then only like trying to open a door which is already open.  So it is better to err on the side of treating for a block even if we are unsure of its presence, rather than ignoring what might be a block.  On the other hand, once you have treated a block, you don’t need to repeat this treatment if you are sure you got the points the first time.

 

 

 

 

 

 

 

 

 

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.