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.

 

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.

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.”

 

 

Meaningless mission statements

I often laugh at the slogans companies devise to advertise themselves.  Here are two I have recently seen:

In the Nat West Bank window:  We are what we do.

On the side of a van advertising building work:  Make sure the past has a future

I do wonder who thinks these things up.

In the early days of SOFEA, I was asked by somebody who was helping us with our advertising to think of something which defined what I wanted our school to represent, and I came up with a phrase which I still like:

An ancient form of healing for a modern world

I always felt it had been given JR Worsley’s blessing, because when he read it one day, I saw him nod his head and say, “That’s nice.”

I still think it is nice, and unlike some of the mission statements I see dotted around on every advertising hoarding and on the side of vehicles, I think it still means something.

The Wood element in crisis

As those who read this blog will know, I think both Theresa May and Donald Trump are Wood, and both, unfortunately for the world, appear to be incredibly rigid, unyielding Wood, more stolid oak trees than graceful willows.

I was therefore amused, as well as horrified, by reading this in the Guardian newspaper yesterday about Theresa May:

“Wooden-headedness is a source of self-deception. It is also the defining feature of Theresa May’s prime ministerial stint, and particularly of her “hard Brexit” strategy.  On Europe Mrs May appears to assess a situation in terms of preconceived fixed notions while ignoring any contrary signs.  She then acts on her delusions and does not allow herself to be deflected by facts.  While this might be a good way of winning power, it is not a good way to exercise it.”

And the piece ends with: 

“Wooden-headedness is characterised by a refusal to benefit from experience.  Why not, Mrs May, learn from one’s mistakes and change tack?"

It made me think a little more about how I perceive Wood.  Changing tack, a very nautical expression for changing the sails of a boat to move it in a different direction, is very appropriate for describing the flexibility and manoeuvrability of the Water element.  It is certainly not how I would see Wood moving.  It likes to keep to a straight line, and once on that line is determined to stay on it as it presses onwards towards the future.

We all know that Wood’s function is to do with planning and decision-making.  When in balance these plans will be appropriate and lead to good decisions.  When under stress, which Theresa May always seems to be, the plans, once made, have been rigidly adhered to, and the decisions made on the basis of these plans can easily become the wrong ones.  She has been seen to change her mind suddenly and quite erratically (from a Remainer to a hard Brexiteer in the matter of a few hours, as well as all the volte-faces she has recently made in government). 

I think her dominant Wood official is likely to be the Liver rather than the Gall Bladder.  It appears to be much easier for her to plan (the Liver’s function) than to carry out the plans (the Gall Bladder’s function) by making the right decisions.  Others may see the differences between Wood’s two officials differently.  I have always been reluctant to specify which is the dominant official within an element, because I have always regarded the elements as an almost indivisible whole, the yin and the yang within them indissolubly tied together.  There are, however, definite differences in some elements which I have found easier to see, such as the difference in the Metal element between the Lung and the Colon official (taking in and letting go).

And finally Trump as well!  I need hardly point to Trump in this context.  Enough said, as they say.

 

Interpreting the elements is always a subjective experience

I have been very interested by the comments people have posted on my recent blogs about the differences between Water and Metal.  Some have agreed with my observations, others not.  All have given me something fresh to think about.  They have made me realise that people reading what I write may be assuming that the very personal way I have learnt to interpret the elements over the years is prescriptive, and that they should see and feel things in the same way, rather than what I say reflects my own often maybe quite idiosyncratic approach to the elements.  What I mean by the word prescriptive is that it may be felt that others reading what I write should try and see the elements as it were through my eyes.  I don’t think that this is right or what I would like people to do.  Instead, it is important that everybody develops their own personal filters through which they perceive the elements.  Everything we do, think and feel reaches us only through these filters, and will be interpreted according to what they tell us individually.

What is absolutely essential, though, is that each of us, practitioners as well as anybody else interested in developing their understanding of the elements, subject this understanding to a rigorous system of control.  This is what I have been doing ever since my eyes were opened on to the landscape of the elements spread before me.  I have learnt that I must test carefully my assessment that a person I encounter might at first sight be Earth, for example, against those other people who I have previously thought might also be Earth, and then assure myself that these people have enough in common to warrant being gathered together under the heading of Earth.  Collecting together enough examples of all the elements therefore takes time, and requires a great deal of patience and self-scrutiny as we assess how accurate our diagnoses are.  Being accurate requires us to be very aware that we may often get things wrong, and then be prepared to amend our initial diagnosis.

Some people, of course, will find this the most difficult aspect of being a five element acupuncturist, because we can never really know that we have found a patient’s element until we are offered proof from the results of successful treatment.  As I have often said, what we do is not a calling for the faint-hearted, but, as I have also often added, but it is a calling which, if we persist, brings us incredibly rich rewards.

A headline on BBC news: “Scientists say that they have proof that marriage may be good for the heart”

I love it when Western science, after much earnest research, prides itself on discovering something that we acupuncturists take as self-evident.   Understanding as we do that the Heart official will remain healthy if it is happy, perhaps before we agree totally with this bit of scientific research, we should add an important proviso.  Just as it is likely that happy partnerships will nurture the Heart, is it not just as likely that it will suffer under the effects of unhappy relationships?

Something frivolous for a change (or perhaps not so frivolous)

As light relief from the horrors of this utterly unnecessary election and Brexit, plus the disasters of Trump, I am allowing myself to laugh at myself in this brief blog.

I am of the generation brought up in the real austerity days after the 2^nd world war, when there was nothing available in the shops to buy, and in any case you viewed buying anything which was not absolutely essential as frivolous, and made sure that you saved everything you could.  “Waste not, want not” was the slogan then.  These words popped into my head this morning as I walked, carefully watching where I put my feet on the increasingly uneven pavement (is the local council cutting back on repairing the road as well as everything else?), when I noticed, as I often do, one of the rubber bands which postmen now throw away as they walk on their rounds.  These rubber bands used to be red, but have recently changed their colour to brown.

I am always tempted to pick one up when I see one, because I often need them for all kinds of things, such as packing books together to hand on to my friends, and I baulk at the thought of buying a packet when so many lie discarded at my feet wherever I walk.  And then I thought of how odd it would look to see me bending over from time to time to pick them up (and what if I toppled over again doing this, just as I fell a few weeks ago?).  And should I then wash them to remove the street dirt from them?

So with reluctance I leave them lying sadly abandoned there, although each time I see one a little pang passes through me at the sight of so much waste.

Further thoughts on the differences between Water and Metal (see my last blog on 27 May)

I do a lot of my thinking as I walk.  And I have been doing a lot of walking recently, both because I no longer drive a car (quite deliberately having giving up driving because I’m not sure that all my faculties remain as acute as they need to be to cope with London traffic), and also because, on a more temporary basis, I fell over and bruised my bottom so much that for the past few weeks walking has been a less painful alternative to sitting.  Anyway, on one of these walks I was mulling over my last blog about the differences between Water and Metal, and the following definition just popped into my head:

             Water feels, whilst Metal perceives.

“What is the difference between feeling and perceiving?”, I then asked myself.  You feel through every pore in your body.  It is an instantaneous, immediate reaction to what is going on around you.  Metal, of course, also feels, as do all the other elements, but in a different way;  I do not think it is its first reaction.  With Metal there is a hidden filter between it and the feelings which are being aroused, and this acts as a first stage before the feeling part kicks in.  We know that the Lung filters everything before it allows it through.  At a spiritual/emotional level it filters feelings, too, as much as it filters air at a physical level.  Once feelings are filtered and allowed safe to pass through, Metal then also allows itself to feel. 

This is how I arrived at the word “perceive” for Metal.  It seems to me to be a word which has implicit within it this kind of filtering process - first thinking about something, and then feeling it.

I would be very interested to hear from any Metal people as to whether they recognise this description.  They are perfectly free to disagree with me.  After all, that’s how I continue to learn.

Insights into the differences betweeen the Water and Metal elements

My lovely Indian friend from Bangalore, Sujata, whom I have treated over the past few years on the Water element, has sent me some very acute comments about how she perceives the differences between her own element and the Metal element, which she calls, very correctly, “the medium of air”.

Here is what she has just emailed me:

I was thinking of your previous blogs about observing elements in public places and I watched the swimming pool a bit.  While I was swimming I got the notion (perhaps a little fanciful, I don't know) of the difference between the medium of water and air in terms of connecting to the surroundings.  It is of course easier to see, smell and hear through the air but movements and changes in environment are conveyed sensitively and quickly through water and one can feel them with one's whole body and respond very fast.  This is the kind of antenna a Water person (like me) has, I think.  Constantly sensing the environment (even when apparently at ease or focussing on something, one part is always tuned outwards to sensing), looking for little ripples and trying to re-orient to those, physically or mentally.  Sensing is the very nature of Water, then moving towards or drawing away from, never being able to stand apart in isolation (like an island!).

I love Sujata’s insights, just as I always love hearing those of anybody of the other elements, since they help me understand their element from the inside as it were.  I will never truly understand what it is like to live a life under the protection of the Water element or of the other elements apart from my own, Fire, and even then it is only Inner Fire which I feel I really understand as completely as anybody can ever understand themselves.  So these small openings on to slightly unfamiliar elemental landscapes each helps me grasp a little more how the other elements perceive their lives and therefore adds to my development as a practitioner.