Thursday, April 27, 2017

Absolutely Brilliant Article on Burnout


Thank you so much Katherine for this amazing article.


Vacuous Spleens and Swampy Livers: Burnout in the Acupuncture Profession

By Katherine Kahn
Laura, an acupuncturist and single woman in her late thirties, begins her day by waking up in dread. She feels a wave of exhaustion mixed with anxiety as she heads into the kitchen for a cup of coffee. She thinks of the patients awaiting her at her office today, all of them in varying degrees of discomfort: from angry Mrs. Bankhead, with her livery skin rash, to dying Mr. Engel, nearing the terminal stages of lung cancer. It's a sparkling June morning, and she entertains a nagging compulsion to cancel all her appointments and run off to the beach. On some days, she seriously considers quitting altogether and going back to her more lucrative job as a computer programmer, but she feels trapped by her commitment to her patients and to her career.
Laura ended up studying acupuncture because of the monotony of her career and because she herself had been helped by an acupuncturist. She thought she could fashion a meaningful, satisfying career helping people understand the benefits of Chinese medicine. She didn't count on people not always appreciating her efforts, or that the majority would expect a quick fix from acupuncture. She didn't realize most of her patients would have chronic long-term illnesses from deeply imbedded imbalances. And, being highly intelligent and intellectual, she found herself growing bored needling Spleen 6 for the 20th time that week. Laura also didn't consider that she would feel as isolated in her solo practice as she does.
Laura exhibits the typical symptoms of burnout, but doesn't understand the root causes of her dissatisfaction and what went wrong. So she keeps doing the same thing, day in and day out, developing chronic neck pain, temporal headaches, and experiencing complete exhaustion by the end of the day.
In acupuncture practice, we rarely talk about the phenomenon of burnout, yet being in a helping profession, we are at risk. Indeed, some aspects of Chinese medicine may even predispose us to it. For many of us, Chinese medicine was our chosen dream career: we looked forward to living a lifestyle that embraced our personal and spiritual values, that offered us a great deal of freedom and let us express who we are while still making a living. Yet, our high ideals and expectations may in fact be our saboteurs.
The feelings of burnout are a signal for us to pay attention, an opportunity to learn something profound about ourselves. If we pay attention, we often gain a greater understanding and appreciation for who we are as healers. Burnout is a problem involving negative (and sometimes dysfunctional) attitudes about our work solution, but where do these attitudes come from?
Healing the Unhealable. Although acupuncture school prepared us for treating imbalances in our patients, it did not encourage us to contemplate our own initial calling to the healing profession. It is common knowledge among mental health professionals that people who choose medicine, psychology, ministry and social work as careers frequently have childhood backgrounds of abuse, family alcoholism or psychiatric illness, and other examples of chaotic family dynamics.
Often, we were involved in our families as the child "caretaker," longing desperately to soothe emotional and psychic wounds of the adults in our lives and actually being encouraged in this psychological role as "little parents." We become good listeners, despite the fact that we also become watchful and overanxious. In Dr. Anthony Storr's book Solitude, he says that this "same temperament is not infrequently found in psychoanalysts and doctors, who invite confidences but who are not called upon to reveal themselves."
Many of us witnessed severe illness and disease in our families as children and wanted desperately to find a way to alleviate inevitable suffering, to find a way to control the situation.
Some of us experienced unpleasant or even damaging consequences from Western medical procedures. In our frustration and anger, we vowed to find a better way through alternative medicine and share this with the rest of the world. Among those of us attracted to the healing professions, a strong psychological need to gain and maintain control of feelings and situations is often an underlying personality trait. This may come as a surprise to those who have always thought their desire to be healers as a purely altruistic calling.
Crash and Burn. Burnout arises from this initial draw to the healing professions in several ways, and paradoxically, it is a sign of positive growth. Usually within 1-2 years after being in private practice, it becomes evident to most health care practitioners that they have brought with them an erroneous set of assumptions and inflated expectations about their abilities to effect change and control their patients' illnesses and actions. Most of us then adjust our expectations accordingly, but if we are prone to burnout, we can't adjust.
Almost unconsciously, we continue to expect certain responses from our patients because we are giving so much of ourselves. We expect them to be thankful and appreciative of our efforts, and to be nice to us when they walk through the office door. We expect certain clinical outcomes and are disappointed if that doesn't occur. We become overly attached to the changing feelings and perceptions of our patients. We become attached to results. We hold the irrational belief that if we design the best possible treatment and carry it out, all our patients will recover and heal. When Mrs. Curtis' sciatica vanishes after an electroacupuncture treatment, we are secretly ecstatic. It must have been the treatment. When she comes in the following week saying the pain in her leg is worse than ever, we feel like failures, even when we know intellectually we are not. Again, it must have been something we've done or neglected to do. In our own minds, we have made ourselves too important. We start to resent our patients and their never-ending problems because we realize we have less control over health and disease than we thought.
This can lead to a crisis not only of career but of spirit. Perhaps we become disillusioned with Chinese medicine, blaming it rather than recognizing our own contributions to our attitudes. We are uncomfortable accepting the general ambiguity associated with any type of healing. Are we really helping, or are we just putting a Band-Aid on the problem? Who's to say? What constitutes healing, anyway? These questions form a pathway of spiritual discovery about ourselves and the ambiguous nature of all healing actions.
As an outgrowth of questioning our career, we may also begin to notice that we are being the "caretaker" in other areas of our lives as well. We give to others in our work and in our social and family lives what we, deep down, want to receive. Strangely, we find that even as we begin to realize this, we recognize we have always had difficulties accepting from others that which we want the most. Over a period of time, usually about 3-4 years, we become sick and tired of healing in every aspect of our lives.
Phoenix Rising. If we pay attention, this time can be one of growth and fruition. Recovery from burnout does not happen overnight. It is not simply a matter of taking more bubble baths and going for more walks. It takes time, contemplation, and both physical and mental rest. Chances are you will not be able to do this exclusively on your own, even though it is the tendency of healers not to ask for guidance. Find a counselor or therapist who has helped others with this problem. Your first task is to identify your original calling to medicine. This almost always invokes exploring your childhood, family dynamics, and the past. It is here that you will find the keys to your current attitudes about your work. Once these are elucidated, your possible choices will become clearer.
In addition to exploring how you arrived at Chinese medicine in the first place, you can also take practical steps to help ease your feelings of burden regarding your practice. These also take effort and commitment to implement, but they are useful in feeling more in control of your work in the here and now.
Limit Patient Contact. If you are experiencing sever burnout, one of the first steps you can take to reassert some control in your practice and get some breathing space is to limit patient contact, at least temporarily. This can be accomplished in a variety of ways, and you must decide what feels most comfortable to you. Perhaps an immediate vacation is necessary for your sanity. It is also vital that you schedule routine vacations whether you feel you need them or not. A week or two off every three or four months can help tremendously. Your patients will survive without you and may even admire that you make such healthy choices for yourself!
Many healthcare professionals routinely work a four-day week. It is not uncommon for some to work only three days a week. Whether you create a long weekend for yourself or give yourself a day off in the middle of the week, this extra time can be revitalizing. Examine your work schedule and make concrete decisions as to how to open up extra personal time in your week and on a daily basis, then stick firmly to this new schedule.
Another aspect that can sometimes afford some "trimming" is the actual time you spend actively talking with patients. Although many acupuncturists consider elaborately detailed intakes and thorough client education a vital part of their practice, trying to convince clients that Chinese medicine works or making lengthy lifestyle suggestions can be counterproductive. Have you ever noticed how many clients actually take your suggestions? Of those who do, how many quickly find something wrong with those suggestions? Shorten both your initial intake and the length of time you talk to clients before treating them. You will find you have more energy and won't get so wrapped up in their personal dynamics.
Sharing Feelings. As mentioned earlier, healers often have difficulty sharing feelings, especially negative ones, with others. Finding other practitioners to talk to can often alleviate some of the burdens of our profession. Find other practitioners that you can trust. Talking about your work with someone who may be critical of you, or who is unaware of these issues in the healing professions, can be counterproductive. Choose your confidantes with care. In Western medicine, support groups for burnt out physicians and nurses are commonplace; why not in acupuncture? If you don't have the energy to start your own group, approach a psychotherapist who is experienced in group therapy and request that they start one for healthcare professionals.
Cultivating Detachment. Striving for detachment does not mean becoming callous to the needs of your patients or adopting a "who cares?" attitude. Detachment means to develop an awareness of your self and to observe you are reacting and feeling in your dealings with patients without automatically reacting. Are you feeling anxious about seeing a new client? Do you find yourself plagued by doubts that undermine your sense of self? Are you angry or exhausted? Do you notice how and when these feelings tend to come and go? Detachment is a powerful step toward self-knowledge, and it is a loving step. We can just watch ourselves doing our job and feeling whatever feelings come up, but not holding onto them, or we acknowledge that we do hold onto them. This awareness gives us the capacity to watch others and notice how their feelings may have nothing to do with us at all, even though we can take them so personally. Detachment teaches us we don't have to react defensively when Mrs. Snodgrass comes into our office in a snit. It reminds us not to take ourselves too seriously - we aren't the only healing force in anyone's life.
Another aspect of detachment involves the acupuncture treatment itself. Do you find yourself always striving to perform miracles, or to have Mr. Beidel praise you on how relaxing your treatment is? B.J. Palmer, the founder of chiropractic, taught his students to "take no credit" for positive outcomes of treatment, but to also "take no blame" for patients' continuing symptoms. His reasoning was that practitioners who get caught up in results impair their own abilities as healers, becoming slaves to outcomes. Just doing your acupuncture treatment and letting go of the results can lift an enormous burden from your shoulders. After all, can we really control all factors affecting another person's health? Sometimes patients almost unconsciously desire us to act as though we can. Be careful not to act in collusion with your patient's irrational need for you to "fix" them.
A Lot Going Out, A Little Coming In. Sometimes, the very structure of how your practice is set up can add to feelings of burnout. Are you a solo practitioner who works eight hours a day, five days a week, then goes home to fix dinner for the family; put the kids to bed; and give your husband a foot massage? At the opposite end of the spectrum, do you come home every night to an empty apartment, stick a frozen bean burrito in the microwave, and plop down in front of Seinfeld reruns with a jumbo glass of red wine?
As healers, we spend our days listening to tales of pain and suffering. Unlike a conventional friendly relationship, we don't offer back to our patients what's on our minds unless it has to do with constructive ideas for them. Ethically, we can't turn to our client-practitioner relationships for support or friendship even though we may spend the majority of our days with these individuals.
What are your sources for emotional and creative sustenance in the rest of your life? Sometimes it may seem that our work is the problem when it's actually a lack of balance in another aspect.
Dr. Christiane Northrup, in her book Women's Bodies, Women's Wisdom, describes the areas of everyone's existence that need nurturance: work; friendships; family; nutrition; exercise; community; finances; and creativity. How satisfying is each area of your life? Which areas call out for attention? Because we give so much of our qi in our work, it's critical for our happiness and health that we take the time to maintain other aspects of our life, and that we allow others to give to us. Sometimes, before we make changes in our practice, we must make changes in other areas of our lives.
Working for Pittance. As alternative practitioners, we often remain squeamish about money matters or feel access to health care of any kind should not depend upon a person's ability to afford it. However, if you are suffering from burnout, you must ask yourself, "Does my practice support me financially?"
We hear and know of acupuncturists who have three or four treatment rooms going at once, but most of us are in smaller practices averaging 15-30 patients a week. If we cannot find ways to make our work self-supporting by educating ourselves in (and implementing) business and marketing strategies, we will find ourselves in the burnout-prone position of more going out, not enough coming in. Certain situations in the health care industry set us up for tough financial times. Most of us keep our fees low, charging less than many massage therapists, so patients can afford to come more frequently for the treatments they need. Insurance companies that offer acupuncture to their customers often expect us to discount our services rather than reimburse us the 50-80% that is standard for other licensed health care providers. Hospitals are encouraged in bringing us on board - but only if we're willing to volunteer.
These problems do not mean we can't make a decent living, but they are real obstacles. Therefore, we must be more aggressive in our business strategies if we want to be appropriately compensated for our healing efforts.
Developing Gratitude. When we are stuck in just seeing the negatives of our work situation, we drain our own energy through demoralizing thoughts. These thoughts are also not true reality, but are tainted by our personal perception of the situation. One technique, developed by Dr. John Demartini and described in the book Count Your Blessings, can be used to reawaken a more balanced view of our practice and develop feelings of gratitude and thankfulness for where we are right now and what our practice provides us. Take your time doing the following exercise: First, make a list of 10 things you actually like about your work. Then, create a list of 10 things you hate about it. Next, with the list of things you hate, take each of those statements and write down how that particular aspect has had a positive effect on you. This may be difficult at first. How, you might ask, can I find anything positive in something I dislike? Sometimes the answers that come up may surprise you. In life, no situation is 100% negative, even in the worst set of circumstances you can imagine (including instances of abuse, violence and social injustice). Recall the Taoist theory of yin and yang, in which yin resides in yang (and yang within yin). This most basic of Chinese theories is applicable to our own lives and careers! Let yourself deeply experience the positive aspects you've discovered. By finding the positive in the negative, you will find some of your emotional energy is freed.
As an example of how this works, let's say your first negative item was, "I hate it when I have to deal with toxic, angry clients." How could dealing with difficult people be positive? Perhaps it is an opportunity to watch the feelings an interaction like that brings up within yourself without reacting. Perhaps it enables you to feel better about yourself when you address the situation successfully, or gives you an opportunity to learn how to be assertive without defensiveness. These situations can be true gifts of self-exploration for which we can be thankful.
Take your time and be thoughtful in your consideration of the above exercise. You may find yourself experiencing a new appreciation of how your career as an acupuncturist serves you. This in turn will give you the perspective you need to make choices about your career and where you want to explore the future.
Other Paths. Few of us ever imagined becoming bored with the rich tapestry of philosophy that underlies Chinese medicine, yet once in practice, we find our scope of what we do may be more narrow than we'd originally considered. I remember, when working as an acupuncture assistant, one of my mentors mentioning to me that I may eventually become tired of private practice. I could barely fathom what she was talking about. Now I understand all too well, having done my 400th treatment of lower back pain.
If this is a component of your burnout tendencies, some simple remedies await. Sign up for more continuing education courses. If you have been in practice long enough, teaching is a possibility, as is taking on a student assistant. Writing articles for local newspapers or acupuncture publications can also reawaken your interest in Chinese medicine. Recall that there are many aspects of Chinese medicine - historical perspectives; Taoist religious thought; tui naqi gong; the martial arts - the subject matter is endless. Step outside of the treatment room and pursue some of your original interests.
What Next. Sometimes we do all we can to remedy the feelings of burnout, but to no avail. Perhaps we've struggled with it for months or years with varying degrees of success. We've let go of our unrealistic expectations surrounding our work; found ways to vent our emotions and nurture the rest of our lives; and yet we still end up feeling uneasy about our work as acupuncturists.
It is okay to ask yourself questions. Is this where I really can give what I have to offer? Are my energies well spent in this career, or perhaps in another? Do I need a break?
Typically, no easy answers await, but by now, it should be clear that your range of options is much greater than what you originally considered. Consider also the statistic that, on average, an individual can expect to change careers - not just jobs - five times during his or her lifetime. Perhaps Chinese medicine will continue to be a part of your professional life, or perhaps you will choose a new endeavor. Whatever your next well-considered choice may be, the wisdom of Chinese medicine will have most certainly permeated and enriched your life. Good luck!
References
  • Blevins C. Overcoming professional burnout. The Optimum Institute website, 1998-2000.
  • Demartini J. Count Your Blessings. Boston: Element, 1997, pp. 20-27.
  • Demartini J. Sacred Healings videotapes. 1994.
  • Farmer S. Adult Children of Abusive Parents. New York: Ballantine Books, 1989, pp. 64-67.
  • Nelson VJ. Nurses and burnout. Newsweek website.
  • Northrup C. Women's Bodies, Women's Wisdom. New York: Doubleday, 1998, pp. 577-641.
  • Novack D. Physician's personal awareness may influence patient interaction. Journal of the American Medical Association 1997;278:502-509.
  • Ram D. How Can I Help? New York: Alfred A. Knopf, 1988, pp. 184-216.
  • Storr A. Solitude: A Return to the Self. New York: Ballantine Books, 1988, p. 115.


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http://www.acupuncturetoday.com/mpacms/at/article.php

Saturday, November 14, 2015

Financial Freedom is just an Envelope Away

When I first began working in the finance industry prior to becoming an acupuncturist, I worked with a financial planner whose approach to money management was rooted in the principles of Debtors Anonymous.  Its precepts espouse mindfulness, living on a disciplined budget, incurring no further debt.  Pretty typical for most folks who follow Dave Ramsey or Suzy Ormand's philosophy.  What perhaps separates the DA program from others is the insistence that pleasure and savings must be included in your spending plan, and that as you pay down debt, you don't just roll over the additional cash flow to paying down your next vendor, you in fact spread the wealth to your other categories like vacation, hobbies, savings, educational goals, with an eye to never incurring more debt.  In short, it focuses much more on creating a LIFE as opposed to eliminating debt.  

I have fundamental issues with many of the financial pundits because their focus is on eliminating debt as fast as possible, with not enough attention being given to creating a meaningful budget that can be sustained LONG TERM.  It is almost as if the fact that we have incurred the debt means that we have to wear the proverbial hair shirt and live a Spartan existence devoid of pleasure and beauty until we are debt free and earn the right to have joy in our lives again.  

All work and no play makes Jack a dull boy.
(Remember what happened to Jack Nicholson in The Shining?  Exactly.)



But all work and debt repayment ALSO makes Jack a whim based crazed shopper, leading to impulse purchases and buyer's remorse.  An emergency fund of only $1000 (another Ormand/Ramsey rule) even for a single person is ridiculously small.  (4 tires, a canine UTI, and an unexpected new windshield last year took care of mine last year).  

As a small business owner (firmly steeped in the principles of DA) I didn't know that to begin a business requires capital and that in fact 5 years into my practice I would have over $30K in business start up debt.  Stuff happens, clinics fail or move, cash flow is dicey the first 5-10 years, economic down turns happen.  In fact, I was my own worst enemy in terms of self-flagellation with regard to carrying business debt.  But being steeped in mindfulness in spending, once cash flow was established, those balances were put on automatic payments and basically forgotten about.  I turned my attention to cash flow and creating wealth and in order to do that, I had to include a basic principle that is overlooked by most of financial planners: PAY YOURSELF FIRST.

You are more important than your credit card (or other kinds) of debt.  You, your family, your life.  And in my experience, an eye to wealth creating brings in more wealth.  I had to take my mental focus OFF the debt repayment, and I keep those payments low enough to PAY MYSELF FIRST so that by the time I paid off all my start up debt, I also had a decent amount in savings (which then got used during the downturn in 2009 and 2010, so grateful I had it). 

I didn't start this practice until I had been in practice at least 6 years, and I wish I had done it sooner.  Things are often sporadic in terms of cash flow in a new business, and I tended to squirrel money away in fits and starts rather than in a systematic payment. Things really changed when I started paying myself on the first with an automatic draw into my savings account.  And while it may sound crazy, somehow there was always money remaining at the end of the month even though I took out a chunk for myself and the IRS. This was my first step toward wealth accumulation.

Somewhere in this process, I had the great good fortune to read a book by 
Dr. John Di Martini, noted author and new-age philosopher of sorts, which lifted the emotional charge I had to my business debt years ago and changed everything.  Instead of castigating myself for the CC debt I had engendered starting my business, I needed to reframe how I saw the credit card companies.   These companies (namely Citibank, Chase and MasterCard) were in fact my investors:  they believed in me enough to supply me with the capital I needed to grow my business at a time where no one else would. 

Now you can be cynical about these companies and complain about interest payments, etc. but the fact of the matter is that new business owners do not qualify for business financing through the SBA unless they have been successfully turning a profit for two years and have at least 50K in capitol reserves.  Sorry, but if I had that kind of operating capitol back in the early days, I WOULD NOT NEED THE CREDIT CARDS.

The fact is that Citibank and Chase loaned me that money, and this simple change in perspective allowed me to stop blaming myself and feeling guilt.  I shifted my focus to gratitude that I had been able to have that capitol when I needed it, and gratitude is an incredibly powerful tool in terms of attracting more abundance.   I took advantage of teaser rates and balance transfers as I paid down the balances, but I took my focus OFF the interest I was paying and looked more to creating a sustaining and meaningful budget which supported my life.  Even now that all that is long since paid off, my budget hasn't really changed much in the last 5 years, since my basic needs are being met (I added opera lessons).  Now my attention has turned to long term savings and repayment of student loans.  

I have counseled dozens of students, friends, and colleagues in what I call the "Come-to-Jesus-talk-about-money-and-finance,"  and professionally lecture on these principles at the graduate level.  What I have discovered is that almost no one is taught sound principles about how to handle money in a powerful and confident manner.  The biggest mistakes I see in working with individuals and families is under-budgeting in areas such as food, household or lack of emergency fund, and many times trying to pay down debt too fast.

When starting a mindfulness approach to budgeting, I have found the following tools helpful:
  1. BUDGET BUDGET BUDGET:   Create a savings and spending plan for yourself which includes categories for every aspect of your life.  Jerry Mundis' book "How to Get out of Debt, Stay out of Debt and Live Prosperously" is one of the best books I have ever read on the principles of DA and creating a spending plan, and you can buy a copy used for $1 at Amazon here. He demonstrates how to create a working savings and spending plan which includes both paying yourself first and disciplined debt repayment.  I include categories like vacation savings, gift savings, beauty products, clothing, emergency, pet, entertainment.
  2. Keep a spending journal.  Yes, until you have this down, write down every single purchase for one month. It can be illuminating.  One of my former students was lucky enough that her parents covered her tuition and rent while she was in school. She had basically no financial aide.  She took out some student loan money near the end of school to help cushion the cost of board exams and licensing, and actually ran out of money before the end of term.  I had her go through three prior months of bank statements and list every single purchase.  She came back shocked that she had spent over $6000 going out and drinking beer, a new surf board, impulse road trips, etc.  A spending journal is essential if you don't know where your money has gone.
  3. CUT UP or freeze your cards in a block of ice. (really) I rarely make impulse purchases with cash.
  4. If you don't have 2-3 months of expenses in savings, PAY YOURSELF FIRST until you do.   Keep your debt payments smaller, and create a cushion.  Once that is established, THEN you can focus on paying down the remainder of the debt.  Sitting in the discomfort of carrying debt is also a crucible of sorts, a means of transformation in itself.  "But what about the interest," you ask.  Fugedaboutit!  At least until you have some savings.  Paying yourself first is more important and sets the stage to avoid future debt. (An exception is if you are over your limit and incurring overance charges.)
  5. LIVE on CASH:  If you have trouble with impulse purchases or going over your budget, consider moving to the envelope method in terms of your personal budget.  On the 1st (or the 15th or whatever your pay period is), consider putting cash in envelopes for each of your categories.  I have used this meethod for years and rarely have issues with it.  If there is a month where I splurged on a pedicure, or dinner out, then it may been to come out of another envelope.  If I don't use the money, I carry it over to the next month.   Folks who have big families with kids and pets  also know that unexpected expenses come up with greater frequency so need to allow for that in their budgets.  
  6. When it all become too much, and paying down that bill looks never ending, like my student loans do at times, I have to remind myself to stay in the moment.  The truth is I have enough to last me until I go to bed tonight;  I have a warm bed to sleep in and a roof over my head, running water.  It's a good day, better than for many people in the world.  I am one of the lucky ones.  
I had to be careful not to let the budget become a tool for rigidity or deprivation.  This is a plan, not a sacred tomb found in a burning bush. I have made big financial mistakes (especially in business, yikes!), and if I learn from them then so much the better.  My financial mistakes ironically are sources of unbridled mirth when my former students do the same thing, and I like to think that the fact that I can laugh about it now (when I wept about this 10 years ago) is healing of a different sort.  We all make these mistakes.  We are ALLOWED TO.  
    Perhaps the biggest difference that I learned in the DA program (as opposed to other types of financial approaches) was that miracles happen when we become clear in our approach to money,  regardless of our spiritual path.  But the miracles I experienced were not rooted in the airy-fairy  "I created my vision board and now it will all manifest effortlessly."  No, these miracles were borne out of hard work, sacrifice, and not a little nail biting.   They say courage is just fear that has said its prayers, well I say AMEN brothers and sisters.  Unexpected windfalls and cash flow happened sometimes in the nick of time, and sometimes things got paid off even sooner than I had budgeted.

    For me, moving to a minimalist lifestyle includes an exploration of what is meaningful to me and creating a life that supports that.  It seems that financial clarity was part of that journey even before I started giving stuff away, so I am curious to see how this may change in the future as I strive to simplify further. 

    Saturday, October 31, 2015

    From the Trenches

    RWF ::: NIGHT AT THE MUSEUM (2006) ::: Teddy Roosevelt
    I have renamed my blog to what was always my dream title, and is also the fantasy post-graduate lecture series for other acupuncturists.  

    From the trenches?  Is this a war, you may ask?  

    Yes I think it is. 

    A war of hearts and minds being wrested away from the dependency fostered by an unscrupulous and for-profit medical system. 

    A war away from the misinformation generated by direct marketing to consumers from the drug industry, creating a generation of patients who think that everything can be cured instantly by one little pill without any effort on their part to change things.

     A war of beleaguered and often impoverished practitioners who dearly love their clients, but are drowning under the weight of oppressive student loans and the energetic demands of trying to support their clients while averaging $40 for an office visit.  

    A war against for-profit acupuncture schools who think nothing of raising their tuition to the maximum allowed under federal law every time the federal government raises the lending limits available to students, but refuse to teach them how to successfully run their businesses.

    A war against our own resistance to running professional practices including insurance and workers compensation because no one has stepped forward to show you how it can be done.

    From The Trenches has been simmering on the back burner for years, and is nearly ready for being launched in a bigger way.  Stay tuned!

    Monday, October 12, 2015

    What Price Compassion?

    I had a conversation with a neighbor last night that left me so angry I couldn’t sleep and got me thinking about the nature of compassion in the health profession. My neighbor said that practitioner A was more compassionate that practitioner B because they charged less money. Unfortunately for my neighbor, I went bananas (apologized later) but it really hit a sore spot with me.


    I found myself on the soapbox about the difficulties of practice, and defending my colleagues even though his comments really had nothing to do with me, and they didn't need defending. And since we are never angry for the reasons we think we are, it got me thinking about WHY I reacted so strongly to his assertion that a doctor’s compassion could be measure by the difference in charging $15 and $30 dollars.

    Why IS compassion in our society is measured by how much someone charges? And why is it the expectation that the serving professions such as doctors, nurses, clergy and teachers, to name a few, are expected to do this at the cost of their own financial well-being? As if wanting to serve and help others also implies that we must do this at our own expense? Where did service and poverty become linked?

    As a long term clinician who has gone through multiple levels of transformation regarding my practice and those I serve, this is something I have given a good deal of attention to. Being in private practice is hard and expensive, and in my experience those who are able to stick it out for more than the first 5 years seem to be able to continue by beginning to put limits on how much they give away, or perhaps to recognize their own depth and knowledge. In the beginning, I wanted to be one stop shopping – a place where patients could get a lot of what they needed or at least be directed to other practitioners who could serve them as needed. And in order to further develop that expertise, most of us continue with post-graduate work, advanced degrees, and trips abroad to study with learned scholars, all of it unpaid or without compensation. After a decade or so, many of us have a depth of training that far exceeds anything we learned in school, in whatever modality – MD, chiropractic, massage, energy healer, therapist.

    After about 15,000 patients visits, I realized that the need, the suffering was unending –the well was deep; it will never be done, no matter how much of myself or my personal life I sacrifice, so I better find a way to create a vision for my practice that was more sustaining, that does not burn me out, and that allows my inner child to have the freedom to do other things besides practice medicine (such as go to Italy or study opera).

    Master Usui of the Reiki path in Japan found this out painfully after several years of trying to give away his energy work for free. He found that unless there was an energetic exchange on some level between the patient and the practitioner, many of his clients did not get better. And although it was a difficult change for him, he began to charge for his services. The question of how much to charge and what to include for that charge is a personal one, and a doctor’s compassion cannot be measured by that alone. But I think it is impossible to work at a deficit forever – you cannot constantly give and give without having being replenished in some way, or you will burn out. I find it heartbreaking that so many of my colleagues are leaving the practice of medicine forever in search of greener pastures. This is a tremendous loss – it means we have younger, less trained clinicians available to serve both patients or as mentors to younger practitioners.


    While I feel guilty that my neighbor got the full force of my feelings on the subject, he also did not realize how truly expensive it is to practice medicine, or the amount of sacrifice involved. I don't think compassion can be measured by something so trivial as what we charge for our work, especially in light of an HMO culture that has become accustomed to a $10 co-pay.  Do you realize the fee schedules for ancillary services such as chiro and acupuncture have not gone up at ALL in the last 22 years and in fact have been reduced in most cases.  Many of us stagger under the weight of 6-figure student loans.  Mental health and massage are now not even covered benefits for many insurance holders.    

    In some ways, charging what you are worth is perhaps more a measure of learning to have compassion for yourself in addition to your patients.

    Sunday, September 27, 2015

    What is your goal for treatment? 

    How quickly would you like that to be accomplished?

    This is a question that we really should ask every new patient who comes through our door – and usually the answer seems obvious enough:  “Fix X as quickly and as easily as possible.”  

    It is my role to support and enhance a patient’s treatment  goals, and within the course of treatment to lay down a blue print of balance in the body in order for healing to occur.   In my role as supporter, in addition to acupuncture, moxibustion and massage therapy, I may offer suggestions that, in my experience,  will often speed up the process.   This may include suggestions for chiropractic care, deep tissue massage, dietary changes, supplements or herbs.  A patient is never required to follow these suggestions,  however it may be impossible to meet their treatment goals within the desired time-frame without including them.   These recommendations are made based on over 25 years experience o of training, working with other patients, and treating my own injuries. 

    The truth is I facilitate a healing process that is already trying to come forward into physical expression - yes, the body WANTS to be whole and in balance.  That IS its natural state.  My job is to try and remove the blockages that interfere with that process.  That’s it - notice the emphasis on “try.”  I didn’t say I can.   I make my best effort but I think many patients do not understand the impact that their day to day choices have on their bodies ability to move forward into a  healthy state.   This is partly because often, those day-to-day choices don’t show an immediate effect.  Many times the effects are gradual and cumulative (e.g. years of not stretching or having massage work leading to chronically tight muscles which then don’t heal  after a car accident.)   Because patients  don’t realize it, their medical providers often receive take blame.  It becomes our fault that “Condition X” isn’t resolving in the time frame they want.  

    A patients timeline to recovery depends on so many things which are out of our control:  how serious is the injury, how long have they had it, diet, lifestyle, attitude, psychological fitness, unresolved unconscious anger or other aspects of psychological or spiritual wounding, use of medications and just plain old genetics to name a few.  In truth, what I actually have control over is where and with how much skill can I put the needles (or moxa or use my hands).  In fact, that might be the ONLY thing I have any control over, so at  in my case I strive to do it well.

    Ultimately, I have absolutely no control over the time-frame  of the healing process, and in truth neither does the patient.  While it may be true that their positive actions with regard to their state of health will many times shorten that journey for them, at the end of the day it is really up to something bigger than both of us.  Sometimes a patient gets better in 3-4 visits, sometimes they don’t in 300 - 400.   Sometimes they die. 

    My sensei reminds us to treat to the best of our ability, but to try to let go of the results.  This is found in every tradition on the planet – the notion of surrender to something greater than ourselves.  Daily, I try to offer my service in the hope that it will be for their healing, in whatever capacity.  Sometimes it is as simple as their sciatica or headache goes away, but sometimes it is to render aid and comfort as they prepare for the next stage of their journey, whether that is surgery, childbirth, or death.

    One of my favorite clients passed away a few year ago, and I saw him on and off for about 6-7 years.  In the early days, since he was a very active senior (still digging ditches in the basement in his late 70s), so he would come in for periodic symptom relief of back pain and sciatica.  After he fell off the roof of his house and was seriously injured, he declined rapidly:  his eyesight went, his heart condition became more serious, and he came in more frequently. By the last year of his life he came in about twice a month, and while I felt sometimes powerless to help both his physical decline, and his corresponding depression at the loss of his independence, I also noticed that while he was here, I would hear peals of laughter coming from the rooms as my staff worked on him, he would play with my dog, and he would  grumble on EVERY VISIT about the out of pocket expense of the acupuncture.  However, he would leave chipper and in a much happier state, more steady on his feet and with a much brighter countenance.   I, however, tried everything in the book to try and relieve his pain, would beat myself up about missing this, or that, since it seemed like no matter how much we did, it was not enough. 

    I did not find out until his son called to tell me of his passing that he lived for his visits in the office.  To him, it was much more than medical care – it was  a social outlet, a way to reconnect with the outside world.  I never knew he felt this way because on the outside mostly we heard grumbling about the cost.  It was a reminder that we never really know how we are helping someone, or if we are helping them at all. 

    We become so goal oriented about a certain result, that we miss the fact that simple touch, a hug, or a shared laugh together is ALSO part of the treatment, and often a more important part of the treatment.  

    Monday, July 20, 2015

    That the powerful play goes on.....

    Thank you Uncle Whitman and Robin Williams for the reminder. 


    They always say hindsight is 20:20, but looking back on my motivation to return to graduate school in my 30s to study oriental medicine, I didn't know what I didn't know.  I didn't understand the heartless for-profit nature of the healthcare industry, human nature, or what it meant to care for the sick and the toll it takes on your own psyche over the years.



    Being completely na├»ve about the nature of both patient care and the health industry in general, it was a vision that was doomed to failure on a number of levels.  I didn't know that I would be entering a field that was vastly under compensated and undervalued for the role it plays in the our current healthcare system, or that I would spend 50% of my time wrangling with insurance companies, or writing reports to justify a $25 payment, or dealing with patients who wanted my services but frankly didn't want to pay for them. I hadn't known prior to becoming an acupuncturist that a net income of $40K was considered wildly successful, but that the $122,000 student loan burden would take about 1/4 of my take home pay.   And I didn't understand the role childhood wounding plays in the doctor-patient relationship.   

    All I knew when I started the program was that I wanted to help people naturally, and to help prevent the level of physical suffering that I had experienced after 5 car accidents and some serious autoimmune issues of my own.

    Fast forward 13 years, and the learning continues.  We cannot give from an empty place in any capacity long term without it sucking the life out of us.  While this may not seem the same as a "soul-sucking" job in corporate America that you hate, for most of us, Mother Theresa aside, there needs to be a way to restore and replenish ourselves or at some point our lives will implode, either physically or emotionally.  The reasons you become a doctor (or caregiver of any sort) are not the reasons you stay a doctor.  

    Personally, this came to head on a trip to Paris six years ago (finally Paris!), when I realized that while financially I had achieved an income level that was now meeting my needs adequately if not lavishly, I was more unhappy than I had ever been.  The toll of working 70 hour weeks for the prior decade to finish school and begin my practice, to serve people 12 hours a day in physical, mental and emotional pain while barely earning enough to pursue my own dreams was huge.  In short, I was bitter, angry and resentful of clients, and exhausted with the pressure of being "on" and positive, a health cheerleader of sorts, when inside I was living a life of quiet desperation.  I was in the throes of what I now know, many years later, as care-giver burnout: something which seems to happen in every field of constant one-sided giving (clergy, teachers, social workers, parents, doctors, nurses.... the list is endless).   


    I had finally reached a level of professional competency in my business that I THOUGHT was the magic ingredient to happiness, and in fact had simply substituted a new set of problems for the old ones.   What happens when you reach the seemingly impossible carrot, and you feel worse than before?  Or worse yet, there is a new bigger carrot that I am supposed to want (home ownership for example).


    Something had to change, and evidently that something was me.  


    This has been a long journey, and one I could not do alone.  After wallowing a couple of years being pretty stuck, masking my pain, and suppressing with whatever tools were available (TV, netflix, shopping, outings, food, wine), thankfully I hit a limit.  I was smart enough to enlist the aid of people smarter than myself to help get me unstuck.  Change is difficult and it is infinitely easier to get support while making big changes - and since I seem to be on the short bus, it took a village (and still does):  a new therapist, a couple of great acupuncturists who are soul sisters, a dog, a beloved mentor and sensei in Japan, and a small group of passionate and dedicated colleagues in the Japanese acupuncture community that have become a second family.  


    The last 5 years were a difficult and yet rewarding time of resetting boundaries (no easy task for a bleeding heart caregiver), raising prices, practicing forgiveness in all my affairs, travels to study with people smarter than myself, and allowing myself to be gently dismantled and reassembled.  It wasn’t pretty, as my team will assure you, but I feel like we might be getting somewhere at last.  We see the rewards with new patients, new skills learned in Japan, a more clear sense of " Ok this treatment is complete" (thank you, Sensei), new students who actually want what I have to teach them, and a group of medical doctors who find value in our work at the clinic and refer clients who might otherwise never seek help.  


    Alas, I still seem to be stuck at the crossroads of work - life balance.  Perhaps my explorations of minimalism will be part of the equation.



    What I wish I had known bout starting a business....

    To all my beloved students and former students stuggling with the ups and downs of starting their own practice, read on mcduff! Awesome article completely true and courtesy of Gretchen!!



    11 Things I Wish I Knew When I Started My Business

    A lot of people like to fool you and say that you’re not smart if you never went to college, but common sense rules over everything. That’s what I learned from selling crack. -Snoop Dogg 




    My name is Stephanie St.Claire, and I am an unfunded entrepreneur. I’ve been in business for 3 years, after engaging in my own personal and tenuous renaissance (uh…divorce) and rediscovering my Divine Core Purpose. In other words, I grew a pair of ladyballs and started living the life I always wanted to while making money doing it.  But there was a LOT to learn, and some of those things weren’t covered in Who Moved My Cheese.
    Finish reading this wonderful article here:  https://medium.com/i-m-h-o/3dc264023df5