Healing alliances

How can I optimize the treatment of my patients? How can I provide the best healing experience possible? It begins with a partnership with each patient – a unique healing alliance. How does this alliance develop?

Listening

It begins with listening. Listening for a patient’s personal understanding of whatever symptoms brought him or her to me. Dealing with illness or pain can be as emotionally draining as it is physically trying. So I also ask about expectations and anxieties. I listen for small details that might convey meaning. It isn’t uncommon for a patient’s needs to be greater than what can be objectively diagnosed. How else to discover this than by listening?

What follows

The result is shared communication. Shared attention. Shared concern. And how could it stop there? Compassion follows automatically. As does a shared vision of what this person’s life would be like without whatever symptom has initiated this interaction.

This is what it means to say I strive to treat the person, rather than the symptom. This is certainly one of the things that drew me to Chinese medicine in the first place.

The unexpected power of the therapeutic alliance

What I now realize is that this interaction has healing power in and of itself. Progress on the road to healing can begin even before acupuncture, before herbs, or before any kind of treatment. Several clinical studies have demonstrated that there is therapeutic value to this healer-patient interaction. This is why randomized clinical trials are needed, after all. Researchers attempt to control for this phenomenon when testing the efficacy of a new drug or treatment. Otherwise, how would we know when a new treatment was effective beyond this important baseline?

All of this is true for Western medicine, too. There even have been instances in which once-orthodox drugs and treatments were abandoned later because subsequent controlled studies demonstrated that the main variable bringing about the positive outcome was the interaction with the doctor, not the treatment itself. Isn’t that amazing? It’s even true for some surgical procedures, believe it or not. Patients were experiencing healing for reasons other than the specifics of the operation. Doctor and patient expectations can have such dramatic effects on treatment outcomes.

A humble suggestion regarding medical research priorities

Dear mainstream and alternative medicine researchers, please focus more investigative energy on that part of your research that is normally referred to only by way of comparison with a main treatment group -- that phenomenal baseline of healing. Please discover more about how all practitioners can be better healers, regardless of the types of treatment involved. What mind-body phenomena are at work when patients and doctors interact, and how can we enhance these effects? What physiological interactions between the nervous, immune, and endocrine systems are taking place when a healer and a patient establish an alliance?

Until we’ve discovered more, I’ll keep listening for clues from my patients.

Road to Gotham

Starting this business has been one of the best experiences of my life. And whenever I’m in danger of losing sight of this, I pull out one of my business cards, put it on the table and have another look at it. And there it is, Sarah Hayes, LAc, Acupuncture Northwest, The Gotham Building, Suite 171, Portland, Oregon. Yes!

While I was on that long road from graduate school to practicing acupuncturist, I initially had only vague notions of how I was going to reach my professional goals. I had no idea how many business questions I would be asking, or how many people I would be relying on to help me know what questions I should ask. Three and a half years of medical training had me ready to treat patients, but the two business classes (two!) left me feeling like a babe in the woods.

Looking back, we were all so wrapped up with our studies that the business ahead of us was the last thing on our minds. We were focused on learning the medicine. If I thought about it at all, I thought I might join another practitioner, or maybe a group of alternative care practitioners, or maybe purchase an established practice. Like I say, it wasn’t exactly clear during my student days. In the end I decided the way I would ultimately be the happiest was on my own. I wanted to go it alone. Looking back, it was the right choice for me.

First questions

How much rent could I afford to pay? How much should I charge my patients? How many patients will I need in order to break even? What part of Portland would be best to locate in? Is off-street parking important? What should my business cards look like? How much do they cost? How else to advertise? Should I create a web site? What insurance companies should I contact for liability insurance? How do I become eligible to charge patients’ insurance companies? What kinds of treatments are covered by insurance companies? Who are the best medical suppliers? Should I build my own inventory of herbs? What software would be best for bookkeeping? On that glorious day when I have my own treatment room and a treatment table, should I use sheets or a paper roller to save on laundry?

Finding a business manager

So what I really needed was someone to put these questions in their proper order, tell me which ones to answer first. I remember thinking “Shoot, what I need is a business manager.” Followed by “Oh my gosh, that would be me.” I was about to become a business- managing/landlord-contacting/insurance-calling/bookkeeping/ laundering acupuncturist. Last thought that night before going to sleep: “Oh my god.”

A comparative study looking at CAM practitioners

How many times has this realization occurred to someone like me? Many, many times, as it turns out. The Sept-Oct, 2002, issue of the Journal of the American Board of Family Practice has this article in it: Characteristics of Licensed Acupuncturists, Chiropractors, Massage Therapists, and Naturopathic Physicians. The authors (Cherkin et al.) wanted to compare practitioners of the four main branches of complementary and alternative medicine (CAM) with conventional physicians. The result that caught my eye was that more than 60% of the acupuncturists in their survey practiced solo. This compares with about 25% for conventional physicians.

Also mentioned in this article is the fact that although there is increasing interest in and use of CAM, there is still a good deal of separation between differing healthcare services in general. CAM practitioners, when they do work in clinics, tend to associate with other CAM professionals, and likewise for conventional physicians. Acquiring integrated care, at least by this measure, is still largely the individual patient’s responsibility.