Talking to Patients About What to Expect from Acupuncture
By Laura Christensen, MA, LAc, MAc
I have long been uncomfortable with the use of the word cure, and have never used it in my practice, for fear of not being able to live up to that ideal. A friend recently reminded me that the word cure is often associated with quackery. That was what I sensed.
However, in the traditional medicine literature from China, the word cure is used in every research report. Indeed, my friend reminded me that if the patient presents with foot pain, and it goes away as a result of our treatment, it has been cured. In fact, the word comes from the Latin cura, meaning to care. That was good to remember.
It was helpful for me to realize that I may have been overly cautious about using this word with regard to my practice. I see now that acupuncture can be a cure for many people. However, we still must be thoughtful about how we discuss what to expect from acupuncture when speaking with patients.
When I went to acupuncture school, in the early 80s, we were not really told what to expect from acupuncture treatments, other than the usual Chinese rhetoric about 10 daily treatments in a row, rest a week, repeat, rest a week, repeat. It was implied that our treatments would cure people of the conditions they brought to us. Our teachers taught us what their teachers had taught them about acupuncture. There were few books in English, no research to speak of, and we learned our TCM differential diagnosis and point prescriptions the way our teachers taught us. That was all we had.
Eight years after I graduated from acupuncture school, I began my practice. I immediately stumbled across a very tricky problem. My patients wanted to know what to expect from the treatment and how many treatments it would take to reach their goal. I had no idea. Therefore, I told them that we should consider this an experiment until we start seeing what the outcome would be. Some of my friends thought I was being overly cautious. I quickly realized that few patients could afford to pay $60 per treatment for 10 days, and do two or three courses of that. And after doing that, how could I tell the results of acupuncture from what might have just been the natural course of the disease. It seemed to me that if you did enough treatments on any condition, it would go away after some period of time.
Of course I attracted, as many of us do, the people with the most horrible health problems. Many of them had either rejected what allopathic medicine had recommended, neglected their wellness for years, and/or were hoping for miracles. One of my first patients had something called Crest syndrome (a type of scleroderma). I had no idea how to talk to her about what to expect from acupuncture. She had high hopes, and I had no clue. Her husband was a cardiologist at the local university medical center, so I was acutely aware of the pressure. This was very humbling. She stuck with me as I tried to see her through the lens of TCM and intervene appropriately, but really had little hope of helping her. I was honest about my doubts. She trusted me. I was lucky that she was so generous and forgiving.
I heard stories from patients who tell me that they went to an acupuncturist who enthusiastically assured them that their problem could easily be cured. Sometimes those were problems that I strongly doubted acupuncture could really cure without expert treatment (including herbs) for a long period of time. I was angry at those practitioners for leading on those patients. I saw them as shortsighted for not wanting to admit or even see their own weaknesses, and for making promises they might not be able to keep. I had a feeling that they were promising cures to keep people in treatment, ultimately for their own financial gain.
I remember being in that place myself, afraid to tell someone I did not think I could do much more, because my practice was tiny and I was starving. I suspect that we have all experienced at least something like this at one time or another. How did we handle that communication with our patient? What influenced the way we spoke? Were we even aware of the subconscious motives we brought to that communication? Did we try to temper our desires, hopes and illusions, in favor of stark honesty? Or did we, as was more my personal style, tend to give up early, try not to mislead patients and starve a bit longer while we learned more about what acupuncture could do.
Now, after 18 years in practice, I know much better what to tell patients about what to expect and how soon to expect it. I have survived the experimental stage of my practice, but it took a long time. In fact, my honesty about admitting when I don't think I can help has actually made patients whom I failed to help, refer their friends and family. Often people tell me at intake that they have heard that I am very honest and that's why they chose me over my competition.
Why is it important to make our best attempt to accurately express what we believe the patient can expect from our treatment? Well, for one, to reduce our risk of being sued or having a complaint lodged with our board. But even more, because we owe it to our patient to be honest with them and to not overstate the results that we may be able to produce. We owe it to our profession so that we are seen not as quacks but as legitimate, ethical practitioners. In speaking with patients about outcomes, we must gauge how willing the patient will be to follow our instructions, how financially doable it will be for them to get to where they want, and how motivated they will be to stick with it. Then, we must tell them when we think we have done all we can, and refer them elsewhere, even if that might be drugs, surgery, or other allopathic modalities. We may even refer them to other therapists while we continue the acupuncture.
We must keep renegotiating the contract with the patient so that their expectations are in line with our vision of things. We want to keep checking with them to make sure they are feeling OK about continuing when the results are not coming the way they had hoped. I have a fibromyalgia patient I have seen weekly for 10 years. I have considered giving up many times, but she reassures me that even though she makes limited progress, it is the acupuncture that keeps her functioning as minimally a she does. So I don't dismiss her from treatment. We just keep this contract open and up for discussion on a regular basis.
Patients don't know what we are thinking. Some are afraid that they are going to be rejected for not doing well enough. Some are resentful of us. Keep it all verbally out in the open. Make sure they know they can leave at any time. Make sure they know you are trying to do your best, and you will let them know if you think there is no more you can do for them.
We do our patients and ourselves a huge disservice by making promises that we cannot fulfill. Of course, we cannot always know what to predict, but we must also be honest about that. It is healthier for us, our profession, our patients and our world, in the end.
Click here for previous articles by Laura Christensen, MA, LAc, MAc.