When They Don't Want You Anymore: Patient Rejection Following Clinical Success
By Felice Dunas, PhD
Making a living in TCM is too hard to do if you don't love it. You don't eat without forging ahead against the odds. You are an under dog, still struggling to teach your local communities that you aren't a quack.
You labor to become skillful clinically, knowing, as your professional ancestors have said that it takes generations to get good. Since it's not reasonable to wait for your kids to take over your practice you have a lot of education to gain quickly and the hard way, though trial and error. Perhaps your work is fiscally undervalued. Many acupuncturists charge less than is comfortable, working long hours to survive financially. Other medical professionals may not know what to do with you so building referral networks can require great patience and the willingness to educate over long periods of time. Perhaps you grapple with the challenges of running a business, something many of us didn't study before putting out our shingles. With all these mountains to climb, it takes a lot of grit and legwork to succeed.
The commitment required must come from passion, belief and personal conviction that you are doing something of value for those seeking your help. You have to fall in love with your work and be deeply loyal to the welfare of your patients. To be good at this medicine you must strive for their sake, and perhaps, more importantly, for your own. You must own your choice to be in this line of work and intentionally immerse yourself in the process.
The sicker some one is the more likely that he or she will work with you in the healing process and the stronger the partnership between the two of you will be. Severely sick patients listen to every word and implement whatever they can. On your side, you slave over texts into the night, looking for just the right formula or point selection. You attend CEU courses and call colleagues to get second and third opinions. You ponder, you worry, and you genuinely care.
Your authenticity makes it all the harder when they leave you. Yes of course, they must leave. That is the point. Very few people continue to see an acupuncturist when they are healthy, even though, historically, treatments were administered continually throughout life. Because we live in a "help me when I am sick" culture, patients move on to other pursuits when they feel well enough to avoid spending any more time and money on medical care.
But what if, when they leave, you become associated with the illnesses rather than the healing? What if their deeper thoughts include "good riddance, glad that is over with" rather than "Thank you, I will never forget the goodness you have brought me." It is easy to become part of a negative memory for a patient, especially the really sick ones. Here is an example from my practice that really shook me.
Holly was a television producer. As was typical of her field, she worked countless hours under continually high stress. When her body broke under the strain she was in her late thirties. It began with hives that did not respond to her physician's treatments. She also experienced digestive problems: severe diarrhea and bloating. Her body had become so yin deficient from her high powered job that she wasn't absorbing the nutrients she was taking in. Food flowed right through her. Suddenly engaged in a battle to hold weight on, Holly came to my practice looking gaunt and pale. Her endocrine system was coping poorly. She was pre-diabetic and not menstruating. Exhausted, she was inappropriately slender, frightened, sleepless and at a crisis point in life. She had been single "forever" she told me, and was becoming acutely aware of the passing of her child bearing years. "Even if I meet the right guy today" she moaned, "I'm not healthy enough to consider starting a serious relationship and it would take years to be ready to have kids. I'll be over 40 by then!"
Holly and I worked together, through thick and thin, for 16 months. She quit the job, moved to a smaller home, re-organized routines and shifted priorities. She went into debt to give herself the room and time to heal. She was a stellar case of high patient compliance and, consequentially, strong results. Our work became a lifeline to her new future. Friendships changed, hobbies were born, diets researched and recipes tried. For the first time she began working with a psychologist and getting regular exercise. Holly was wringing every once of goodness from that illness and leaning on my expertise to show the way.
As her transformation and illness came to an end and her new life was solidly in place, it was time to end her course of treatment with me. At our last several meetings she brought me gifts, wrote loving notes and made sure her friends were immersed in my practice. Her last appointment was significant and poignant. Thinking of her over the following months brought me a smile.
I saw Holly a year later at a local restaurant. She looked robust and happy, sitting next to a man who was openly showing his adoration. I walked up to say hello and was surprised by her response. Rather than the bright smile and warm demeanor that I expected, Holly was, shall we say, cool. The moment of first connecting with my star patient of the year before was awkward, stilted and confusing. She hurriedly introduced me to her "fiancé" and said she would call me to catch up the next day. She did not. Two weeks later I called her.
To my surprise, Holly was, again, unwelcoming. She gave me the five-minute version of her current life and was ready to get off the phone. Before she could do so I asked her, point blank, why she seemed so uncomfortable. "You remind me of my illness, Felice. That's a time in my life that I don't want to think about. Everything is so much better now. It's nothing personal. Sorry." She abruptly hung up. That was it. I haven't heard from her since.
In the 42 years of my practice I have run into many "Hollys" and have come to accept this cold reality. No, I no longer take it personally. But, after I wholeheartedly devote myself to creating the customized path that combines my work and a patient's needs, I know I must let go of all expectation, even social civility. Ouch! This may be a blessed path professionally but it isn't always an easy one.
Every piece of the patient care process has its idiosyncrasies: how you connect when they come, how you interact while they stay, and how you let them go. As a new practitioner you bumped into the "relationship" aspect of medicine, just as you struggled to master diagnosis, point selection and herbal decoction choices. No matter how socially adept you are, the relationship dynamics surrounding patient care requires unique skill cultivation. This surprising learning curve can hit you hard as a bucketful of stones, as you open for business and can surprise you even if you have practice for decades. Skill sets are often borne of bumpy experiences, managing human beings as they pass through your clinic. Sometimes the pain of it shakes you deep down.
Have you ever wished your patients understood your commitment and what it took from you to help get them well? Have you felt their rejection or lack of recognition for your devotion to the subtleties of their care that makes all the difference? Whether they know it or not, you put in those late nights studying for them. You sweat and fret for them. To be continually growing for the good of all concerned you stretch your values, education and perspectives, while expanding tolerance and Buddha-like acceptance of the choices patients make.
If it comes to pass that you feel unrecognized for your value, if you are rejected as part of a bad memory, remember this article. Remember my story and bear in mind that others feel what you feel. All your colleagues know the dark places. Ultimately, in the sacred pain of this professional path, you are not alone.
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