In every medical field, there are lines of professionalism that cannot be crossed. Ethical considerations are of the utmost importance to practitioners and patients alike. One of these concerns pertains to whom the practitioner should treat.There is an old adage that it is not in the practitioner's best interest to treat individuals with whom they are very close. The closer the bond, the more difficult the relationship for both clinician and patient. I know many practitioners who do not treat their spouses, leaving that work to a colleague. I also know a handful who can't stand to see their partner suffer and will needle them in a pinch. Ethical boundaries are rarely cut and dried.
In the course of treatment, it is possible for feelings to develop between patient and practitioner. These feelings need not be sexual in nature. There are many different types of relationships that develop between people. For example, as time goes on and treatments bring positive results, patients may develop feelings of gratitude and respect for the clinician. With ongoing treatment, friendships can develop, and with friendship can come a certain type of love. When that happens, what is the acupuncturist to do?
In Yiddish, we would describe my current acupuncturist as a "mensch." The English translation is: a person who is honorable or noble, a person to emulate. Colloquially, it means a good man, the kind you want to take home to your mother or hope your son grows up to be. My acupuncturist is a mensch by any definition of the term.
I think what I like most about my practitioner is that he is clearly, markedly professional, and yet he can relate deeply to his patients. I was referred to him for a psychospiritual malady, a shen disturbance. In the initial consultation, he immediately registered my fear and sadness, sat with me quietly, and gently took my hand to reassure me. He was all business, but he was not distant. He did not stand at the foot of a bed, as so many doctors do, and pound out questions one after another. "When was your first menstrual cycle? When was your last menstrual cycle?" and a lot of other nonsense that had nothing to do with the reason I was in his office. He certainly got to those questions, but not until after he had explored the heart of what was upsetting me.
Of course, I responded immediately to this practitioner, perhaps more than I might have someone else who could have given me the exact same treatments. My clinician employs more than acupuncture in his treatments; he uses a fair amount of creativity and good sense. He sometimes seems to know what I need more than I do myself. The day someone I loved deeply broke my heart, my acupuncturist met me at the door with outstretched arms; I needed a hug as much, if not more, than the acupuncture. When I was so forlorn that I could barely get out of bed, he insisted that I meet his family and a bunch of his kids' friends to go bowling; I went and it was the beginning of my turnaround from that depression.
If I'm terribly sad, he will sometimes talk with me using funny voices and characters to entertain me. My favorite is Mildred. She is the saboteur in my head who tells me that I can't do anything worthwhile and may as well not try. When that perspective has me in its clutches, my acupuncturist pulls out her voice and makes fun of her until I laugh. He also does cowboy impersonations before my frequent trips to Texas. Last week, I had a breakthrough so profound, it shifted my entire worldview, and unnerved me. I e-mailed my acupuncturist constantly, telling him what was wrong; he simply reminded me to observe the change. His words calmed me. All of these efforts add value to the treatments and have helped me tremendously.
I'm sure a few readers may be shocked or outraged by the use of "non-acupuncture" interactions in the treatment. At a symposium, I heard one of my acupuncturist's former classmates condemn such practices. "We are acupuncturists, not psychologists. Get the patient on the table and the needles in." As a patient, I ask you to suspend judgment prior to investigation. In my opinion, there is absolutely nothing wrong with providing your service in a way that enriches the patient's experience. While I'm not suggesting that the practitioner engage in psychotherapy, I insist that patients should be treated like people. I'm not a pin cushion, but a human being. My acupuncturist relates to me as such. He doesn't treat me on an assembly line or have four rooms going at once. He interacts with me. I don't believe he sees patients on his table, but unique individuals. I'm not "the first patient of the day," at 9 a.m., but me, Connie. He doesn't treat me like a sick person, but as a friend.
In case it isn't already clear, I love my acupuncturist and I am certain that he loves me. There's nothing creepy, sick or even unprofessional about it. My feelings developed out of appreciation for being given what I needed at the levels of mind, body and spirit. Sometimes what I need comes from the needles and sometimes the needles are helped along by the words and actions of a man who is like a kindly uncle: caring, unflappable, nonjudgmental and patient.
Is it wrong for my acupuncturist to continue treating me? I will suggest not. Isn't the ideal that one should love all one's patients, even if you don't always like them very much? My feelings for my acupuncturist developed in a clinical setting as a byproduct of the treatment I received. It is difficult not to feel kind-hearted toward someone who helps you heal. In fact, I will go so far to say that when a patient loves, trusts and respects you, as I do my acupuncturist, you have really made a difference for the better in their life.
I admire the students who study with my acupuncturist. There are a number of teachers who can teach Five-Element Acupuncture in the Worsley style as he does, but no one I've yet met relates to patients as brilliantly as he. He's able to teach practitioners how to help a patient open their heart so that they can discover what is calling out to be healed. I know that sounds a little "airy fairy"; a romanticized view of what acupuncture can do. But I don't believe it is. A patient is not just a manifestation of a diagnosis based on a pulse. Deeply relating to your patients is a gift for you and them. Sometimes love is both reasonable and appropriate.
I work in the field of addiction, a field in which ethical behavior and strong boundary-setting are of the utmost importance. Thus, I looked up the National Certification Commission for Acupuncture and Oriental Medicine's (NCCAOM) code of ethics.1 I wanted to see what the field's accepted standard of behavior is for patient/practitioner interaction. My view on ethics can be considered "edgy" to some critics. Let me suggest that there is a great deal of grey area with regard to ethical relationships and that this matter should be open for discussion.
For the sake of discourse, let's ask the question, "Is my acupuncturist acting unethically by treating me as he does?" If my acupuncturist is to be faulted for acting unethically, according to the NCCAOM code of ethics, one would have to prove either that his actions exploited my trust as a patient or that he performed outside the scope of practice. For the former to be true, my practitioner would have to have taken something from me, some good or service, that was not due him. That is certainly not part of our relationship. For the latter to be proven, one would have to show how my acupuncturist performed psychotherapy with me. Is sitting with me while I cried over my grandmother's death or making me laugh at goofy voices when I'm sad outside the scope of practice? If it is, the ethical boundary-setting in the field has become ludicrous.
Western patients who go to acupuncturists, in my observation, are overwhelmingly looking for one of two things. The first is a last-ditch effort to cure or treat an ailment that Western medicine has not been able to touch, or as an adjunct to western medical interventions. The second group is looking for a medical interaction that is not dehumanizing, as Western medical practice so often can be.
The beauty of acupuncture is that relationships develop between patient and practitioner that are akin to what my grandmother used to say about the neighborhood doctor. He cared. He knew her and the family; what happened to them mattered to him. Modern acupuncturists would do well to emulate not the modern Western physician, but the old country doctor who practiced, as my acupuncturist does, not only with the tools in his medical bag, but also with his heart.
Constance Scharff has a PhD in transformative studies from the California Institute of Integral Studies. The focus of her research is on the spiritual and transformative experiences of alcoholics and addicts. She can be reached at