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Acupuncture Today – February, 2011, Vol. 12, Issue 02

Creating Healthy Work Boundaries

By Denise Cicuto, LAc

It's important to separate yourself from work, even if you love what you do.

For acupuncturists this is especially important because we interact with patients who tell us very private details about their lives. Sometimes it's a lot of information to carry on our shoulders.

In a previous article, I discussed self-care for acupuncturists. Make sure you're doing what you need to take care of yourself and stay healthy. Creating good boundaries is part of that.

Start and end your day right. Do you have a routine in the morning to get you prepared for seeing patients? Maybe you do qi gong or yoga. Maybe you have a cup of tea. How do you end your workday? Do you do some kind of energetic cleansing? Do you take a shower? Do you go for a walk?

These are good things to consider adding to help you separate yourself from work.

Focusing On Appearance

How you dress for work will influence how the patient perceives you as a healthcare professional.

Do you wear a lab coat or hospital scrubs to look more like a Western medical professional? Do you wear a Chinese style button down jacket? Do you wear jeans and a nice Hawaiian shirt? I can't tell you the right way to dress in your clinic, it depends on you and the environment you're working in.

You'll have to decide for yourself but be conscious of your choices and how you present yourself to patients and prospective patients. As Honora Wolfe pointed out in a Blue Poppy continuing education class - if you live in the same town you practice in, when you are off duty you never know who you might run into when you're out shopping, so don't go out dressed sloppily.

Establishing Patient Comfort

If you are about to needle or moxa an area on the chest, groin, buttocks, feet, abdomen or any area that the patient finds to be sensitive, painful or ticklish, always tell the patient what area you are going to needle before you do.

If the patient is new to you, ask them before you start the treatment if they have particularly sensitive parts of their body and where they are. This may be common sense, but it might be necessary to spell out both for the comfort of the patient and practitioner.

If you know that a patient is a survivor of sexual abuse, please take extra care and ask them if there are certain areas that they don't want touched at all and avoid them. You can do another acupuncture point on another part of the body. You may have to be creative in your prescription, but you can do it.

You may have learned "draping" in your acupuncture techniques classes. If not, get a massage therapist friend to show you how to "drape" a patient using a sheet to expose certain areas of the body for needling, like GB 30 on the buttocks.

If you are going to needle CV 17 or SP 21 on a woman and can't reach it easily, it is OK to ask them to move their breasts aside. Do not assume you can do it yourself. Always ask female patients to unhook their bras if you need to access points on their back or ask permission to do it for them.

Needle phobia (also known as Trypanophobia or Belonephobia) can come in many forms and degrees of severity. A patient may not like needles in the face, or from past experience, they may know that they have a vasovagal (fainting) response to being needled in certain areas of the body. Avoid those areas and make a note of it on their chart in big letters so you won't miss it.

As stated earlier, you can be creative in your prescription and find an equally effective point somewhere else on the body.

Some patients are severely needle phobic and they may not be the right fit for acupuncture. Some are willing to try. Patience is key. You may find that you need to set aside more time in your schedule to work with these patients. I have had a few patients who don't want me to leave the room while they have the needles in, so I block off that hour in my schedule. You'll have to decide for yourself if this is something you are willing or can afford to do.

Enforcing Policies

Make a cancellation policy and enforce it.

Have new patients sign a form acknowledging the cancellation policy and remind them of it when they call you an hour before their appointment to cancel. Sometimes they don't call and sometimes they don't show up. When a patient doesn't show up and doesn't give you advanced notice, you lose both time and money. You can't prevent it all the time but if you are firm with your cancellation policy, it will help.

Maybe you have a patient who always shows up late. Maybe you have a patient who avoids paying the bill. Maybe a patient addresses you as "sweetie" or "honey." Maybe a patient asks you to give her the same herbs that the last acupuncturist gave her, even if they're no longer appropriate. Maybe a patient at a community clinic takes advantage of the free herbs and asks for herbs for many different things. You might approach each of these situations differently but they may each push on your boundaries.

How do you handle them?

It's OK to tell the patient you can't see them if they show up half an hour late. It's OK to remind the patient that you prefer to be called "Doctor X" or however you prefer to be addressed.

You can tell the patient that the formula they were on before is no longer appropriate for their condition. Maybe explaining to them how their pattern has changed according to Chinese medicine may be helpful. It's OK to refer the patient to another practitioner.

How you handle it depends on you and your personality but remember that you can always ask your colleagues for advice.

Unplug yourself

Shut off the cell phone, computer, and other communication devices during meals or when you're on vacation. Don't respond to phone calls or e-mails during your off hours. The messages will still be there when you get back to work the next day. You will feel more refreshed by having had some time off.

These are some of the ways to create healthy boundaries that will help you to enjoy both your work and personal time. Chinese medicine is all about balance. Sometimes we need to be reminded of that so we can keep doing what we love and avoid getting burned out. Creating good boundaries is important for our well-being as practitioners and for our patients.

Denise Cicuto is a licensed acupuncturist and Chinese herbalist, specializing in women's health and immunity. Denise has a private practice with offices in San Francisco and in Alameda, Calif. She can be reached at

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