Acupuncture Today – April, 2010, Vol. 11, Issue 04 >> Patient Education

Patient Noncompliance

By Constance Scharff, PhD

Sometimes patients don't listen to or comply with a single thing the acupuncturist says. I expect my acupuncturist to improve my health despite my noncompliance; I believe most patients do.

Last week, I felt some cramping in my lower abdomen. It started out like menstrual cramps, but it was the wrong time in my cycle for that. As the week progressed, the pain intensified. It shifted from slight cramping to more intense cramping and then to a sharp pain just above the pubic bone. I began to have difficulty walking, sitting or standing. Sitting was the most painful, as a stitch would develop that would hurt so much when I moved, I'd lose my breath. The pain migrated slightly to the left and intensified. I could not stand to my full height and shuffled when I walked. The pain became unrelenting after a few days.

I called a friend in another state who is an accomplished acupuncturist. He's a close friend of whom I have no problem asking medical advice. He made note of my symptoms and suggested that I see my physician. He thought I could have a strained muscle or possibly an ovarian cyst. I needed to have the area scanned.

I explained that I did not want to see my physician. My medical insurance (which explicitly does not cover acupuncture) has such a high deductible, it can be considered cruel and unusual punishment. Because of a pre-existing condition, this is the only medical insurance I can get, so I keep it for the catastrophic events it would cover. I told my friend that I did not want to go to the doctor, get an expensive scan, and then be told I had muscle strain for which they could do nothing. I had visions of being out $800 to $1,000 to be told, "Rest." My friend was exasperated. "You need to see a physician and get the area scanned," he said. "No," was my only reply.

If I look at the situation in a detached way, I can understand my friend's frustration. He only gives me medical advice when I ask for it, though once he does, I rarely follow it. He's made suggestions for me to change my diet, sleep patterns, see various practitioners (of Eastern and Western modalities), and take herbs. He's never suggested anything to me that hasn't already been suggested by other acupuncturists. Sometimes I'm willing to take the herbs that my friend suggests. Other than that, I usually say something like, "No, I want you to fix me." He sighs. I think many, if not most, of his patients are like me in this regard; it's easier to let the practitioner do all the work.

Ignoring my friend's advice, I decided to try to heal myself by looking up my medical condition online. I searched medical Web sites for my symptoms, trying to breathe through pain so intense that sitting upright was almost impossible. I had no fever or nausea, and the pain was localized to a particular area. I ruled out conditions like appendicitis and although I didn't think either of these was likely given the pain's location, figured I could have an ovarian cyst or femoral hernia. Most likely, I had muscle strain. Armed with this information, I e-mailed my regular acupuncturist and let him know the exact nature of my symptoms before my appointment the next day. I also let him know that my friend had suggested that I see my physician, a prescription I'd flatly refused.

Seeking Comfort

I was 20 minutes late when I hobbled into my acupuncturist's office the next morning. My practitioner was waiting for me. I'd left him a message, sobbing, that I was sorry to be so late, but that I could hardly move. There was obvious concern etched on his face when he saw me.

I see a practitioner and instructor of the classical Five-Element acupuncture system. In this system, practitioners do not generally treat patients symptomatically.1 Five-Element practitioners diagnose and treat a patient's causative factor,2 their underlying elemental imbalance, which they believe to be the root of most disease. I didn't care at all about philosophies or medical systems at that point. I was in pain and wanted my acupuncturist like a hurt child wants their mother.

Usually, my acupuncturist spends the first half of our session talking with me. We sit in leather chairs and chat like old friends. That day, I went directly to the treatment table, which he had to lower for me, so I could slide on. I moaned and said something along the lines of, "You've got to help me." To which my acupuncturist responded, "Why is it that you don't want to see your physician? You really should have the area scanned."

I was in too much pain to answer his question fully. My physician is competent, but she's expensive and emotionally detached and well, I don't feel about her like I do my acupuncturist. He's like a kindly uncle. He doesn't judge. He's compassionate and soft-spoken most of the time, except when he needs to be firm. He holds my hand when I'm scared and talks with me. I wanted help and comfort from the man I trust and know, not an ultrasound or MRI machine and some hospital technician. I've had other patients express similar feelings to me when their acupuncturists have asked them to seek care outside the clinic.

Treating Despite Noncompliance

While he said that he wished I'd see a Western physician and insisted that I speak with a colleague of his who is both an acupuncturist and neurologist, my practitioner set to work checking my pulses. He needled me locally for the pain, which helped. He then did an Akabane test. This test was developed in Japan to discern the bilateral balance of qi distribution in the channels.3 The practitioner applies heat to the ends of the meridians at the fingertips or toes using an incense stick.4 In my case, the test showed deficiency on one side of the stomach channel, which the practitioner treated. About 85 percent of the pain vanished immediately. I breathed a sigh of relief. When the treatment was done, I put in a call to the neurologist, who said that the root of the problem was probably found, since I had responded so well and quickly to the treatment, but that for goodness sake, if the pain returned, to see a Western doctor and have the area scanned. I sighed.

My acupuncturist friend asked me to walk after the treatment; he said that gentle walking would be good for me. I lay in my car with the seat back until my next meeting. He asked me not to eat foods that were cold, including all raw foods, like fresh fruit and salad. I had a hot lunch, but couldn't help but have a little ice cream after. I was told to sleep early, but nodded off again, like I often do, at my computer working on a project.

Three days have passed since that treatment. The pain is 99 percent gone. I feel an occasional twinge, but nothing more. I expect to be completely better by tomorrow. I just got off the phone with my acupuncturist friend. He asked what I was doing this morning. I said working on this article and having breakfast. "Anything good on the menu?" he asked. "Yes," I responded, "Ice cream." He chuckled. I'll call him in about an hour when "my tummy is a bit off" and he'll suggest a hot drink...but I won't listen. Patients are like that sometimes.


  1. Gumenick N. Symptoms: Distress Signals, and Nothing More. Acupuncture Today 2003;4(10).
  2. Worsley JR. Traditional Acupuncture: Volume II Traditional Diagnosis. Miami Lakes, Fla.: The Worsley Institute of Classical Acupuncture, 1990.
  3. Gumenick N. Classical Five-Element Acupuncture presentation at the Southwest Symposium. Austin, Texas, 2009.
  4. Worsley JR. Traditional Acupuncture: Volume II Traditional Diagnosis. Miami Lakes, Fla.: The Worsley Institute of Classical Acupuncture, 1990.

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 .


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