There are all kinds of doors

My house in San Antonio when I was growing up had a very remarkable door.  And by “remarkable” I mean that very often people would ask me “Oh so you live in the house that has the six door knobs?”  That was us.  Tall, grey double doors that, because of their hexa-knobbiness, always made people pause as they approached it.  “Do I have to touch them in a certain order to make this thing open?”  What made it even better was that not a single one of the six knobs actually turned.  They were simply ornamentation.  I think people often tried turning one, then another and another, thinking surely one of them had to turn.  All the door needed was a little push.  So the knobs were simply there for aesthetics.

I make no bones about it: this temporary plywood door up at the clinic is completely lacking in aesthetics.   But the door is only part of the process.  Wanting to open it and come into the clinic; telling your friends and neighbors; participating in the community of qi--those are the the bigger parts.  The door is just one small piece of the representation of all that.  We find them apt metaphors because they slice out a plane of everything and indicate: things on this side of the door are like this, and things on the other side will be like that. 

The needles and cups and recliners and comfortable lighting and planetarium music and bespectacled acupuncturists are all still here in their proper places.  All those things that make this a door worth opening are still here.  And so once more, with feeling: we are open 7 days of week (regardless of what type of door we have up).

In the hour of the wolf

Not to disparage wolves....but sometime in the wee hours of September 28th, our front door was smashed in; computer, money, and a camera taken. While painful certainly, I feel strangely less violated than when I have had my house ripped off in the past. Maybe it's because, although I am an owner, South Austin Community Acupuncture is a public place ultimately. That feels like a kind of buffer somehow. And so it becomes more a matter of just cleaning up the mess, piecing together data from a few days, and moving forward. It's unfortunate that this individual hit a business whose mission is to serve their fellow man, but so it is.
    I came home after a long day of cleaning up and tending to insurance and police reports and such, and I sat in my yard staring at a glorious Live Oak, my two canine companions cheerfully at my side, and the woman who is soon to be my wife. I counted my blessings. The inconveniences of the day a small thing comparatively. Whatever suffering is driving that individual to steal is greater than any suffering I have known. My very humble world is resplendent with little treasures of all kinds: the little purple flowers that open up on the fence line in the morning, the countless interactions with the many fine folks who come to us at South Austin Community Acupuncture with all manner of this and that, and on and on....every vantage point a place of beauty.
     And so today we are back, with a boarded up door that is not so much a thing of beauty at all. But we are here, same as we were the days before, ready to do what we love doing the most.

What it is, and what it is not

Wally, the human acupuncturist here:

 

A conversation with a patient recently got me thinking about how, again, it is time to clarify what community acupuncture is and what we are doing here at South Austin Community Acupuncture.

Ironically, it is not uncommonly the patients who are more oriented towards a “holistic” approach to their health that kind of miss the point of community acupuncture. These people often speak a language that actually belies a very compartmentalized view of their bodies, and their lives. It is a linear language of inputs and outcomes - Can you put a needle in for my adrenals? - when in fact Chinese medicine would never conceive of any system of the body apart from the context of its relationship to other systems.

Some people exhibit an appetite for information about their bodies and place great value on things like multiple page computer generated workups provided by their alternative medicine provider, for example, but can’t really can’t wrap their brains around what is going on with acupuncture…much less community acupuncture. Perhaps they are seeking an exact and tidy solution to what ails them. And just as their lives and their bodies are not tidy and exact, neither is how acupuncture works (much less community acupuncture) - so maybe it’s hard for them to see how acupuncture could possibly offer a solution.

Or I’ve seen the disappointment when I do not put on airs of gleaning deep insight into a patient’s nature by touching their pulse. To me, when a patient asks me what their pulse tells me, they might as well be asking me what the sky tells me, because essentially what I am doing is observing the natural world. Maybe next time I will simply answer, “The sky is blue.” I don’t know what to say. Sometimes the pulse informs what I do or corroborates with a person’s symptoms, sometimes not. I find usually what is of relevance has been revealed by chatting briefly, or all has been revealed because it is mostly obvious.  And then there are the many times, heaven forbid, that I do not take the pulse at all. The effect of acupuncture, as far as I can tell, is no less for it.

Sometimes it’s the simple things that can make the biggest difference in a person’s life, and I have always admired Chinese medicine for the elegance of its simplicity. That is how I practice: simply.

Likewise, I have always admired Lisa Rohleder of Working Class Acupuncture and grand dame of the community acupuncture movement for her clarity in articulating simple truths about acupuncture and community acupuncture as a way of delivering acupuncture on a grand scale. Just as I was contemplating putting this blog together, I came across a recent piece of writing from Lisa. Of course she articulates what I am trying to say far better than I ever could.  Here is an excerpt:

“One of the big reasons that acupuncture is important and needed in Western society is that it’s not dualistic in the way that so much of our culture and our medicine is. We can talk about yin and yang, certainly, but yin and yang are not simply opposites. They’re the shady side of the hill and the sunny side of the hill, right? Just one hill, not cut in half or separated. In Western society we love to chop things up, especially in Western medicine. Acupuncture doesn’t do that, and that’s one reason we need it so badly.

One of the things that you learn pretty quickly when you are working in a community
acupuncture clinic, whether you are a punk in the treatment room or a receptionist at the front
desk, is that a lot of dualisms go right out the window. Health and illness are not these separate, distinct states -- you can see that in the people who come in to the clinic. Most people are on a continuum somewhere, making the best of it. You can also see that the mind and the body are not at all separate either. People’s mental states have enormous influence on their physical state, and vice versa. And of course, a lot of how the clinic is set up is to make the haves and the havenots less separate from each other. So instead of a lot of nice, neat, abstract categories, in a community acupuncture clinic, what you get is a lot of messy human life. (It’s great.)

I think that lack of dualism is a large part of why so many people feel that our clinic spaces are healing to them. Things that were cut apart get to grow back together, in peace. And everything doesn't have to be perfect before you can relax. You get to just relax anyway.

In Western medicine, there’s often a sense that the goal is to triumph over illness. To diagnose it and to beat it and to win. But so often in community acupuncture, we are treating people who are not going to triumph over whatever they have going on. Whether it’s a chronic condition, or it’s age, or it’s stress, or just some difficult aspect of life, there isn’t going to be any clear-cut victorious moment where you get to pop a bottle of champagne and say, Yay, we won! It’s not like that. In fact, even if you do “beat” one condition, then another one pops up, or somehow, the guy’s left knee still hurts for no reason you can figure out, or just when his shoulder pain was finally going away, he gets into ANOTHER bike accident and breaks his arm. A lot of what we do is to help people accept and work with whatever it is: stress, pain, disability, limitations, illness, terminal illness, loss. We encourage and support and accompany people in working with whatever it is that their lives have given them to work with. We try to get out of the way and let them connect with their own inner resources, their own source of healing -- which doesn’t mean that everything gets fixed.

Probably the main thing we are doing in community acupuncture is trying to give ordinary people a better quality of life. That’s not a dualistic undertaking, it’s not a win-lose kind of scenario. It’s creative and it’s hopeful and it emphasizes working with what you’ve got. And of course, it helps immensely that acupuncture itself almost always gives people more energy, better sleep, a lift in their mood, a reduction in their stress. Those are humble benefits but they are very important.”

So I am writing this because I want people to better understand what we do and also to clarify what we are not.

While we do practice a fair amount of Chinese herbal medicine here, at heart, what we do and what we are about is community acupuncture. We are not spa-like, or new-age, or fancy - and it is enough. We are not here to ply you with hundreds of dollars of supplements, or to exert our authority over every nuance of your life and health. What we do is pretty straight forward: acupuncture, herbs, some cupping as needed.

No Halo Ascension Infusions here…sorry.

ps

Just as I finished writing this, I got taken for $10 by a Reiki master who then proceeded to ask the death knoll question after her first visit, “What is your slowest time?” No shit. 

We are a community acupuncture clinic. We put it on the line every day to make acupuncture affordable and accessible to as many people as possible. If you get what we do, you do not want us to ever have a slow time. This is my mission, and I’d like to you to make it yours. Community acupuncture is community supported acupuncture, and it is only with the enthusiastic support of the community that we can make this gloriously unruly thing happen. Keep South Austin Community Acupuncture busy. Or, how about:
Keep South Austin Community Acupuncture weirdly busy.

More on the politics of acupuncture in Texas

With a sudden groundswell of support, the acupuncture community banded together and actually stopped the Texas Board of Chiropractic Examiners from doing something. That something was a rule that would have acknowledged chiropractors as specialists in acupuncture with minimal requirements.
You can read all about it here.

'World's Largest Shared Acupuncture' Event a Surprisingly Spiritual Experience

Pretty much what we do everyday around here, minus the gongs and drums of course....

Read the story here

Community Acupuncture is Integrative Medicine

I came across a story highlighting a recent survey of integrative medicine centers in the U.S. “One of the most striking, though perhaps predictable, conclusions of this study is that integrative medicine is, in fact, integrative. It integrates conventional care with non-conventional or non-Western therapies; ancient healing wisdom with modern science; and the whole person — mind, body, and spirit in the context of community” (italics mine). What communities are they talking about?

Its highlight, and self-fulfilling, statement: “Integrative medicine is now an established part of healthcare in the United States.” An established part of healthcare based upon a survey of 29 integrative medical centers. Twenty-nine? That's not even one for every state. It seems to me that they are missing some communities. (In all fairness, they were able to identify 60 integrative centers nationwide, but only surveyed 29.)

It made me recall a book that a friend gave to me: We've Had a Hundred Years of Psychotherapy...And the World's Getting Worse. It's co-authored by James Hillman and Michael Ventura. (Ventura currently writes a bi-weekly column called Letters @ 3am that appears in the Austin Chronicle.) The book is a collection of dialogues—conversations, letters and phone calls—that look into the role of therapy. Right off the bat Hillman points out that we are ignoring the impact the environment has on us: “By removing the soul from the world and not recognizing that the soul is also in the world, psychotherapy can't do its job anymore. The buildings are sick, the institutions are sick, the banking system's sick, the schools, the streets—the sickness is out there.” Ventura takes it a step further and says, “Our inner knowledge has gotten more subtle while our ability to deal with the world around us has [...d]istnegrated.”

Disintegrated? Sounds like we need something that's integrative. And so these integrative medicine centers have been popping up and trying to re-establish the foundation of modern healthcare: take our technological breakthroughs in Western medicine, which look at the individual as a machine made up of discrete parts, throw in a dash of “ancient healing wisdom” that knows that the whole is more than the sum of the parts, and voila: ideal healthcare.

Integrative medicine centers are more “patient-centered” and address the “full range” of health issues, because it sounds like that is one of the big missing variables that will help fix the healthcare boondoggle—or at least make those who can afford the doggle happier. But these centers are palaces, generally slick and high-dollar. What community is that in the context of? I look and see that the “regular per session cost is between $115-$124” for acupuncture at one of these centers. That range is so small you should just say it costs $124, you’d save it in employee time wasted on explaining who is at the high end and who is at the low end.

But my main point isn't even about dollars and cents. Practitioners can charge what they want to charge and if people are willing to pay it, then that's no fault of theirs. However, the survey also pointed out that “63% of patients seen are self-referred.” That means more than half the people who get treated with “alternative” or “complementary” therapies are initiating the search themselves—some of them from within that particular healthcare system itself and some who are just looking around for it and an integrative medicine center is all they can find or seems the most credible. “If I’m going to pay a lot of money for this, I’d rather go to a Center.” And that’s really the main point: integrative medicine centers are popping up because people want these alternative options. It’s a market. Something their communities have not had before.

Integrative medicine centers do some great things: they are more apt to be part of the cross-talk between mainstream medicine and alt-stream medicine; they conduct research on alternative therapies to try and examine what has essentially been learned through tradition; and they are on the front line for a lot of patients within the system who have decided their healthcare community is not providing everything their soul needs to be healthy. Yet, is that changing the healthcare environment enough?

I find that one of the great things about the community acupuncture set up is that it goes beyond the idea that a market is available and wants to re-integrate the idea of health with the environment—at least the immediate environment where you are getting care. We often admit here at South Austin Community Acupuncture that we have health concerns, and while we don't overtly talk about them all in front of one another, we do put the healing process in a more public setting—to me that gives soul to healthcare. Gone is the doctor's office waiting room where everyone avoids eye contact with everyone else, because you don't want to have anything to do with someone else's illness. From Hillman and Ventura: “The illnesses are your teachers...[d]evaluing the illnesses and suppressing them removes you from these figures.” And in real communities, illness is not isolated.

At the community acupuncture clinic, in the large treatment room we are all focused on wellness. It creates a web of relationships that is often missing from the health care system today. And that is probably why community acupuncture has exploded onto the scene over the past few years. When South Austin Community Acupuncture opened five years ago it was one of the first ten or so community acupuncture clinics in the entire country. Now there are 161 across the United States. That’s an incredible growth rate. It’s the kind of growth rate that speaks VOLUMES about the “context of community.” It also speaks volumes about the state of the acupuncture profession to create jobs, but that’s beside the point. Whether you come in with friends or strangers, you still find something in this community. And community is, as Ventura calls it, “simply the actual little system in which you are situated.”

-- and here's Ventura's column from earlier this year remembering his friend and collaborator, James Hillman

The Dandelion Harvest, continued...

So this morning I embarked on the process of cleaning the many pounds of dandelion I harvested. This is cleaned dandelion on an improvised drying station (hey, I'm figuring this out as I go). I estimate this to be about 1/100 of what I collected! Called a couple of farms to see if they could help me get it all cleaned. Learned a little about their processes, but no takers...

The Dandelion Harvest

Yesterday I harvested dandelion (Pu Gong Ying) from my yard until my back hurt and my hands were sore and plant stained. It was a beautiful cool and drizzly day. I've been thinking a lot about sourcing plants locally, and trying to grow herbs and exploring what can be grown locally and regionally.  So here ya go...

Now to see if I can actually pull off cleaning and drying this stuff for future use here at South Austin Community Acupuncture.

A Letter to the Editor

The following is my response to a recent practice management article published in Acupuncture Today. I have emailed it to the editor, but given that Acupuncture Today is actually not the open forum they claim to be, I seriously doubt it will see the light of day. And so I am posting it here. This is the same publication that canned Lisa Rohleder of Working Class Acupuncture for her articles on community acupuncture and social entrepreneurism. Interestingly, Lisa was the only author in the history of the publication whose Acupuncture Today online talk back forum actually had any activity. Now the talk back forums are gone. 

Here’s my letter:

In the spirit of Acupuncture Today being “committed to bringing an open forum to the acupuncture profession” I’d like to make some comments about Lawrence Howard’s article, “Many Offices, Many Lessons”. While some of Mr. Howard’s observations offer valid insights into human nature, some represent – to me – a mindset that as healthcare providers we have an ethical duty to transcend.

I congratulate Mr. Howard on his 13^th anniversary of being a practitioner, but have to question the implications of working in more than 24 offices in 13 years. Is this accomplishment a result of the keen self awareness that ‘the likes of those he has worked for or with’ apparently lack? While bouncing around from clinic to clinic may offer a unique perspective, it is hardly a position from which to write about practice management with any authority.

I say this as someone who has been out of school about seven years and successfully owned and operated my own clinic for the last five years.

The notion that “through patient education, the practitioner encourages the patient to raise the dollar value they assign to their discomfort” is nothing short of absurd, and quite frankly morally reprehensible. Yes, Mr. Howard, some people have to “self discharge” because they can no longer afford treatment. Assigning greater value to ones discomfort unfortunately does not equate with greater means, or better outcomes.

And yes, sometimes fees do correlate with patient success. I see it all the time in my clinic, but based on my direct experience of 5 years and nearly 20,000 treatments given to date, it is not at all as you say it is.

How one structures their practice, whether insurance based or cash based, high cost or low cost, high volume or low volume, is a matter of personal preference. I have no issue with people charging whatever they want, however they want, for their services. But this idea that “high fees attract only the most committed patients and consequently have the highest chance of success, and thus referrals”  is one that needs to be put to rest once and for all.

High fees attract only patients that can afford to pay high fees, and sure, if someone can afford high fees they can probably afford to get as much acupuncture as they want or need. But patients are committed to treatment for all kinds of reasons, and people stop coming for treatment for all kinds of reasons, and treatments succeed or fail for all kinds of reasons. To attempt to correlate high fees with greater commitment, or greater success is false logic, and from my perspective seems to be nothing more than the musings of someone who hasn’t been in one place long enough to know any better.

From what I can tell people have a higher chance of success if they can afford treatment. It’s that simple. Likewise, people refer if they see good results. It has nothing to do with how much they pay. I know this to be true because I charge $15 - $35, have committed patients, get great results, and have a vast network of referrals.

Your $300 quit smoking example is a good one. I think people basically are going to do what they do regardless of what they pay, but again their chances of success are improved by their ability to access the medicine. For example I have a social worker on a very limited fixed income coming to me for the NADA protocol currently, which we charge $10 for (that's right, I charge $10 for about 20 cents worth of needles and a couple of minutes of my time). She was distressed because with frequent treatment her budget was being stretched at that price. I offered her treatment for $5 instead, and she’s doing great. At the end of the day will she stop smoking and stay stopped. Who knows? But at least she now has the same chance as someone paying $300 has.

I’m not saying everyone should charge less, or practice how I practice, but this notion that people who can’t afford high priced treatment need merely to be educated or more committed needs to stop.

Perhaps acupuncturists would be well served by focusing on their commitment to their patients instead of their patients' commitment to them.

Comments on Wiki Qi

What follows are an AOMA students comments on my Wiki Qi blog, and my response to him. I'm re-posting as a blog because the way comments are formatted you can't easily see them. Here goes:

Dec 5, 2011 10:13 AM
Dear Wally,

I have read your blog in reaction to the “Wiki Qi group” at AOMA and I was surprised to read such strong opposition from a man who wants to make acupuncture more affordable to the community. I don’t know who our Wiki Qi group is but I felt it was a courageous step in addressing this increasing gap between loan distributions, education costs and costs of living. I would agree that some points could have been addressed differently. There was a great deal of passion present in that email as there is here in your blog. Opinions around finances in the world today are an increasingly tender spot , as making ends meet has become a little harder. This is why your service at South Austin Community Acupuncture is so important.

The student is the end of the chain when finances are tight. The teachers desire more money, the book authors desire more money, the administrators seek more money and so there is a need to increase profits yearly to keep this cycle going. But the government is not giving students more money and so what is left over to live with is getting smaller and smaller. The School (as you will recall) recommends that full time students do not work because of the demands of full time education. Therefore, many students, as you apparently did, take the full amount allowed. After purchasing books, supplies, rent, food, utilities, gas, etc there is not a lot of wiggle room and for some it will not even cover that much. Where are the students to come up with the financial backing for these increasing costs?

You point out that it’s only a 3% increase in several places in your blog as if it’s too small amount to fuss over and yet just recently UT students faced a 2.6 % increase and said enough is enough and it looks like the students have won. The school will come to the decision this week. All of these seemingly small increases are adding up. There are other places to cut costs. And this does not need to be a cut to teachers or staff but perhaps a freeze on income. If no one got a raise next year it might balance out. The staff then, as well as the students, would need to find a way to be more efficient. Student loan distributions have not had a raise in a while after all. When students get a raise, the financial award can get passed up the chain.

This would possibly have an effect on your girlfriend’s income, who is employed at AOMA and I have to wonder if this is why you are so incensed by the student movement as you are not entirely neutral to the effects this might have on you. We are all personally affected by these changes.

I respect Wiki Qi’s opinions and call to awareness and in fact I respect your opinions too Wally. I would add that both you and Wiki Qi could work a little on how your tone and choice of words may not be doing justice to the points which you are trying to make. If we can work through the oppositions we might come to some agreements.

Jason McLay AOMA Student

And my response....

Jan 6, 2012 10:19 AM 

Hi Jason,

Thanks for your input. 

I actually thought that relative to some of the stuff Wiki Qi wrote what I said was pretty measured.

I spoke up about Wiki Qi’s email because I thought it was presumptuous and disrespectful to the point of just being dumb. Regarding some of the points you make:

First of all, you say that I “point out that it’s only a 3% increase in several places as if it’s too small amount to fuss over” when actually, not once was this the point I was making. My point was not to be dismissive of the amount or effect of the tuition increase, my point was to address Wiki Qi’s reaction to it - which was pretty over the top. 

Having said that, I’m not sure what catalog you are under, but the 2011 – 2012 catalog states the following: “AOMA reserves the right to make tuition adjustments of 4-8% per year that reflect changes in the cost of living and cost of education, subject to governing board approval.” These are the terms you have agreed to by undertaking a program under a given catalog. So yeah, I guess you could say it was only 3%. 

The overarching theme of Wiki Qi’s message seems to be that the AOMA administration is irresponsible and incompetent, and that the students bear the brunt for this. I don’t agree with this. I understand it’s hard financially to be a student, and there have been a lot of big changes at AOMA recently, but come on…

It's easy to write a bunch of reactive bs (anonymously no less) about the "school" and the "administration” as if you are writing about a thing rather than actual people. I don’t find it to be particularly courageous or constructive. For me the people that make up AOMA are my friends, colleagues, teachers, and yes – one is my girlfriend. And from what I can tell, they are a fairly capable bunch doing good work with a high level of integrity.

I don’t really know how to respond to your musings about my girlfriend’s income and my neutrality or lack thereof, other than to say yes, my girlfriend is the Director of Finance at AOMA, and no, cost cutting measures that affect her income do not make me angry. Otherwise you’re kind of into the realm of the hypothetical. I didn’t know about “the student movement” for instance.

Regarding your being “surprised to read such strong opposition from a man who wants to make acupuncture more affordable to the community”, I can’t say I follow your logic. I honestly don’t know that there is any correlation between the cost of treatment and the cost of education – if that’s what you are getting. 

When I went to school, then president Jim Coombes pretty much made it clear that this was adult education, and that we needed to take responsibility for our choice to be there. He made it clear there were no guarantees of success and encouraged us to borrow as little as we could. So work part time if you need to. My girlfriend did the whole time she was in school.

The cost of education, and the state of acupuncture in the US are complicated issues and my thoughts and opinions about these topics don’t fit neatly into one camp or another. Nor do I see any easy solutions. While the disparity between the cost of an acupuncture degree and the earning power of that degree is a real issue for many, I don’t think acupuncture schools are out to screw you. And yes, if you borrow all the money you can you are going to graduate with a whole lot of debt and be entering a field where you are pretty much on your own. It is something to think about. Most people don’t really think about it I suspect.