Principals Blog

I was talking to our new first year acupuncture students recently about one of the key qualities which Eastern traditions identify as being important in a healthcare practitioner, be they an acupuncturist, herbalist, nutritionist, massage therapist, or indeed a doctor of Western medicine. This is the quality of being able to still and quieten one’s heart and mind.

There are a number of dimensions to this. Let’s start with our emotions. The traditional view recognises our emotions as an important part of being human and being alive, but notes that it is important to be able to allow our emotions to flow through us and move on. Emotions become harmful both to ourselves and to others when we become stuck in them. Cultivating a quality of quietness of the heart and mind is seen as key in enabling us to get enough perspective to avoid becoming stuck in our feelings. This in turn enables us to cultivate positive qualities of character. Another important dimension is that when we can quieten down within this helps us to maintain our sense of meaning and purpose.

The students and I tried out a few simple, tried and tested approaches to meditation/relaxation, such as focussing on the breath, as a way of inducing an inner quietness, and I think for many of us this was quite effective. There are many methods and techniques of course, many of which have been known for thousands of years. In an interesting fusion of ancient and modern, if you search for “meditation” or “relaxation” there are now lots of apps to try, as an introduction to different techniques.

As I told the students (and reminded myself!) it is a good idea to practise one or more of these meditation/relaxation techniques for 20 minutes or so every day. But there is a further challenge, which is to be able to continue to be in touch with feelings of inner peace as we go about our daily lives. This is a bit easier out in nature, or in a monastery, but less easy in the midst of a bustling city. To help with this, there’s another approach which I came across recently (thanks to Stefan Chmelik). This is a simple “mantra” to use at anytime during our daily lives. It goes “I’m alright, right now”. Straightforward and surprisingly effective. This was coined by neuropsychologist Rick Hanson, author of “Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom”. He explains the ideas behind it in a short article in Psychology Today which you can read at: http://www.psychologytoday.com/blog/your-wise-brain/201106/notice-youre-alright-right-now

In the centre of York there is a famous medieval street, the Shambles. In a small shop in the Shambles, quiet and unassuming, works a truly great craft baker. What intrigues me is that for his simple loaves he only uses flour, water and yeast, yet he creates outstanding bread. Give a mediocre baker the same ingredients, or put them through a conveyor belt, and the result is not nearly so good to eat.

Now I have a scientific background, but the scientist in me has to admit that there is currently no satisfying scientific explanation for this difference. An overly simplistic approach to science might say “same ingredients, same result” but that is clearly not the case. A more sophisticated approach would recognise that there are all sorts of factors, which in theory we could identify, which probably make the difference, and many of them are likely to be to do with subtleties in what the baker himself actually does. An approach rooted in Eastern philosophy might caution that while knowledge and understanding are of great value, we should remember that we will never be able to explain everything in words, but we can still learn from the master baker the craft of baking great bread.

In my experience, something similar happens in medicine. Even in conventional medicine, the same combination of basic ingredients (tests, prescription pad, drugs) can lead to very varied outcomes with different doctors. This is fascinating – what factors make for a more effective doctor? There’s plenty here for future researchers to investigate, but there is also much we can learn from the past. In Chinese medicine these matters have been discussed and written about for 2,000 years. It is generally agreed that it is important for the practitioner (in this case of acupuncture or herbal medicine) to cultivate themselves at the same time as learning the principles and methods of their medicine. The combination of these two can lead to a capacity for “efficacious action” which has something in common with the knack of the master craftsperson. In medicine the development of personal qualities of integrity and open-heartedness combine with practical skills and the capacity to make effective clinical judgements based on an ability to gain insight into complex patterns of disease. Chinese medicine in particular recognises that these complex patterns vary from one individual to the next, and that a good doctor makes judgements in context based on an understanding which cannot always be fully put into words. For me, one of the great strengths of learning acupuncture and Chinese medicine is that the learning develops these abilities and so has the potential to grow great practitioners. To my mind, there is much of value here for conventional medicine too, lest we concentrate so much on the science we forget the human dimension which is so crucial, both in baking great bread and in helping people to heal.

(I’d like to acknowledge the work of Volker Scheid and Dan Bensky, which has greatly influenced my own thinking on these matters. See for example their article “Medicine as Signification” in the European Journal of Oriental Medicine).

Hi All

Just to let you know that Marianne has now completed her time as our blogger and is very much looking forward to her baby arriving soon. From September the blog will be written by our Principal Richard Blackwell. Richard will be sharing with you news about the college,  the latest developments in the profession and just his perspectives on life, the Universe and everything!

Watch this blog!

So I have some news to share…..I’m pregnant! My husband and I are thrilled by this and can’t wait to meet our new arrival, due at the end of October. From a practitioner’s perspective this has already lead to some interesting times and thrown up so interesting patient/practitioner issues to explore.

The biggest issue to rear its head in the early days was morning sickness. Luckily for me, I wasn’t too badly afflicted, and never actually sick. However there were moments when I would be merrily needling a patient in the usual way, and suddenly get hit by a wave of total nausea. On at least two or three occasions I faced the sudden and very real thought of “oh my God, I’m going to vomit over the patient!” Luckily this never happened and I soon learnt that having a glass of water on constant standby and nibbling ryvita crackers between patients seemed to help. Oh and of course acupuncture! Great for nausea and I can personally testify to that!

Then there was the fatigue. Oh boy, tiredness like you have never ever known it before. The kind that makes you not care where or how you fall asleep. You just need to sleep. This wasn’t so bad when I had several patients in a row….keeping moving was crucial. But having a gap made things so much harder. I have been known to take a nap on the couch between patients!

Then finally you get to the stage where you are ready to start telling people. This is not as easy as you would think. For a couple of my patients who I have been seeing since the start of my practice, this was easy, and they were delighted for me. However for newer patients or depending on why they are coming to see me, it’s not that simple. Some patients are dealing with some big life issues, and there appointment time is very much sacred space for them to receive treatment that’s all about them. I felt that to bring any of the time onto other subjects like me, well, was just not appropriate. So picking my moment and how to say it was crucial. I did decide to tell patients, rather than let it just become an obvious issue over time, as I feel it’s an issue of respect for my patient as a fellow adult.

But then there are the really tricky scenarios. Like the patients who have just lost a pregnancy through miscarriage. Or the patients struggling to conceive. Or the ones who just found out they weren’t successful in adoption. Or who have been told they can never have children. How on earth do you go about telling them? I spent a lot of time reflecting on this, talking with a couple of colleagues who have previously been pregnant around patietns, seeking advice and generally hoping for divine inspiration to strike.  In the end I felt honesty and respect was the best way. With some I waited until the end of the treatment, and picked a day when the patient seemed calmer or more centred. With one couple who were coming for the first time, I told them at the beginning of the appointment and made it clear I would not take offence if they chose to see my colleague instead. And so far so good.  It’s been a real test of how to handle issues with sensitivity and respect. And an issue of how much of yourself to share with a patient regarding my own experiences or issues. Our practitioner development tutors at college would have had a field day with some of the issues that arise!

And then you face the issue of the patients who then want to talk about nothing but me being pregnant. And it would be easy to get caught up in this, as let’s face it, it’s my own favourite subject at the minute! But I have to remember that the focus of the appointment has to be the patient, not me or the growing bump and steer the conversation around. With most patients I don’t bring it up as an issue unless they ask me how I am. And let’s not forget the ones who now want to give me advice on pregnancy/motherhood etc!!! It’s very sweet and lovely of them, but again I have to remember the dynamics of my role in that treatment room and keep things how they ought to be.

Of course I have also faced the questions relating to when I will stop work, will I come back, what will the patients do etc.  The truth is I haven’t entirely got the answers myself at the minute, though I have some ideas. And again, I answer honestly, but gauge the depth of my answers to the patient and the relationship I have with them.

Who would have thought being pregnant could bring up so many issues in practice?!

Well here we are in May and broadly speaking my increase in patients seems to have stabilised, in the sense that although a few have dropped off I still have on average more patients each week than before the increase. This is definitely a good thing. In one of my clinics I have dropped my morning session and condensed my day to 1pm onwards. This was because at best I was getting one patient in the morning, then having a gap of three or four hours, then mid/late afternoon to evening being busy. If patients start asking for morning slots then I’ll open it back up again, but it was a complete waste of my time to be there all those hours without internet access to enable me to get on with other stuff.

Well, obviously good patient numbers are great for income levels. Not so good is if you get ill yourself. This was brought home to me a few weeks ago when I was struck down with sudden diarrhoea. Having been ill during the night but at first in the morning, seemed ok, I thought it was just a mild upset and I could go to my clinic as normal. Well, at the point of getting in my car I was rudely reminded that this was not the case. So suddenly I had to cancel a clinic with an hour’s notice. This means no clinic, no patients, no income for that day. The following day, whilst no longer suffering from diarrhoea, I still felt horrific, totally drained and would happily have stayed in bed all day. But, that day was my busiest day of the week and I just couldn’t afford not to go in. In all honesty, had I been a salaried worker with sick pay, I would have stayed at home. Funny how things change when you lose that safety net.  So I staggered in and copious cups of sugary tea later, somehow limped through the day, with luckily then the weekend to properly recover.

So all this combined with other life issues (see next post) has got me to exploring different forms of income protection. As the nice lady on the insurance advice line put it…”…if you can afford to lose your income for months or years at a time, then you don’t need protection insurance….but if you can’t, then you do.” So having been treated to a litany of the potential disasters that could befall me (car crash, mental illness, injury, etc etc etc) this is something I am now exploring. And oh boy is it complex…cover that pays for 2 years, cover that pays for 20+years, cover based on different levels of income, (try answering the how much will you earn this year question when you really can’t be sure!). And that’s before you try and understand the exclusions. Or work out whether you want to take it in combination with critical illness or life insurance cover etc etc. I can confess to being totally confused.

On a less confusing note I have actually been back to York to college recently to attend a pulses workshop with Don. Loved it. Soooooo good to be back and see people, and even better to get a refresher on puls- taking. I hadn’t realised how much I had forgotten. But it was reassuring to see the bits I was doing right too. It’s interesting to see how college has changed in this academic year…two tutors needed to run the daily clinic, lots of students looking busy. Good news for NCA I guess! I still miss going to college (the seeing people, the excitement of learning new things, not the essays and exams!!!) so it was a lovely treat to go back. I guess after three years of NCA playing such a massive role in my life, it’s always going to be a special place for me.

Well, here we are in April. I’m afraid my blogging for March didn’t really happen, due to technical problems with the NCA blog and then the sudden and unexpected demise of my laptop! I was like a fish out of water without access to my internet banking, facebook, emails etc. And not thrilled by the sudden unexpected expense of a new computer! However as luck would have it, since the beginning of March my patient numbers have improved dramatically, but to be honest, I’m not sure why!! One new patient came directly as a result of a talk that I gave to the rotary club. Others just sought out acupuncture as they had heard it would help. The strange thing is that I have had improvement across all three of my clinics. All at roughly the same time. I wonder if it is partly to do with the economy: people will have finished paying for Christmas, and those who are losing/keeping their jobs will know by now, and therefore know what they have to spend. Or, to look at it more from a 5 element perspective, with the advent of Spring, and growth of new Wood, the fresh Winds of spring, are people more ready to embrace personal change? Maybe so.  Especially as a number of my new patients are at various cross-roads in their lives. I’ll be interested to see if this is indeed a trend I see over the coming years!

Another great success in the last month is that as a result of a press release, one of my patients got featured in a big article on the local paper!!! I timed it to co-incide with Chronic Fatigue Awareness Month, and sent in the release about my patient, a local girl, and how she had been affected. Journalists being journalists, contacted my patient and spoke to her at length, but didn’t contact me, (despite the press release coming from me and having all my details on it!) or mention my name, just the clinic name. They didn’t include any of the useful info about acupuncture or BAcC. But still! As a result the clinic has had a few enquiries, and the patient and her mum (patient is a minor) are thrilled and can’t wait to spread the word as far and wide as they can about how acupuncture has helped them. It’s the best feeling ever to realise you’ve helped make such a difference.

Where I’ve not had such great success is in dealing with post-operative nerve pain. I’ve had a couple of patients with this problem in differing areas, and both don’t seem to be progressing. Time to head to the BAcC forum for advice!!!

I am doing really quite well with hot-flushes at the moment too. Kid2 seems to be the magic point at the minute, along with Heat clearing points. What’s lovely is to be gradually building on the number of patients I’ve seen with this condition (and others) to be able to start saying to myself “this worked on Mrs X, so I’ll try on Mrs Y”.

So yes, at the moment I’m really enjoying life as an acupuncturist. Now, if I could just get around to filling in my CPD plan for the BAcC……

So it seems that recent weeks have been a time of great growth in terms of knowledge! I’ve had various patient enquiries, all of which have required me to head to my books/the internet/people more knowledgeable than me to answer. That’s one of the reasons I decided to be an acupuncturist, to have the continual challenge of learning and developing my skills and knowledge. I must remember not to immediately worry about my lack of knowledge on a subject from a western perspective and approach it first from a TCM angle, although that’s easier said than done when the query is “can acupuncture help X condition” and you don’t really know what the signs and symptoms might be!

I also faced my fears and gave a talk to an all male rotary club! What a lovely bunch of gentlemen, they made me very welcome and were good natured in their teasing of their friends who were volunteers for demo acupressure massages! I was somewhat unnerved to realise there was a GP present, but luckily had time to give myself a good talking to in the ladies’ loo beforehand: we are more than trained to hold sensible and intelligent discussions with GPs, or other medics and we are the experts in Chinese medicine, and so should be proud of that! As it turns out, the said GP was quite supportive!

Well, I’ve updated (or rather, disimproved) my website in preparation for the start of the ASA powers to monitor the internet. I have some ideas for things I want to see if I can add. There are two things stopping me from doing this right away: 1. Technically, I haven’t a clue how to do it! 2. I want to wait a wee while and see what the reality of our websites being monitored brings for the CAM profession as a whole. I have to say, I was disheartened to see only one more condition, with caveats, being added to the list of treatments we can refer to, come on BAcC!!! I was also a bit disappointed that the government is not including acupuncturists in the statutory regulation that will apply to herbal practitioners soon as a result of the EU directives on herbs. Whilst it’s great the government thinks we as a profession police ourselves adequately, to have statutory recognition I believe would put us in line with other health professionals and give us a greater standing in the eyes of the public than at present. Hmmmm, is the answer to now study herbs? (Need a lotto win first!).

I’m about to sign up to a cpd webinar about how to set up a multi-bed clinic. This is a dream of mine, currently on the back-burner for numerous personal/financial/practical reasons, but definitely a plan for the future. I strongly believe if acupuncture were more affordable for more people, then not only could we make an amazing difference in people’s lives, but as a profession, alongside the growth and recognition from the public about what acupuncture can do, our profession would grow and develop accordingly. So a timely webinar at the moment will help me keep that dream alive, and you never know, nourish the roots of the seedling idea that at present exists only in my mind.

THIS ENTRY AND THE NEXT WERE WRITTEN IN FEBRUARY BUT DUE TO TECHNICAL PROBLEMS ARE ONLY BEING PUBLISHED NOW!!!

Well I hope everyone is looking forward to the year of the Rabbit. Let’s hope my patient numbers multiply accordingly and current students find their knowledge of TCM growing like an intricate warren!

I’ve been having a really interesting time attending the PR and marketing seminars, it was really inspiring to see so many women pursuing their dream. And what a great place to hand out business cards, I’ve certainly got one new patient just from attending. I’ve written my first ever press release, it took me ages, and I don’t think the papers are going to bother with it, but I’m proud of myself for having done it. Hopefully the next ones will be quicker. I’m going to brain storm things I can do in relation to the list of health awareness days/months that are coming up. In the same spirit of enterprise, I also contacted the rotary club local to one of my clinics and am now booked to do a talk there at the end of next month, and they are going to invite the local media to attend (no pressure!). Which will be (hopefully!) brilliant publicity.

Also, in the last couple of weeks I’ve taken part in my first ever Webinar, an online CPD event about endometriosis. It was brilliant, and I didn’t even have to leave the house to do it. It’s really interesting to see modern technology enabling the dissemination of ancient knowledge! I don’t think I’d like to do all my CPD online though, as it’s good to get together with other acupuncturists and talk shop, make new friends, catch up with old ones etc, but it’s a great addition and a brilliant idea from the people who are running it. I’ve just done the maths, and with the current special offer, I can sign up for 20hrs of CPD and that works out at just £220!! Which is brilliant value for money, when you consider the cost of transport/hotels/food etc to go to other CPD days. 

The 1^st March is also looming re getting websites compliant with the ASA/CAP guidelines that are effectively gagging our profession. I’ve been putting off updating mine, a bit like putting off a trip to the dentist for root canal work. Still, at the very least, by 1^st March I will have removed any offending words (i.e lists of conditions we know acupuncture works for), and as time moves on I’ll add other types of info that I HOPE don’t fall foul of the guidelines but still allows patients to access the info they need to make an informed decision about acupuncture.

Re my patients, I’m happy with how most of them are doing. I had some worries over how to approach a potential new case the other day and I rang one of my old college tutors for guidelines. It was great to get in touch and draw on years of experience and wisdom. Made me wistful for the college kitchen and the cake supply.

One random thing that has happened is that I have received a slightly strange patient email from abroad, asking me to book about 8 hours worth of appointments for patients who will be here on holiday! I emailed back, asking where they were planning to visit (as the email just didn’t feel right to me), and they say are visiting some 200miles away from me! Having just logged on to the BAcC website today I’ve just discovered it’s a scam targeting members!! Glad my instincts were right.  Oh and I’m starting to get letters from potential accountants, or other such business service people wanting my custom.  It’s a strange feeling being on the other end of other people trying to grow their businesses too.

So all in all, February is a month that seems to be offering a chance for knowledge, potential and planning for the months that lie ahead. As Dao 365 says: “Life is, beauty, terror, knowledge.”

Well, this week I’ve signed up to some interesting sounding training. No, not a seminar on the complexities of the function of the Shen, not a masterclass on needle technique or the complexities of St40…but a day on how to market on a shoe string, and how to manage my website! And the week after that, I’m attending a workshop on how to write a press release and engage with the likes of twitter and other forms of social media…all in the name of building my practice. If we are to be strangulated by the Advertising Standards Authority in what we write on our websites, leaflets and blogs then I (and other practitioners) need to arm themselves with every tool they can in order to be able to inform people what we do and how we can help people. Patients need to be informed, in order to allow them the free choice to which they are entitled, and for us as practitioners to grow our own practices. Attending these training days (all free I hasten to add, through a fantastic organisation called Enterprising Women) will also be a further chance to network and hopefully make some good face to face links with people. On this same topic, I’m really hoping that the BAcC come up with some decent guidance on what we CAN do soon. It’s going to take a fair bit of work to update my website in compliance with the codes so it would be nice to have a better idea what I can say instead. To be quite honest, I really dread the task. I just want to practice acupuncture, and keep learning about acupuncture and constantly improve as a practitioner, not spend my time figuring out the intricacies of websites! Anyway, moan over.

I’m really happy at the moment with the progress of one of my patients. It’s a patient who suffers from ME and once having been diagnosed has more or less been left to their own devices to get better. Happily, they found me. It’s just the best feeling watching such a patient improve. And on a mental level, it’s given me a huge and exciting challenge to try and diagnose and plan treatment. I’ve had to return to my books, my notes, seek advice from my old classmates, and basically rack my brains. And so far so good. I’m really hoping that when the patient goes to see their consultant soon that the consultant acknowledges the progress that has been made since starting acupuncture.

On a personal level, I’ve also been working on de-lineating my time in a better way. As a student, trying to fit my studies around my job, my home life etc, I would find myself studying or reading for essays at all times of the day and night. Now I’m practicing acupuncture, I need to create a boundary line, i.e. Nothing acupuncture related after 8pm. Otherwise, it’s very hard to switch off and allow mental rest. If I don’t do that, I find it hard to get rid of the feeling that I should be reading something, planning something etc and I risk not being as balanced as I would like to be. I’ve also decided to book in for some regular acupuncture treatment. I know it’s something I need to do, but funnily enough, recently, I’ve been so busy thinking about acupuncture in relation to other people, I’ve almost forgotten about it in relation to myself. Which is kind of ironic really, seeing a it was going for treatment that got me interested in it in the first place!

Money. It was a subject some were reluctant to talk about whilst still in college. But the hard fact remains that unless you are one of the few people who can afford to pursue acupuncture merely as a hobby, without the need to make an income, the subject of money will rear its head very quickly as soon as you graduate. As mentioned previously, the first few months of life after graduation involve lot of cheque writing. The rest are involved in trying to get the money to come in, rather than flow out in oh so poetic rivers. I heard it said many a time as an anecdotal piece of knowledge that it takes roughly one year to get to a full day of patients. I’m not sure what that “fact” was based on, as it seems that (unsurprisingly) it varies, based on how many hours you are available to work, where you set up, what kind of practice you move into etc etc. The variables are many. Speaking purely for myself, nearly five months into practice, if i combined my patients from different clinics into one block, I would vary from just under a day full, to a day and half full of patients. The variation week on week can be dramatic. And I’m certainly (after taking of money for tax, petrol, needles, BAcC fees etc etc) not earning great riches yet. But there again wouldn’t expect to be so quickly. However a bit more wouldn’t hurt that’s for sure. Back in November it seemed I was almost approaching a full day in just one of my clinics. Something to be aware of is how quicky numbers can drop off in the run up to events like Christmas….not only do people divert their money into Christmas presents, but parties, family get-togethers and over-all busy-ness kick-in (never mind unexpected snow, ice, bad weather) and all of a sudden patients cancel the appointments or don’t rebook. And therein lies the next problem: once a patient has broken their course of treatment, not all of them come back. Post-Christmas, at the other end of the spending spectrum, patients don’t have any money left, especially so this year when in an effort to beat the VAT rises people have forked out on big items such as a television or washing machine. So the trickle in of new or old patients after Christmas seems painfully slow. And then you factor in the unknown variables: the flu/bad cold/chest infection epidemic that seems to be going around. I’ve had numerous cancellations from such illnesses. So you can go from having six booked in, to three. Or worse. So you thought you would earn X, and suddenly, you only earn Y. As someone previously used to getting a salary that landed nicely into my account each month, this is quite hard to get used to, and not for the faint hearted. Oh and don’t forget, as your knowledge and skills work together and you help your patient to get better, well, you need more patients to replace them! Those more experienced than me tell me business tends to pick up towards the end of February…I’ll let you know. What I’m trying to say, is whilst I think that ultimately it’s possible to earn a good living from acupuncture, you are very unlikely to do so straight away. Patience and a good financial plan are essential to get through the period where you are establishing your practice.