Tuesday, October 11, 2005

We Call It a Practice, But It's Real Life

There are many issues that come up in the practice of East Asian medicine, or really any medicine, in the modern setting. On the face of it, healthcare seems very straightforward: people get sick or hurt, and they come to you for help. You poke them with needles and give them some herbs, and they get better (or not).

But the reality is that we live as part of a society, and as part of an economy, and there is no escaping the fact that the care we provide is in fact a series of financial transactions that accumulate to provide us practitioners with a livelihood. I have struggled with this for a long time, because I have always been troubled by the psychology of on the one hand wanting my patients to get better, but on the other hand wanting them to keep coming back for more treatment so that I could pay my bills. I believe that our need to pay our bills, and our desire to do better than that - to accumulate some kind of wealth and a comfortable lifestyle - has resulted in the industrialization of our medicine. What I mean by this is that even though acupuncture and herbal medicine are supposed to be holistic and natural, economic pressures have forced many of us to adopt a model that is very similar to Western medicine, in which we treat as many patients as possible, using three or more rooms and demanding that we devote only fifteen minutes or less per patient.

It's easy to justify such a style of treatment not only on economic grounds but also with the reasoning that the patients don't seem to mind and in fact derive great benefit from our speedy ministrations. There are whole systems of medicine built on this model. And besides, we argue, when you get good you can just book, you get into a groove and treat those patients, bam bam bam!

But I have to wonder. I think that a large part of the care in healthcare has to do with caring enough about our patients to spend some time with them. Especially with a hands-on medicine like ours. How can you notice that this patient's spleen channel has little lumps and dips along it, or that patient has telltale little blood stagnation venules around UB-40, if you don't have the time to palpate and look? Is it enough to feel the pulse and look at the tongue and, within the five minutes you have allotted, declare your diagnosis and stick a few needles before moving on to the next room? Often, it may be enough. But sometimes, it may not be enough, and we don't make a difference when we could have. And always, we should ask ourselves: is this the best we can do for our patients?

We like to call what we do a practice. The practice of medicine. Or even sexier, a spiritual practice: "The medicine that I practice is just an extension of my spiritual path." This is fine and dandy, but for the patient it's not just practice. It's real life. Their real lives. So I think that for us it should be real life too. Let's take the time to live our medicine the way it was meant to be, with great care and attention and authenticity, even if that means we have to slow down. Slowing down and taking a breath - that's good for you, right? It'll be good for our patients too.

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