by Gord Grant PhD, RAc

This is the second part of a series that describes ATP’s “turning points”  — it’s about my insights along the way as we have engaged and participated with our clients in caring for their health.  Last time I introduced the idea of community acupuncture and how it is now integrated into the culture at ATP.  I see it not only as an alternative, but also as a necessary complement to private treatments, and to all the medical and other care each client receives outside of our clinic (read that article here). 

Now I am going back in time to the beginning of our story.  Here I discovered the dilemma every healthcare practitioner faces; efficiently moving through many treatments or slowing things down to discover each client’s unique story and what works best for him or her.  How one faces this dilemma perhaps comes to define a practitioner’s fundamental outlook on much more than healthcare.

When I first opened the doors in the summer of 2009, before I had considered the possibility of community acupuncture, I offered private room treatments the way most other acupuncturists do.  Many acupuncturists operate such that they are occupied with other clients during a treatment, especially if they get busy. This is the model typically used by acupuncturists, physiotherapists, and physicians, who often overlap patient bookings to increase the efficiency of the process.  The first treatment however, is often an extended and special visit in the healthcare industry, and more is charged accordingly because of the extra time. So acupuncturists typically book 1 ½ hours on the first visit, with the first ½ hour being fully dedicated to thoroughly assessing the problem with the client, and the next hour being a normal allotment of time for treatment in coordination with moving quickly among other returning clients.  In subsequent return visits, clients are in treatment simultaneously and dealt with in quick succession in separate rooms. 

Paying more attention pays off  – but at a cost.  At “The Acupuncture Turning Point”, I decided to do things differently, right from the start. First of all, I got rid of the extended first treatment, since I found not only that it cost too much for some people, but also that a lot of my assessment came by seeing someone’s reaction to a treatment. I came to better understand the problems and the solutions when I paid attention to the response to treatments and the ways a client’s symptoms changed week to week.  I found the extra initial assessment to be less relevant, and unnecessary, when compared to taking the time to pay attention each time and watch for trends, which inspired clients with ideas and homework too!  Also, the extra time for getting to know someone better, beyond the technical aspects of assessment, diagnosis, and putting the needles in, often resulted in unexpected positive outcomes for clients.  I could find out more fully the story of their lives, and notice and learn about other factors and subtleties that relate to the bigger picture of their problems.  I would find myself second guessing my original assumptions in a treatment series, and took the effort to become an investigative detective in health, in partnership with each client.

In the beginning, I could afford this extra time since I was just establishing the business and wasn’t too busy. Compared to later on when I got busier, and I tried treating multiple clients, I noticed the positive difference of spending the extra time — especially when there were big changes occurring between sessions, and especially for people with more complex situations with several factors affecting their symptoms.  At first, I chalked this up to my inexperience and needing more time to assess and treat.  But I came to realize this was not so….

I came to see and identify this dilemma as a choice between making the business work from a financial point of view, and the best interests of our clients.  This is a very difficult issue that I believe every healthcare worker, or anyone who serves another individual for that matter, must deal with. When you think about it, it is very difficult to find a healthcare professional to spend extra time and really problem solve with you.  The market or system forces his or her eye to be on the clock.  To spend more time becomes a very costly and unsustainable proposition to the practitioner, if the time is not reflected fairly in the fees, or to the client, if it is!  Regardless, I noticed when I and my colleagues took the extra time (by not treating multiple patients at the same time) to understand a person’s unique situation and be more responsive during each session (not just the first), we noticed that the practitioner and client both usually gained much greater insight and understanding of important nuances of the problem over a series of treatments.  Not only could we complete a more in-depth assessment, but we could combine body work with acupuncture, or achieve balanced front and back treatments in a one hour session instead of the client having to come back a second time. Subtleties not apparent in previous sessions are often discovered that can make all the difference when we take more time.  This can translate into changes in our treatment protocol, lifestyle or diet adjustments, teamwork collaboration among our therapeutic team, or information sought that translates into referrals or new questions for a client’s physician or other healthcare workers.

But, as we got busier, if we still wanted to guarantee our capacity be more attentive and responsive when necessary, we could not treat more than one client at a time! This was a difficult dilemma – one we still face each day.  We can not always anticipate when this extra time is required.  Often, people feel profoundly relaxed once the needles are in, and we like to let them rest, and even sleep.  When and which client will need this quietness and when he or she will need something else, is not so predictable.  At these times we could easily be treating other clients; it can even seem like a waste of time if we do not  (we could be helping more people more efficiently!).  Oddly though, I have found that if I am idle when waiting for a client’s quiet session to finish, I will hit my textbooks and the internet or discuss with other team practitioners about complex situations in treatment for that client or another.  So a new and unexpected opportunity has emerged for us to actually become better practitioners when we get this “free” time.  I have found clients often benefit from this extra attention – by that I mean being available to engage in discussion and further investigate and treat, both on the first visit and in subsequent follow-ups. 

We could not have realized our current service options unless we developed the transparent less-cost option of community acupuncture.  Now, in order to offer best possible services for our clients that are sustainable because they both cover the overhead of the private room and clinic and also give practitioners fair pay for their time, we offer a few options.  For the initial treatment, a full hour of practitioner time is necessary booked so he or she can perform a thorough assessment and treatment from the start.  The practitioner and client then decide how to proceed next, including the options of more advanced sessions which include more time for investigation (and presenting the case to the team for support, ideas, and referral), or simpler routine sessions where there is less need for reassessment.  Community acupuncture in a group setting is also an option for standard protocols needed weekly over time, such as fertility, headaches, pain management, or simple health promotion.

Our method is more responsive and effective than the default traditional model of aiming to treat multiple clients at the same time. We stive to find the right match of our time for each client as things evolve —sometimes this costs more, sometimes it costs much less.  But we know for us, and many of our clients know too, it’s really worth the extra attention we give when we need to.

I have asked my team many times to imagine what would it look like if we really looked after people’s best interests – the choice we now give for extra time in private treatments on one hand, or the less costly alternative of community acupuncture on the other, has helped us come closer to this ideal.

Next: Next in the series I talk about the experience and results of community acupuncture compared to private treatments for both practitioner and client alike, in “Cost: The big limitation of private treatments; but are they always necessary?”

For the initial treatment, a full hour of practitioner time is necessary, and booked so he or she can perform a thorough assessment and treatment from the start.