by Bob Flaws

In my experience, most of our school acupuncture clinics do a poor job in modeling real-life practice for students, and I see this as a real problem for the success of practitioners individually and our profession as whole.

First, either by design or simply due to too few patients, clinical preceptors often spend an hour on a single patient. In China, one quickly learns (in fact, immediately learns) in clinic how to treat 3-4 patients simultaneously, each patient receiving approximately 1/2 hour of treatment. Since some of this time involves passive needle retention, the practitioner does not need to speed a continuous 1/2 hour with each patient. This model of time management is important since it teaches students how to make a good living doing acupuncture. If one only treats one patient per hour, then that one patient has to pay him or herself for that whole hour of the practitioner's time plus the whole hour of expenses for running the clinic. Either this makes acupuncture an expensive proposition for the patient, thus limiting usage (by number of patients, by any one patient, and by the socio-economic status of patients), or it means the practitioner is not earning what they should. If patients can't afford our services, they don't get well and we can't stay in practice. Given the time, effort, and expense of training to enter this profession, our graduates should not have to live a life of genteel poverty.

Follow up:

Secondly, patients at most school clinics only receive one treatment per week. In China, the norm is one treat every other day, three treatments per week for chronic conditions and one treatment (or more) per day for acute conditions. In my opinion, many of the therapeutic failures of American acupuncturists have nothing to do with pattern discrimination, point selection, or hand technique. They have to do with too few treatments spaced too far apart for the severity and intransigence of the condition. I routinely hear from relatively new practitioners asking why they are not getting the results they and their patients are expecting, only to find out that the practitioner is only treating once per week. In some cases, this is because the practitioner is too insecure and inexperienced to feel confident in telling the patient to come in three times per week. In other cases, the practitioner has only seen once-a-week treatment and has never questioned whether such infrequent treatment is standard of care. For them, based on what they saw in their school's clinic, it was de facto standard of care. Yet there is no suggestion in the Chinese medical literature that once-a-week acupuncture was ever standard of care.

Third, I have often heard American students claim that one clinical preceptor explained and treated a case one week and a different clinical preceptor explained and treated the same case differently the next week. In other words, at some school clinics, due to shortage of staff, there is not continuity of care of one patient/one practitioner. At schools where several different systems of acupuncture are taught, such as TCM acupuncture, Japanese meridian therapy, and Worsleyan Five Element acupuncture, this can be extremely confusing for the students, not to mention potentially ineffective for the patients.

In China, I went to clinic every morning, six mornings per week. (Lectures were in the afternoon.) This meant that, at first, I saw the same patients treated three times per week over a several week period of time. Within a month I was treating patients myself at this same treatment frequency. Thus I got to follow these patients carefully over an extended period of time, seeing what worked and what did not. I also had the same clinical preceptor for months at a time. So I learned a consistent message and a consistent set of techniques.

I fully understand and appreciate the financial and time constraints within which American schools operate. However, since the end goal of our students' education is (or at least should be) to train them to be the best acupuncture healers possible, it seems that more attention should be placed on running our school clinics in a way that models the best possible clinical practice. We humans are a very creative species. Thus I believe we could come up with a win-win solution to this fundamental problem in American acupuncture education if A) we applied some of this creativity to this problem and there was a will to change. By win-win, I mean a win for the school that has to operate within budget, a win for their students who need to learn how best to practice, and a win for patients who simply want to get well. Right now, the way too many school clinics are run, I believe these last two groups of stakeholders are not being served the way they should be.

Copyright Blue Poppy Press, 2009. All rights reserved.