by Shawn Kirby L.Ac.

I’ll speak for all of us – we have hard jobs.

Since I’ve moved back home to Colorado I’ve been catching up with old friends and colleagues that I haven’t seen in years. After getting up to speed on each other lives, the conversation invariably turns to war stories from our practices. Some of the tales I’ve listened to would turn your hair white. I can’t tell you the number of practitioners I’ve heard beating themselves up and stressing out over their patients. We start out in life as baby TCM grads, filled with expectations of becoming brilliant acupuncturists and erudite herbal scholars, healing the ills of mankind. And then reality hits and we start wondering if we’ve accidentally wandered into the mental ward. This isn’t, of course, unique to TCM. As a friend of mine in western medicine bluntly put it, “welcome to health care.” The question becomes – how do you cope?

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There is a piece of advice that I received early on in my education that has held me in good stead throughout my career. It was given to me by a former professor of mine, a veteran of over 25 years in practice. Understood and applied, this simple bit of homespun wisdom can make a big difference for you in your practice.

“Don’t get too excited over your failures,” he said, “and don’t get too excited over your successes either.”

That’s sage advice.

It’s not your fault

Let’s say a woman walks into your office with almost a dozen different chief complaints ranging from Hashimoto’s thyroiditis, to anemia, to chronic fatigue syndrome. Further inquiry reveals that she made these diagnoses herself based on extensive research on the internet. “All the doctors I’ve seen are idiots,” she claims, “which is why I went to an independent laboratory in Mexico to get my own blood and stool samples analyzed.” As you move through your first few treatments, she opens up to you and talks about all her troubles and complaints with her husband, her children and her co-workers, reciting a litany of vitriol that would wither a city. At first she seems pleased with you, conspiratorially gossiping with you about everyone else in her life no matter how much you ignore it or change the subject. After the fourth treatment, however, she begins to take umbrage, even telling you she doesn’t think you know what you’re doing. At last she leaves you a message on Sunday at 10:30 pm to cancel her appointment the following morning. Apparently, she feels that your treatment hasn’t done any good at all. She did, however, want you to know that she’s feeling much better now following the coffee enema she took on the advice of the high-school girl working at the health food store.

It's not your fault.

Or perhaps a patient comes into your office complaining of back pain. She’s been in 5 car accidents in the last four years and has undergone 3 surgeries. She got into these wrecks because her epilepsy makes her prone to losing control while driving. She wants to get off the OxyContin that keeps her from going into a coma from the pain. She doesn’t really “believe” in acupuncture of course, but after having gone to 5 different doctors before you, she’s decided to give “this weird Asian voodoo a try. You know, as a last resort.” Like a TCM version of Don Quixote, you take the case. You proceed with thrice-weekly acupuncture at a severely discounted rate (she has no money since it’s all tied up in law suits from causing all those wrecks, particularly the one she was in after her driver’s license was revoked.) After six months of steady progress her pain level goes from a 10/10 to a 6/10. Just when you’re starting to think you’re on the right track she comes in with her boyfriend, a drug dealer who also just happens to supply her with medical marijuana. He verbally abuses you at the top of his lungs for fifteen minutes, calling you a useless quack, while your patient sits in a chair and cries.

It’s not your fault.

Maybe you’ve seen enough of this kind of thing and you’re finally starting to get wise. Now you do a free initial consultation to weed out potential problems before you take on a new patient. A woman comes into your office one day stating that she has a severe UTI. This condition is exacerbated by the fact that she only has one kidney, and it only has partial function. She has refused the course of antibiotics prescribed by her doctor and signed a form indicating that she has done so against medical advice. Despite the fact that her doctor feels the condition has progressed to life threatening status, she doesn’t “believe” in western medicine and wants to rely only on natural healing modalities. She states that she has great faith in her current regime of 2 tablespoons of hydrogen peroxide taken internally twice daily. When you protest that this may not be the best idea, she produces a stack of literature from the multi-level marketing company that she bought the hydrogen peroxide from to reassure you. She’s OK with acupuncture and herbs, but she will only take the herbs if you allow her to muscle test them to confirm your diagnosis. At this point you explain to her, in measured and even tones and using your best manners, that you will not be treating her and that you cannot advise her strenuously enough that she needs to get back into her doctor’s office ASAP or she will become septic and die. Upon hearing this she leaps from the chair, calls you a Judas and a patsy for the godless corporate healthcare conglomerate and storms from the office. You know you did the right thing, so why are you still awake at 3:00 am wondering if this woman will live out the month?

It’s not your fault.

Your job is to do the best you can, using your education as an acupuncturist and Chinese herbalist, to benefit your patient’s health while being scrupulously careful not to create iatrogenesis. You are NOT a surrogate mother, father, daughter, son, friend, confidant, counselor, scratching post, whipping boy, or idiot butler. You may or may not be able to help them with their problem. That’s OK. Don’t beat yourself up about it. Your only responsibility is to do the best you can, adhering to your scope of practice. That’s it.

Except when it is your fault

It’s also vitally important, however, to remember that your patients can give you nothing other than monetary compensation for your time and services. If you need validation in any other way, shape or form, don’t look for it from your patients. Working for an “atta-boy” is bad medicine.

Don’t get me wrong – you’d have to be less than human not to feel chuffed when you get a good result. When you nail that pattern discrimination perfectly and your insomnia patient sleeps through the night for the first time in over ten years, you’ve got to feel good about that. When a rock climber comes in with recalcitrant shoulder pain that his chiropractor and massage therapist couldn’t touch and you get him out of pain with one good session of cupping and gua sha, you’ve got to feel good about that. But if you’re basing your self worth and self-esteem on the results you get from your patients, then you’re heading for trouble at 80 miles an hour.

It is part of your job as a provider of health care to fill up your tank with all the self-esteem and self-worth you can muster before you step foot into your treatment room. When you feel good about yourself you can laugh things off that would drive other people crazy.

Let’s face it though – who among us feels that great about ourselves? We could all use a little boost in this regard. The key is to make the promotion of your own mental health and wellbeing a part of your practice. Every day that you treat, finish the day by washing your hands, stomping on ground to ground yourself, and then go out for an ice cream. Get a massage once a week. Get up in the morning, look at yourself in the mirror and tell yourself what a gorgeous specimen you are. And if you feel that you need additional help, then get it. Therapy can be a life saver for those of us in the field of health care.

It’s important to remember that every patient that comes into your office, to one degree or another, has unreasonable expectations of you. Killing yourself to live up to those expectations will shorten the length of your career by decades and drive you nuts in the process. We can’t control what our patients think, say, or do. What we can control is how we react to our patients. When you can do this calmly and with sanity, based on a solid platform of self-worth and, most importantly, a sense of humor, you’ll really have mastered the art of medicine. I’m nowhere close. But I’m working on it.

This blog is dedicated to the all the pracs out there who relayed these horror stories to me and to all the others who can relate. (Yes, those were real case histories.) Stand tall – you are the heart and soul of our medicine.