Remember when you were a student or a brand new practitioner? Chinese medicine was endlessly fascinating and working with each new patient was an exciting challenge that propelled you to your office with a combination of joy and curiosity each day. After a few years in practice however, the bloom may be off the rose. Practice may feel repetitive and not very interesting. You may feel tired of listening to other people’s complaints and daydream about being a NASCAR driver, a photographer for National Geographic, or a rock star. Maybe your practice is full and you are making a decent living, but cannot find a way to grow your practice or your income any further. In recent weeks, I’ve spoken to several successful practitioners with these types of problems asking me to help them re-energize their interest in their work, get their groove back, or just figure out how to change their current practice situation so that it brings them more satisfaction. I’ve been giving these issues some thought and here are my ideas for those of you in the doldrums for one reason or another.

1. Practice fewer hours or fewer days per week. If your practice is full and the load is getting you down, change your schedule. Let go of one day per week for six months and see if that refreshes your psyche and allows you to be more present for the patients that you do see. You might consider hiring someone else to take over the day or days that you are not there. Charge a little less for appointments with the new practitioner, and pay them a flat salary for standing in for you one or two days per week. You are giving a younger practitioner a job and much needed experience, you can still make a little money on this person’s work, and you have time to rest your bodymind. Then….
2. Take up a new hobby or learn a new skill. This might be dance classes, large metal sculpture in the afternoons, learning to sing, speak a new language, or do amateur NASCAR style racing! You could also work for a political cause that’s near and dear to your heart. Whatever it is, it may allow you the variety in your life to feel that your work is interesting to you while you are there.
3. Take up a new in depth subject within Chinese medicine. Have you felt that one or more areas of study eluded you when you were in school? Did you feel that you could learn herbs again from the beginning? Is there a teacher out there whose work has fascinated you but you have yet to attend any of their classes? Would you like really become good at one specialty? Do you have an interest in one of the new doctoral programs? Do you want to learn Chinese so that you can access the medical literature in its original tongue? If so, then do it now. Take that time you have gained back from practicing less and use it to increase your skill and knowledge. You may be surprised at what you learn and how much it energizes you.
4. Take a “vacation” and volunteer for a free acupuncture program. There are more and more opportunities these days for expanding your horizons about what this medicine can do. There is the Guatemala Acupuncture Project, Acupuncturists Without Borders, the Yayasan Bumi Sehat Clinic in Bali with a satellite clinic in Banda Aceh, or numerous small local volunteer efforts around the country. If you cannot find an organization like this that suits your interests, then create one! How about a Native American reservation? Or a free public clinic in Uganda? You may find that being a volunteer for a few weeks for people who really, really need your services may give you incredible inspiration and be something you want to do every year.
5. Steer your practice toward a very specialized niche that you enjoy. It is always true that being a specialist allows you to get really good at something. The confidence that comes from going really deeply into one group of diseases or one type of treatment has many benefits. Confidence is seductive; people can feel it radiate from you and they will respond to it. Also, everyone knows that specialists charge more than GPs for their time.
6. Raise your prices. It may be that you feel completely different about your work when you are making more per increment of time spent. You may lose a few patients, but most people experience that they end up with the same number or even more when they take this step. When was the last time you raised your rates? If it was more than three years ago, it really is time to do it.
7. Repaint your clinic with some bright, bold colors, buy some new artwork, fountains, carpets, window coverings, or a new treatment table. You will be surprised by how much changing the look of your clinic can alter your state of mind. Do this especially if you have white, grey, tan, or cream colored walls surrounding you every day. Remember that rich colors and beautiful surroundings are healing both to your patients and to you!
8. Go buy some beautiful new pieces for your wardrobe. Have you ever watched one of those “make-over” TV shows?? Did you ever notice how the “after” person is usually more attractive, more powerful, and more effective than the “before” person? You can experience this phenomenon, too, by getting a few really beautiful and probably expensive items to wear to work. I am not saying that clothes will make you a better acupuncturist, but I do know from experience that when I am dressed like a million bucks, I not only feel more beautiful, but more powerful, more energized, even more intelligent! While I don’t suggest shopping therapy on a regular basis, I do know that we should wear our most beautiful clothes to the office. Why should they stay in your closet? What are you waiting for? Again, remember that beauty is healing.
9. Hire an intern. If you have been in successful private practice for some time, you probably have a lot to share with a student or new practitioner, whether you know it or not. By hiring a part time employee, you serve the community by creating a job, take off some of the load of work in your practice, and you also do a great service by helping a young practitioner learn what it really takes to run a practice. When we what we know by teaching by teaching it to others, even in an informal way, we find out the depth and breadth of our knowledge as nothing else can show us. Who knows, you may be inspired enough to hire an advanced student or young practitioner each year to help them toward their own success. Bringing in other people adds energy and a new element to your practice, so sit down and make a list of all the things such a person could do to lift responsibilities from your shoulders.
10. Work on a list of long-term goals. What would you like to be doing in 10 years? What will it take to get there? Who do you need to contact for help to reach these goals? What are your absolutely wildest dreams? If they don’t include the practice of this medicine, then how will you plan your departure for the least chaos and the most success? If they do include the practice of this medicine, how would you want it to be different from what it looks like today?

Remember, a good relationship with your work is not unlike a marriage. It requires a little work and TLC every day to keep that spark of interest alive. If you have other ideas on how to keep your interest in your practice alive and energized, please send them to me at honora@bluepoppy.com

Honora Lee Wolfe, Dipl.Ac., lives in Boulder, CO and is the author of Points for Profit: The Essential Guide to Practice Success for Acupuncturists and The Successful Chinese Herbalist. For other books and free articles by Honora, visit www.bluepoppy.com.

What items should be on it…in what priority?

•Any actual patient appointments!

•Marketing activities (this is where your next patients are coming from so this is second only to patients you already have!)

•Family obligations and events

•Calls to return (patients, marketing activities, other professional calls)

•Bookkeeping, patient billing, insurance paperwork

•Inventory management (needles, supplies, herbs, other)

•Clinic maintenance (cleaning, repairs, shopping)

•Self care (yoga class, writing to a friend, a glass of wine)

•Other (volunteering in the community)

When you cannot yet delegate…

At the end of each work-day, spend five minutes making your list for the next day. I like to put these items right onto my calendar book (or into calendar/planning software if you prefer)

While you are building your business, think about what could you do to take better care of the patients you already have. Have you asked them for referrals? Do you have referral request signage in your clinic? If not, that’s a good “to-do” list assignment.

Prioritize based on what’s real. If you need more ptx, marketing and outreach time is first.

Don’t dink around on Facebook unless that’s REAL marketing for you. Instead, write a blog or search for opportunities to write for other publications.

If you had the guts to do anything at all for just 30 mins a day to grow your biz, what would it be? In fact…that’s where the juice it…that’s where the new patients may be.

Once you actually have someone to delegate some items to…

•These things should be what your employee is doing when the phone is not ringing…

•Calls to return; bonding calls, reminder calls

•Bookkeeping, ptx billing, insurance paperwork

•Inventory management (needles, supplies, herbs, other)

•Clinic maintenance (cleaning, repairs, shopping)

•Ptx file maintenance

•Proofreading things you have written for promotional purposes

•Sending letters to orgs. to find speaking gigs for you; Sending letters to find publications for your written pieces

Then…

•Do what you can and let it go.

•Don’t be lazy, but don’t beat yourself up for things not completed…just put things on the next list!

•Don’t delete self-care from your list

•For things not completed, create tomorrow’s list and put them at the top

•Consider doing the things you least want to do first, so they are over with!

Teach your employee(s) a new skill so you can delegate more!

So if you are feeling scattered, overworked and overwhelmed, maybe organizing things into a realistic to-do list could help you relax at the end of the day, knowing that you’ll know exactly what is on tomorrow’s plate when tomorrow becomes today.

Best wishes!

The end of this April marks the end of a wonderful era for me at Blue Poppy, so for one of my final blogs I would like to offer a sincere thank you to Blue Poppy and our outstanding readers.  I am afflicted with a constant desire to keep studying Chinese medicine, and over the past few years I have been finding it increasingly difficult to resist the desire to spend more time in Asia to take my studies to the next level.  It has been a great honor to work with the team at Blue Poppy and I plan to stay closely connected to the Western world of Chinese medicine, but for now I have decided to spend more time focusing on my study of Chinese herbal pharmacy and quality discernment.  I may periodically chime in with some comments or a guest blog at times, but for now, it is with a proverbial tear in my eye that I wish our readers a fond farewell.

I often feel incredibly fortunate to work in the field of Chinese medicine because our community is full of wonderful, positive, and passionate people.  My time spent working at Blue Poppy has left me with an even greater appreciation of our field than ever before, partially because I’ve had the chance to meet more friendly practitioners around the country and partially because being part of the Blue Poppy team gave me the chance to experience the wonderful inside of the industry.  My direct colleagues at Blue Poppy form an incredible team, and I will forever treasure my relationships with many of the great people from the wider world of Blue Poppy’s distributors and suppliers.

Over the past few years, I’ve enjoyed countless laughs and smiles with Blue Poppy’s practitioners- the radiant Honora, Shawn and Malia- and I will cherish friendships with the wider Blue Poppy team for years to come.  Each Blue Poppy employee has a specialty: Rick, our guru of graphics, moonlights as Superdad and lifts the whole office with his smile. Steve, the artisanal master crafter of the external line, runs the warehouse with military precision and lurks out of the spotlight as the unsung hero that keeps Blue Poppy running smoothly.  Jesse rides his mountain bike across the county through rain and snow to get the boxes safely out the door, and the customer service team tirelessly handles a deluge of calls with grace on a daily basis.  Margie and Bruce, our accountant and GM, round out the team in true Colorado-style.  Margie’s warm smile and fresh photos of fishing expeditions brightened every morning, and I’ll never stop cherishing my memories of traveling the hills of Guilin with Bruce and his wife during our site visits to China.

Beyond the human relationships, there was something intangibly great about riding my bike to a wind-powered office that prioritized the planet and the people over the normal priorities of the business world.  Chinese medicine is a field unlike any other, and I’m truly proud to have been a part of the Blue Poppy team for the past several years.  To all the people at Blue Poppy and to all our customers and blog readers, I bow my head in a sincere thank you and wish everyone the best on the next stage of the journey.  It has truly been an honor and a pleasure to write here.

A couple of weeks ago, I was visiting a number of the schools in Florida, speaking to students and meeting faculty and administration folks. At one of these events, a student asked me what did I think was the most important skill to possess in order to be successful. In the moment, I rattled off some platitudes about positive thinking, taking care of your health, how the tortoise wins the race, never giving up, and the like. But having had some time to think about that student’s question, my current thought is that patient communication skills are the most important thing to develop for a successful acupuncture (or any other type of alternative healthcare) practice.

But wait, you may say, what about knowing your herbs, point locations, needling techniques? And yes, I agree that all those things are important skills as well. Still, I have seen practitioners whom I did not believe to be greatly skilled clinicians, but who, because of the way they communicated with patients, were and are fabulously successful practitioners and got consistently acceptable results as well.

So here are my few pieces of advice for effective communication with patients.

1. Create a few written educational flyers or articles about how you help patients to heal to use on your website and as handout materials. These may or may not be “condition specific.” Use a short intro about your clinical specialties and some bullet points with statements such as:
   1. Acupuncture helps all the systems in your body return to and remain in dynamic balance. This allows our body’s natural healing mechanisms to work more effectively for us.
   2. Acupuncture helps keep your immune system strong so your body can fight off disease.
   3. Chinese herbal medicine work naturally with your body systems to bring you back to health without side effects.
   4. Acupuncture gently fosters healthy brain chemistry to keep our emotions on an even keel.
   5. According to the World Health Organization, acupuncture has proven to be effective in treating over 40 specific conditions! See the back of this flyer to check out this list.
   6. Our clinic specializes in supporting patients with chronic allergies (fill in your own specialty). We are here to help you experience an allergy-free Spring and Autumn season!

These are just a start. What other ways do you feel you help your patients? If you can articulate this on paper (and on your website) then don’t be shy in telling your patients this good news. Remember that most people don’t have any experience of Chinese medicine or acupuncture and no idea what we can and cannot do.

1. Learn to do a thorough, gentle, efficient Western medical exam, as seems appropriate for each patient. This may include visual examination, palpation, percussion, listening, or other specific simple tests. Of course we do take each patient’s blood pressure, but by adding on some simple examinations appropriate to their condition, we  give them reassurance that we are “real” healthcare providers. This is most important on the patient’s first interview and assessment visit.
2. What educational tools do you use to help your patients feel more comfortable with our medicine? Brochures are great, of course, but how about a 3-5 minute video for all new patients available on your website? If a new patient says they have not watched it, perhaps it can be available in your history-taking room as well. In this video you use some version of statements shown above in #1 and then do a treatment demonstration on a willing patient or family member while you talk them through how the needles are very fine, insertions do not create any great discomfort, patients feel relaxed and often fall asleep, etc.
3. How about a research notebook with articles on all the conditions you like to treat that can be made available as copies for patients to take home? This is facilitated by simple signage that says something like “Want a copy of research on Chinese medicine and _______ ? (migraines, arthritis, allergies, sinus pain, insomnia, infertility, etc., etc.) Ask the front desk for a copy to take to a friend, colleague, or family member.”
4. Speaking of signage, how about a nicely framed copy of the WHO list of conditions amenable to acupuncture? Remember that most patients don’t know all the things acupuncture can do.
5. Write a 2-3 minute speech about how this medicine works that can be spoken to the general public or in response to your new patients’ inquiries. Not complicated, not technical, and very careful with the word “qi,” since we cannot really translate or explain its meaning in our own literature.
6. In the treatment room, touch and treat with confidence, even when you aren’t totally sure what to do. Learn to method act confident body language until you no longer need to method act!  Just create/choose a treatment and do it with panache. That way you don’t lose out on the placebo effect piece of every treatment and patient encounter! Remember that 30-50% of every successful medical treatment of any kind is placebo effect.
7. Use a bonding call to build rapport with patients. This is a part of good patient follow-up. After their first treatment, call the patient within 24 hours. Ask them how they felt after going home from your clinic, if they have any other questions, if they have booked a follow-up visit, or if they understand their home care or herbal medicine instructions.
8. Other outbound calls include a birthday call (or email), reminder calls the day before every appointment, and an occasional “we haven’t seen you for awhile and I just wanted to know how you are doing” call.
9. Finally, when you touch each patient, do it with as much confidence, care, and affection as you can transmit through your hands. When you are with each patient, make sure they know they are the only person in the world for you during that time.

If you can manage to create a system to include even half of the above ideas, I guarantee that you are more likely to keep your patients coming back longing, getting treated more frequently, and referring their friends and colleagues more often.

For a database of free research articles on Chinese medicine, create a login/password here at the Blue Poppy Website and check out the TCMInfoline for over 1500 pages of translated research from Chinese medical journals.

Need to study up on your Western medical exam skills? Check out my and Dr. Bruce Robinson’s book, Western Medical Exam Skills for Asian Medicine Practitioners.

By Eric Brand When should herbs be taken? With food, between meals, before bed? Actually, there is no one rule across the board. There are guidelines for when to take various herbs: before meals, after meals, before sleep, and on an empty stomach. “Before meals’’ and “after meals’’ mean an hour or two before or after meals.

Before meals: Most enriching medicinals are taken before meals, as are medicinals addressing complaints below the diaphragm, such as stomach, liver, and kidney problems. After meals: Stomach-fortifying medicinals and medicinals that irritate the stomach and intestines are taken after meals, as are medicinals used to address complaints above the diaphragm, such as dizziness, headache, eye problems, and sore throat. Before sleep: Spirit-quieting medicinals are taken just before going to bed at night. On an empty stomach: Worm-expelling and draining-precipitants are often taken on an empty stomach. Any time: In acute problems such as vomiting, fright reversal, stone strangury, and throat problems, medication can be “drunk as tea” at any time.

Chang Shan is a medicinal that is somewhat rarely used in Chinese medicine, yet it contains constituents that appear to be promising for autoimmune diseases and cancer. Originally used as an emetic agent to induce vomiting, Chang Shan has also been a key medicinal for malaria over the course of Chinese medicine. According to this article, Harvard researchers have been assessing the constituents of Chang Shan and have found one compound that seems to block the development of highly inflammatory Th17 cells that are thought to play a role in the development of autoimmune disorders such as multiple sclerosis, psoriasis, juvenile diabetes, rheumatoid arthritis and Crohn's disease.

In this article, research results suggest that HF has anti-proliferative and anti-leukemic effects. It appears that one of Chang Shan's key active constituents has an ability to modulate "transforming growth factor beta (TGFβ)," which is a cytokine that regulates multiple cellular responses, including inhibition of cell proliferation and induction of differentiation, senescence, and apoptosis. Historically, Chang Shan was used to promote vomiting to treat conditions of accumulated rheum (thin pathological fluid) in the chest. It also possesses a malaria-interrupting action, which means that taken a few hours before episodes it can prevent their arrival. Chang Shan is used for all types of malaria in Chinese medicine. For this purpose it is stir-fried with wine. It can be used singly, either steeped in liquor or decocted. Alternatively it can be combined with Cao Guo (Tsaoko Fructus), Hou Po (Magnoliae Officinalis Cortex), and Bing Lang (Arecae Semen), and boiled in water with the addition of rice wine. When treating malaria, the emetic effect of Chang Shan is not required and can be reduced by the addition of Chen Pi (Citri Reticulatae Pericarpium) and Ban Xia (Pinelliae Rhizoma).