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Dynamic Chiropractic – February 12, 2008, Vol. 26, Issue 04

Answering the Question: "Now What Do I Do?"

By John Amaro, LAc, DC, Dipl. Ac.(NCCAOM), Dipl.Med.Ac.(IAMA)

Some years ago, after considerable hounding by the publisher of a national health magazine, I finally got around to sitting at the kitchen table, one gloomy Sunday afternoon, to write out a long-promised article on acupuncture.

I pulled out a couple of graphics and a cover letter, and the article was mailed without fanfare on Monday morning. Little did I know this simple article would change the lives of numerous individuals for years to come.

Approximately three months after the article appeared, I received a letter from a medical physician in Connecticut asking, "Now what do I do?" His letter stated that he had a 42-year-old male patient, who suffered from nocturnal enuresis and had wet the bed to some degree (anywhere from a few tablespoons to a full saturation) literally every night of his life.

The patient had received every known treatment, medication, remedy, counseling, etc., since he was a child. Other than the fact that this adult male suffered from nocturnal enuresis, there was absolutely nothing wrong viscerally or psychologically, as far as anyone could determine.

In my article, I had explained using pressure from a ballpoint pen to what may be considered a highly questionable acupoint. Incidentally, the MD had no knowledge of acupuncture, philosophy or theory, other than his new-found awareness of an acupoint that had an effect on bed-wetting, according to my article. After the first attempt at a simplified acupuncture procedure, the patient never experienced another bed-wetting incident in the one year following my communication with this doctor.

The doctor's question of "Now what do I do?" was certainly legitimate. He was asking: "What do I do now? Do I continue to treat him or leave the condition alone?" The answer to this question depends, of course, on who is answering. To me, the answer is obvious. To use an old quote, "If it's not broken, don't fix it."

Everyone is familiar with the three monkeys carved 800 years ago into the side of a former horse stable in Japan, which illustrate "Hear no evil, see no evil and speak no evil." This carving is internationally known. However, the small relief which sits next to it shows a cat sleeping under flowers. The philosophy of this relief was "What do you say to a sleeping cat under flowers in bloom?" Of course, the answer is "Nothing. Let the cat sleep and leave it alone."

Far too often, we do not leave conditions alone once they have attained healing and symptomatic relief. We can be found guilty of one of the worst clinical and professional mistakes a practitioner can make, which is simply overtreatment. Ask yourself, how many times in the last year have you seen patients who were asymptomatic after a short term of treatments? Because the treatment plan wasn't finished, the patient had the "anything you say, doc" attitude. For any number of reasons (including, unfortunately, greed), you went ahead and treated the patient, only to see their symptoms return to full-blown status.

If you're a student or a very young practitioner, and you haven't experienced this yet, be patient; it happens to all of us. However, the objective is to learn by our mistakes and minimize this occurrence. In my opinion, one of the cardinal rules of healing is to understand when the patient is to be released from active care. Had the medical doctor from Connecticut continued to treat the same acupoint which relieved the patient's symptoms, the possibility and probability of the original symptoms returning is a significant factor.

In the case of the patient with the 42-year nocturnal enuresis, the treatment consisted of one treatment with a ball point pen to a specific acupoint (the exact center of the bilateral proximal pip and dip joint of the small finger on the palmar side). That was all which was necessary. The patient would have agreed to having treatment every day for the rest of his life had that been suggested (at considerable financial reward for the practitioner). However, the doctor received a much larger reward through the multitude of referrals and personal satisfaction by releasing the patient after only one treatment.

Use common sense in scheduling your patients' continuing care. Acupuncture point stimulation can have an immediate energetic healing response, which will alter the selection of future rationale for treatment. Proper evaluation of the patient is essential in determining on-going treatment. If you are not at that point in your clinical development to determine by examination what to do next, you are best advised to discontinue the use of any specific acupoint as soon as significant clinical response has been achieved.

For a number of years, I routinely have scheduled three to five new patients a day. All of my patients come from either patient or colleague referral. I've heard my philosophy criticized as being wrong for practice development; nevertheless, I stand by it. Release the patient from active care as quickly as possible. I find if I schedule patients to return for management treatment three or four times a year, as opposed to trying to cram once a month or more down their throat, my referrals and follow-up treatments rise significantly. I schedule maintenance treatments whenever the universe changes and that is when the four seasons are observed. For each of the seasons, we will find the body likewise experiences similar changes. I also don't cut off my referrals by dragging patients in for treatment when they are no longer experiencing a problem.

I fully realize the response to that last comment is simply "patient education," and I agree. However, I have not found my philosophy to be anything but successful. We've all heard the adage, "Find it, fix it and leave it alone"; sage advice from the old-timers. The significance of that statement may well be the best advice you'll hear all year.

Attempt to achieve stellar clinical and healing response in the least amount of time, with the least amount of treatment, with minimal financial outlay and your practice will be overflowing with grateful, happy, referring and returning patients.

Click here for previous articles by John Amaro, LAc, DC, Dipl. Ac.(NCCAOM), Dipl.Med.Ac.(IAMA).

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