Dosing your medicine

A patient walks into your office with years of IBS and headaches. They want to feel better. You do your full questioning, make a diagnosis, give them an amazing acupuncture treatment. And then what do you do?

Do you ask them when they want to come back?

I hope not!

Why? Because you should be telling them exactly when they need to come back.

If you’re letting your patients do whatever they wish in terms of your care, then you are doing them a huge disservice. Because they are not the expert, you are.

Yes, you. You are an expert. Don’t forget that. I know, in our medicine you can feel like you could live 2,000 years and still have more to learn about our medicine. I love that about our medicine. And yet, still, you are the expert. Now. You know so much, and certainly far more than your patients do. Even if you literally just graduated yesterday.

It’s your responsibility to advise your patients in their best interest. As an expert.

An expert who can make a very personalized recommendation for them, taking into account their goals and their history and your knowledge of your medicine and your experience.

Do you know that that’s what everyone wants? To be personally advised by a confident and compassionate expert? I love walking into my favorite wine store. It sounds funny, but hear me out… They ask me what I’m looking for, I tell them what I’m cooking for dinner (salmon and asparagus) and what kind of wine I like (balanced, full-bodied, smooth finish, around $14), and then they choose a wine for me based on their expertise and my personal situation. And it’s way better than the bottle I would have chosen for myself based on the pretty label. This is why I always go back to that wine store. They always deliver what I want: 1) a good wine, but because I get 2) a personalized recommendation from an expert that I can trust.

That’s what your patients want too, and even if they don’t realize that’s what they want, it’s what they need and deserve. A personalized recommendation from an expert that will help them get the results they want. It’s your responsibility to give it to them. And we’re not just talking wine here, we’re talking someone’s health, so there’s way more at stake.

As an acupuncturist, you must dose your medicine. You must make a recommendation as to when your patient needs to come back, how frequently they should be getting treatments, and give them an estimate of how many treatments they should expect it to take.

This is practicing good medicine. It’s just as much your job as inserting needles.

If you’re not doing this, it would be like a doctor giving their patient antibiotics and not telling them how many to take or when to take them. It’s reckless, and it’s not best for the patient.

Have you ever heard someone say “yeah, I tried acupuncture and it didn’t work” and then you ask them how many treatments they got and they say just one? Their acupuncturist who neglected to dose their medicine did that patient (who probably could have benefited from acupuncture) and our medicine a disservice. Now that person thinks acupuncture doesn’t work. And they are still suffering. But the acupuncturist just didn’t dose it correctly. It takes more than 1 treatment to turn years of symptoms around.

How many acupuncture treatments will it take?

It can be difficult, if not downright impossible, to predict exactly the moment when your patient will experience significant improvement in their symptoms. The good news is that you don’t need to predict it precisely. But you do need to give an estimation.

I give my students guidelines for estimating how many treatments it will take:

1. How long have the symptoms been going on? The longer, the more treatments it will take.
2. How old is the patient? The older, the more treatments it will take.
3. Are symptoms consistent? If symptoms, say pain for example, are always a 4 out of 10 in terms of pain, the more treatments it will take. If they are sometimes a 2/10 and sometimes 8/10, it will take fewer treatments.
4. How is the patient progressing? You can continue to tweak your estimation as you work with the patient, and update your expectations and recommendations based on what you see. There is a beginning, middle, and end to a course of treatment. The beginning is how many treatments it takes for them to start seeing improvement. The middle is where you make most of the progress. And the end is making it stick. If the beginning stage takes longer, you know the middle stage will take longer too. You can adjust expectations based on this progress you see.

My simple rule of thumb: When in doubt, I recommend telling patients that it should take around 6-8 treatments.

I personally find this to be the magic number in most cases. (Aside from fertility, which I tell patients to expect about 3-4 months of treatment).

What I’ve found is that this gives enough time for you to at least make some improvements. By 6-8 treatments, most patients are at least seeing some improvement, if not a significant improvement, in some or all of their symptoms. And this makes them want to stick around.

Most people have been bouncing from doctor to doctor, medicine to medicine, surgery to surgery, in search of solutions and relief. Even if you haven’t completely solved all of their problems in 6 – 8 treatments, just having made some improvement will be incredibly encouraging and supportive and a very hopeful change for patients.

You’ve got to confidently and compassionately insist, guide, and lead them to receive the number and frequency of treatments that are appropriate for them and going to help them get the most benefits.

Don’t do what I did in my first few months of practice after graduating – I used to say “when do you want to come back?” until a patient replied, “I don’t know, you’re the doctor”. Doh! That’s how I learned to step into my role as the expert – from my patients!

When they insisted I give them my recommendation I’d hesitantly say “let’s give it 3 treatments and see how you do”. Forehead smack! Three was often not enough! I feel badly that I led those patients poorly. That they might have left my office after three treatments thinking acupuncture couldn’t help them. I really did them a disservice.

It’s because I lacked 1) confidence and 2) the training in how to effectively dose my medicine.

I don’t want you to make the same mistakes I did. Please 1) have confidence in yourself and our amazing medicine and 2) dose your medicine appropriately and advise your patients in their best interest.

To help you do this. I’ve asked acupuncturists what their experience has been – how many treatments it usually takes to see significant improvement for various symptoms.

I got more than 180 responses. Here’s what the data shows.