42. Tips for novice five element practitioners

It takes time for new five element practitioners to become sufficiently comfortable and relaxed in the practice room to make their patients feel safe enough to remove their masks and tell us what their problems really are.  So those starting on their practice must not demand too much of themselves.  Many of the problems the novice practitioners have are learning about how to maintain control in the practice room.  I think their greatest worry is always at first directed at trying to diagnose the right element, rather than doing that most essential of all things, which is getting to know their patient and putting their patient at ease with them.  No patient stops coming for treatment if we don’t diagnose the right element, but they do stop if they feel uneasy in the relationship to us.  Rather than concentrating all our attention upon trying to track down the element, we should instead take as much time as is necessary to establish a sense of trust between our patients and us, and make sure that they feel we are really interested in learning about their lives.  This provides the necessary foundation for a good patient-practitioner relationship, without which no diagnosis, even of the right element, will ensure successful treatment.  If a patient is uneasy in our presence, I like to think that their elements cower away, and fail to respond to treatment, however focussed it is.

It is good if we take some time for what I call setting the scene for treatment for our patients, so that they understand better what treatment involves.  It is useful to have in our minds a checklist of the topics we should discuss with them before they start treatment. They need to be given some facts, such as how many treatments they should be prepared for, how spaced-out these treatments will be and how treatment might affect them.  We also need to give them time to ask their own questions, for most of them will arrive for their first treatment with very little idea about what treatment will involve and what they should expect from it.

This blog is also in answer to more of the questions the practitioners at our latest seminar in Beijing asked.  Thinking how best to answer them, I realised that it would be useful for me to work out a kind of protocol to act as a checklist for each of us to go through with any new patient.  In our eagerness to get started, we often forget that patients come to us usually unfamiliar with acupuncture, and very uncertain about what to expect; they are therefore often uneasy.  It helps both them and us if we prepare the ground before they come for their first treatment so that they are already to some extent prepared for what is going to happen. 

In working through this preparatory checklist now, I had to think about how much to include in it, and how to condense the essential components of five element treatment into a simple format.  The list below is my first attempt at doing this.   

1. First of all, you must show that you are really interested in your patient, and are curious to learn as much about their lives as they wish to share with you.  Often the time with us is the first time anybody has shown them any real interest in their life, apart from perhaps their physical symptoms.  You have to develop a good memory for all the things they tell you, noting particularly those things which send up little warning signals in your mind.  We were told to call them “red flags”, meaning that here is something significant which we need to explore in greater detail with our patient later on.
2. .We must help our patients understand that five element acupuncture treats the whole person, body, mind and spirit, and that, unlike Western medicine, we are not interested only in their physical symptoms, but in their emotional well-being as well.  This is often a surprise to them, and usually a very welcome surprise.
3. We must not be judgemental or bring our own agenda into the treatment room.  We do, however, bring our own life experiences with us so that we can offer our patients help based upon what we ourselves have learnt.  Even if we have a patient who we find difficult to deal with because they have such a different approach to life or different values from us, we must be careful not to show that we find their opinions difficult or find them in any way unpleasant as human beings.  We have no right to impress our own values and prejudices on our patients.
4. We must remain in control of treatment at all times, which means that we don’t allow a patient to direct whatever he/she wants from treatment.  It is up to us to decide what treatment the patient needs and which element to treat, and we should not involve them in discussing our clinical decisions.  The frequency and spacing of treatments is also a clinical matter, and we are the only ones competent to decide on this.  If they are not happy with this, we are quite in our right to suggest that they go to another practitioner.
5. One of the lessons we all have to learn is to not to allow ourselves to be overwhelmed by events in our patients’ lives, but to develop sufficient emotional strength in ourselves to cope appropriately with whatever problems our patients present us with.
6. If you feel that there is something not right with your relationship to your patient, then do what we are often too nervous to do, which is learn to talk things through with your patient.  Always start by saying, “I feel that….(for example) you are not happy with your treatment..”  Often this will resolve problems because you may be surprised that your patient is quite happy with what is going on and it is your uncertainty which is making you doubt that your treatment is helping.
7. Don’t discuss a patient’s treatment with them outside the treatment room. If the patient has a problem they want to discuss with you, tell them that you will discuss this at the next treatment, and make an appointment for them to come.  Don’t discuss their treatment on email or social media.  All discussion needs to be kept private in the practice room.  If the patient wants to go on talking at the end of treatment and your next patient is waiting, you have to tell them that you will discuss this further at their next treatment.  Always keep to your treatment schedule, because some patients love to go on talking!
8. I don’t think it is helpful for patients to be having different kinds of therapy at the same time, for example herbs and acupuncture, because you never know which of the therapies is helping or whether the patient is not responding to your treatment because of the effect of the other therapy.  If a patient wants to try out all sorts of different therapies, I always tell them that it would be better if I don’t treat them.
9. There is always a problem with how to deal with a patient taking medicines prescribed by Western-based medical practitioners and five element acupuncture.  Some drugs are life-saving and must never be discontinued.  Others can gradually be reduced if the acupuncture treatment is helping the patient’s condition, but this must always be done with the consent of the patient’s prescribing practitioner.  We must not interfere with Western medical treatment, even if we feel that it is not helping our acupuncture treatment.  We always hope, though, that our patients will persuade their doctors to reduce the drug doses when the drugs are no longer necessary.
10. I believe that we are given our guardian element at the moment of our conception, and that it stays the same throughout our life, shaping that life in a special way according to the qualities of the element that has been handed to us as our elemental destiny.  I do not believe that it changes, although different elements may colour the dominant element at different stages of our life, depending on the life experiences we are subjected to.  For example the Metal element may appear to overshadow our guardian element for a while if we suffer some great bereavement, or Fire if we are very happy in our relationship.  But below this superficial colouring of another element there always remains the presence of our dominant element.