My dissertation for CETAD at Lancaster University is finished. Its been fun! Here is the wording for the pamphlet I intend to publish as one of the outputs from the research.
For acupuncturists and friends everywhere
WHAT ON EARTH HAPPENS DURING NEEDLING?
A journey through the complex world of explanations for the curious patient
by Penny Kay MSc, Dip Ac, MBAcC
‘What are those needles doing?’
Are you often asked this question by patients? Do you have a stock answer that you’re happy with? Or does it fill you with dread? Do you give a brief summary of the Yellow Emperor’s Canon? Do you describe what happens when hormones are released? Do you show Youtube clips of the infrared thermography showing the effect of a needle in LI4? Do you look wisely to the heavens or do you tell patients to lie still and quiet so the needles get a chance to work?
What to say has been an abiding dilemma for me since I started training. I’ve followed in the lovely footsteps of Silvia Shroer (2005), who told us how patients tend to describe the effects of needles in metaphors; how they tend to disregard the scientific or bio-medical explanations, and also sometimes talk of ‘believing’ in the treatment.
I’ve asked lots of practitioners what they say, how confident they are, how much they vary what they say and what motivates them to say what they do. Here are the results. It is my belief that understanding can support outcomes and empower patients. Use this in any way you wish, but keep making acupuncture accessible!
‘I just find myself waffling!’
How many options do you have for explaining?
There were four broad groups of explanations:
•Chinese Medicine Principles (CM) – Qi, Yin Yang, Channels and Meridians, Levels, points
•Basic principles not just associated with Chinese Medicine – flow, balance, harmony, energy
•Figurative language including metaphors, analogies – rivers, dams, bread making, cars
•Biomedical approaches – autonomic nervous system stimulation, hormone release, fascia.
‘I’ve always felt very comfortable sticking to classical Chinese principles – patients seem to appreciate it.’
Who uses which explanations?
Many practitioners used all four interchangeably, others used just one consistently. Some acupuncturists had preferences that changed over time depending on who they had been training or studying with. For some it was a choice based on what they thought would suit the patient and for others it was a matter of listening closely and matching their answers to the patient’s questions.
‘Needling restores the flow. Whether it’s Qi, blood, fluids, happiness, sadness, everything should flow and when it gets stuck we feel pain. Deficiencies and excess are also evened out by making things flow.’
What influences our choices?
The main influencing factors were:
•the way in which the question was posed by patients
•the preference patients had for an explanation
•what they had heard others say including colleagues, tutors and online
•how much energy and time practitioners had to devote to the answer
•in what area practitioners felt most confident
•what acupuncturists most typically say every day plus their own treatment style.
‘The lungs are the carburettor (air intake), the stomach/spleen take in the petrol (food) and the kidneys are the battery’
Why is this question important?
There isn’t currently much directly taught during training about what to say by way of explanation, although we all learned it for ourselves (Although there are some interesting activities at a couple of colleges now!) The way in which people tackle this question varies a lot. It often depends on how a practitioner began their practice and who their clinic supervisors were. I think it’s really important because we know acupuncture works and we love it! Perhaps we should be able to say why and how that happens in ways that work for our patients. My belief is that understanding can empower patients to get well, to make changes and learn how to manage their own health better.
‘Suggestions to help me sound like less of an idiot when trying to explain the mechanism of acupuncture?’
For some colleagues, how to explain what is happening during needling has been a skill developed over time. Several students admitted they hadn’t really considered what to say yet. A significant number of practitioners in my study said they felt rather awkward, under-educated and grasping at words and phrases that they couldn’t really back up. Others felt their usual explanations didn’t suit everyone and wanted more of a toolkit of options.
Top Ten Hints!
What my research suggests:
1 My top tip is to think about it before you begin to practise. And keep thinking about the question as your career in acupuncture develops. Many experienced practitioners said they had changed what they said over time and added more options to their original ideas.
2 You won’t find the correct answers here! There are many factors affecting your decision about how to answer the question ‘What is happening during needling?’. Develop your own unique style and keep your eyes and ears open for other great stuff to add to your repertoire.
3 You can always say ‘No-one really knows for sure. What we do know is that it works!’
4 We have wonderful colleagues who spend their time developing clear and effective language and graphics to help us.
5 Lots of practitioners do feel confident and have developed ways of talking about acupuncture in their own style. Seek out those inspiring souls!
6 There are a broad range of explanations out there that you might find useful. They include Western Medicine, infographics, Chinese Medicine principles and lots of clever, funny analogies.
7 Work on your grasp of mainstream biomedical ideas – it’s the starting point for many patients who come to you.
8 Practitioners who listen actively to the patient find it easier to craft the right response for them. Stay curious about why they have asked and in turn, ask them what will help. Be prepared to ditch the ‘usual suspects’ and have stuff ready from a different viewpoint.
9 Don’t assume that the job patientsdo, their gender, age or interests will automatically lead you to the right choice. Medical professionals who come for treatment may be interested in a different way of looking at things. The idea that men want plumbing analogies and women like laundry analogies may be very wide of the mark!
10 Become a research-hungry practitioner, armed with knowledge about the latest top quality evidence from our profession. Have confidence in your practice and in your explanations. Your acupuncture rocks!
More information for you
Detail about my MA research at Lancaster University at www.nudgeacupuncture.co.uk/MAresearch
Lots of metaphor ideas at http://bit.ly/2ubfmFY
Our dear colleague Mel Kopperman is Director of Evidence Based Acupuncture – a website developing accessible information http://bit.ly/1vwZFlo
Watch Mel in this webinar for bio-medical explanations in a nutshell http://bit.ly/2wh9g8f
watch this clip to show what is happening when a needle is inserted at LI4 http://bit.ly/2wuNpJK
Go to BAcC for lots of research on common conditions at http://bit.ly/2v8FuCz
Watch Hugh MacPherson on the value of research http://bit.ly/2ubh5L9
Read Sylvia Schröer’s 2005 research in EJOM http://bit.ly/2vCdNF4
Read the classic texts again. They can inspire and reawaken our curiosity.
Contact me at email@example.com
Follow me on Twitter @NudgeTCM
Facebook page Nudge Acupuncture