Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Dear All, As a 2nd year acupuncture student, I'm noticing in our student clinic that several patients seem to be 'dependent' on their therapy sessions, and find it hard to move on and terminate their contracts. I imagine this is a common problem in most practices (of course, it must be nice to have regular patients, but the goal presumably is usually to discharge people at some stage). Does anyone know of any papers or studies on this subject available on the net (even if they're not specific to TCM)? I'd also be interested to hear how people try to deal with this as practitioners. Regards, Tom K. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Tom, For me it depends on the patient. Some patients come to me weekly for months and even years because the treatments feel good and it helps them de-stress from their day or week. It is like a spa treatment. I periodically check in with them to make sure they still feel like they are getting value from their visits. Other patients really do have conditions that requires a lot of treatments to make a difference, and sometimes it could be a life long symptom management scenario. I feel that as long as we are upfront and honest about what we are doing and what we believe we can do, it is up to the patient to decide about their treatments. I'm really only the hired help and I do everything I can to empower my patients to make their own choices based on their time, finances and the level of relief they feel the get from our treatments. If I feel they are becoming " dependent " on their treatments, as in they no longer serve them, I will talk with them about what they are hoping to get out of our time together and be honest about what I think I can do for them, but always leave it up to them to decide. Christopher Vedeler L.Ac., C.Ht. Oasis Acupuncture <http://www.oasisacupuncture.com/> http://www.oasisacupuncture.com 8233 N. Via Paseo del Norte Suite D-35 Scottsdale, AZ 85258 Phone: (480) 991-3650 Fax: (480) 247-4472 Chinese Medicine Chinese Medicine On Behalf Of tzkennedy Friday, April 28, 2006 3:28 AM Chinese Medicine 'Dependent' patients Dear All, As a 2nd year acupuncture student, I'm noticing in our student clinic that several patients seem to be 'dependent' on their therapy sessions, and find it hard to move on and terminate their contracts. I imagine this is a common problem in most practices (of course, it must be nice to have regular patients, but the goal presumably is usually to discharge people at some stage). Does anyone know of any papers or studies on this subject available on the net (even if they're not specific to TCM)? I'd also be interested to hear how people try to deal with this as practitioners. Regards, Tom K. Subscribe to the new FREE online journal for TCM at Times http://www.chinesemedicinetimes.com Download the all new TCM Forum Toolbar, click, http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 and adjust accordingly. Messages are the property of the author. Any duplication outside the group requires prior permission from the author. Please consider the environment and only print this message if absolutely necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2006 Report Share Posted May 2, 2006 Dear Tom, You bring up a very important and sensitive issue for practitioners: boundaries. There is a talmudic saying which will illustrate a point that I want to make: " The best physicians go to hell " . Usually this is understood that the quality of arrogance with can accompany someone who is really good can cause him to be complacent, and bring about unnecessary harm or even death. However, a different reading of it is that the very best doctors are those who are prepared to enter the " hell " that their patients suffer, in order to bring them out! The point is that for one to practice medicine properly, IMVHO they requires a sensitivity, a boldness, a focus and a clarity of vision. Not just be good at what they do, but empathize and be supportive of their patient as well. So what can a physician do to prevent a patient from becoming dependent, or even addicted to him/her? I would suggest that the dynamics that lend themselves to dependency come from ground rules not being established heretofore, ie.boundaries and the absence of a treatment plan and timetable. Just like a good teacher, a physician needs to train a patient what is ok and what is not ok, when they can call, and when they can't. Master teachers I have heard (on more than one occasion) use the following example? How they train dolphins at Sea World to jump higher? by rewarding them with fish. By being consistent, setting limits, using incentives, and of course showing compassion, a patient will become compliant and appreciative. Sincerely, Yehuda tzkennedy <tzkennedy wrote: Dear All, As a 2nd year acupuncture student, I'm noticing in our student clinic that several patients seem to be 'dependent' on their therapy sessions, and find it hard to move on and terminate their contracts. I imagine this is a common problem in most practices (of course, it must be nice to have regular patients, but the goal presumably is usually to discharge people at some stage). Does anyone know of any papers or studies on this subject available on the net (even if they're not specific to TCM)? I'd also be interested to hear how people try to deal with this as practitioners. Regards, Tom K. Subscribe to the new FREE online journal for TCM at Times http://www.chinesemedicinetimes.com Download the all new TCM Forum Toolbar, click, http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 and adjust accordingly. Please consider the environment and only print this message if absolutely necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2006 Report Share Posted May 2, 2006 I would add one more thing: I think that part of the responsibility of the physician is to educate and guide the patient as well. I think that patients really appreciate it when they are told what therapy they are receiving, and to let them know that it is ok for them to ask any questions that they might have. Furthermore, because treatments at times can elicit strong emotions, it is very important that the physician consider him/herself as a sort of tour guide, to make sure that their patient is in a safe place when the treatment is over, and not just walk away to the next patient. tzkennedy <tzkennedy wrote: Dear All, As a 2nd year acupuncture student, I'm noticing in our student clinic that several patients seem to be 'dependent' on their therapy sessions, and find it hard to move on and terminate their contracts. I imagine this is a common problem in most practices (of course, it must be nice to have regular patients, but the goal presumably is usually to discharge people at some stage). Does anyone know of any papers or studies on this subject available on the net (even if they're not specific to TCM)? I'd also be interested to hear how people try to deal with this as practitioners. Regards, Tom K. Subscribe to the new FREE online journal for TCM at Times http://www.chinesemedicinetimes.com Download the all new TCM Forum Toolbar, click, http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 and adjust accordingly. Please consider the environment and only print this message if absolutely necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2006 Report Share Posted May 2, 2006 Dear Yehuda, What does IMVHO mean? Thanks, Donald J. Snow, D.A.O.M., M.P.H., M.S., L.Ac - yehuda frischman Tuesday, May 02, 2006 1:11 AM Chinese Medicine Re: 'Dependent' patients Dear Tom, You bring up a very important and sensitive issue for practitioners: boundaries. There is a talmudic saying which will illustrate a point that I want to make: " The best physicians go to hell " . Usually this is understood that the quality of arrogance with can accompany someone who is really good can cause him to be complacent, and bring about unnecessary harm or even death. However, a different reading of it is that the very best doctors are those who are prepared to enter the " hell " that their patients suffer, in order to bring them out! The point is that for one to practice medicine properly, IMVHO they requires a sensitivity, a boldness, a focus and a clarity of vision. Not just be good at what they do, but empathize and be supportive of their patient as well. So what can a physician do to prevent a patient from becoming dependent, or even addicted to him/her? I would suggest that the dynamics that lend themselves to dependency come from ground rules not being established heretofore, ie.boundaries and the absence of a treatment plan and timetable. Just like a good teacher, a physician needs to train a patient what is ok and what is not ok, when they can call, and when they can't. Master teachers I have heard (on more than one occasion) use the following example? How they train dolphins at Sea World to jump higher? by rewarding them with fish. By being consistent, setting limits, using incentives, and of course showing compassion, a patient will become compliant and appreciative. Sincerely, Yehuda tzkennedy <tzkennedy wrote: Dear All, As a 2nd year acupuncture student, I'm noticing in our student clinic that several patients seem to be 'dependent' on their therapy sessions, and find it hard to move on and terminate their contracts. I imagine this is a common problem in most practices (of course, it must be nice to have regular patients, but the goal presumably is usually to discharge people at some stage). Does anyone know of any papers or studies on this subject available on the net (even if they're not specific to TCM)? I'd also be interested to hear how people try to deal with this as practitioners. Regards, Tom K. Subscribe to the new FREE online journal for TCM at Times http://www.chinesemedicinetimes.com Download the all new TCM Forum Toolbar, click, http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 and adjust accordingly. Please consider the environment and only print this message if absolutely necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2006 Report Share Posted May 3, 2006 " in my very humble opinion " (really!) Donald Snow <don83407 wrote: Dear Yehuda, What does IMVHO mean? Thanks, Donald J. Snow, D.A.O.M., M.P.H., M.S., L.Ac - yehuda frischman Tuesday, May 02, 2006 1:11 AM Chinese Medicine Re: 'Dependent' patients Dear Tom, You bring up a very important and sensitive issue for practitioners: boundaries. There is a talmudic saying which will illustrate a point that I want to make: " The best physicians go to hell " . Usually this is understood that the quality of arrogance with can accompany someone who is really good can cause him to be complacent, and bring about unnecessary harm or even death. However, a different reading of it is that the very best doctors are those who are prepared to enter the " hell " that their patients suffer, in order to bring them out! The point is that for one to practice medicine properly, IMVHO they requires a sensitivity, a boldness, a focus and a clarity of vision. Not just be good at what they do, but empathize and be supportive of their patient as well. So what can a physician do to prevent a patient from becoming dependent, or even addicted to him/her? I would suggest that the dynamics that lend themselves to dependency come from ground rules not being established heretofore, ie.boundaries and the absence of a treatment plan and timetable. Just like a good teacher, a physician needs to train a patient what is ok and what is not ok, when they can call, and when they can't. Master teachers I have heard (on more than one occasion) use the following example? How they train dolphins at Sea World to jump higher? by rewarding them with fish. By being consistent, setting limits, using incentives, and of course showing compassion, a patient will become compliant and appreciative. Sincerely, Yehuda tzkennedy <tzkennedy wrote: Dear All, As a 2nd year acupuncture student, I'm noticing in our student clinic that several patients seem to be 'dependent' on their therapy sessions, and find it hard to move on and terminate their contracts. I imagine this is a common problem in most practices (of course, it must be nice to have regular patients, but the goal presumably is usually to discharge people at some stage). Does anyone know of any papers or studies on this subject available on the net (even if they're not specific to TCM)? I'd also be interested to hear how people try to deal with this as practitioners. Regards, Tom K. Subscribe to the new FREE online journal for TCM at Times http://www.chinesemedicinetimes.com Download the all new TCM Forum Toolbar, click, http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 and adjust accordingly. Please consider the environment and only print this message if absolutely necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2006 Report Share Posted May 3, 2006 I don't know where to pick up on this thread, but had these thoughts at Tom's first inquiry. I came from a 5 Element tradition as a patient and practioner where long term relationships were formed between practitioner and patient. It doesn't feel dependent, just continual movement through a healing journey. I have been to my practitioner for 12 years - now more monthly and sometimes longer because I have to travel and hour and a half to get there. I also get other treatments like osteopathy and rolfing (all far away) but worth it. Now, for my patients - yes some may been dependent on the feel good aspects of acupuncture without making lifestyle changes on their own. I continue to coach, and wahlla - there is change and it could take years. That is up to the patient in my opinion, not me. I once heard Jack Daniel, a 30 year practiioner say, " I don't fire people, they fire me. " Now of course Jack has rules, about showing up, paying etc,. I have also heard practioners say, " If the patient won't make lifestyle changes, they're out. " I tend to fall somewhere around Jack and Christoper here. I have terminated patients, but I don't do it often and it is generally because I think we aren't going anywhere (and yes, I now give 3 referrals) or I sense a real uncomfortable fit. Anne C. Christopher Vedeler L.Ac. wrote: >Tom, > >For me it depends on the patient. Some patients come to me weekly for >months and even years because the treatments feel good and it helps them >de-stress from their day or week. It is like a spa treatment. I >periodically check in with them to make sure they still feel like they >are getting value from their visits. Other patients really do have >conditions that requires a lot of treatments to make a difference, and >sometimes it could be a life long symptom management scenario. > >I feel that as long as we are upfront and honest about what we are doing >and what we believe we can do, it is up to the patient to decide about >their treatments. I'm really only the hired help and I do everything I >can to empower my patients to make their own choices based on their >time, finances and the level of relief they feel the get from our >treatments. If I feel they are becoming " dependent " on their >treatments, as in they no longer serve them, I will talk with them about >what they are hoping to get out of our time together and be honest about >what I think I can do for them, but always leave it up to them to >decide. > >Christopher Vedeler L.Ac., C.Ht. >Oasis Acupuncture > <http://www.oasisacupuncture.com/> http://www.oasisacupuncture.com >8233 N. Via Paseo del Norte >Suite D-35 >Scottsdale, AZ 85258 >Phone: (480) 991-3650 >Fax: (480) 247-4472 > > >Chinese Medicine >Chinese Medicine On Behalf Of >tzkennedy >Friday, April 28, 2006 3:28 AM >Chinese Medicine >'Dependent' patients > > >Dear All, > >As a 2nd year acupuncture student, I'm noticing in our student clinic >that several patients seem to be 'dependent' on their therapy sessions, >and find it hard to move on and terminate their contracts. I imagine >this is a common problem in most practices (of course, it must be nice >to have regular patients, but the goal presumably is usually to >discharge people at some stage). Does anyone know of any papers or >studies on this subject available on the net (even if they're not >specific to TCM)? I'd also be interested to hear how people try to deal >with this as practitioners. > >Regards, > >Tom K. > > > > > > > > > >Subscribe to the new FREE online journal for TCM at >Times http://www.chinesemedicinetimes.com > >Download the all new TCM Forum Toolbar, click, >http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 > > > and >adjust accordingly. > >Messages are the property of the author. Any duplication outside the >group requires prior permission from the author. > >Please consider the environment and only print this message if >absolutely necessary. > > > > > Quote Link to comment Share on other sites More sharing options...
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